Telemedicine's Next Wave: The Episode of Acute Care
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Telemedicine's Next Wave: The Episode of Acute Care

By John Birkmeyer, MD, Chief Clinical Officer, Sound Physicians

Telemedicine in Acute CareJohn Birkmeyer, MD, Chief Clinical Officer, Sound Physicians

Telemedicine has been most commonly deployed by health systems to deliver one-off specialist consultations (e.g., telestroke in EDs or elective specialist consultations in a PCP office). Along the journey from fee-for-service to value-based care, healthcare organizations are discovering that telemedicine can be utilized as a clinical management tool across the acute episode of care, helping reduce delivery costs in the hospital and coordinate care across settings after discharge.

Sizing Up Opportunities

The acute care landscape is evolving, with salaries and expectations rising and provider supply and reimbursements declining. As healthcare shifts from fee-for-service to value-based care, telemedicine will play an increasingly important role in helping to reduce costs and manage patient outcomes across the continuum of care. This will continue to be critical as the U.S. population ages.

"It’s inevitable that the dissemination of provider-to-provider telemedicine will continue to accelerate and play a leading role in managing the episode of acute care"

Telemedicine can extend high-quality care to hospitals and healthcare facilities of all sizes. For practices that are difficult to recruit to, telemedicine offers skilled physician coverage and reduces transfers. Conversely, large facilities can leverage telemedicine to change their staffing mix or build surge capacity while delivering the same clinical outcomes to patients.

Post-Acute Telemedicine
Sound Physicians is deploying telemedicine solutions to enhance continuity of care, streamline costs, and improve outcomes in skilled nursing facilities (SNFs), a healthcare setting that can surely benefit from having a national network of physician expertise at their fingertips.

According to Sound data, post-acute spending accounts for more than 60% of the total costs in the acute episode of acute care, with nearly 40% coming from utilization and readmissions associated with SNFs. As managing episode costs becomes more significant in value-based care, telemedicine is an effective lever to enhance the quality and consistency of care that occurs when patients are discharged from the hospital and transition to the next best site of care.

Hospital readmissions result in thousands of dollars added to episode costs, and readmission rates from SNFs hover around 25%. With nearly two-thirds of these readmissions being clinically avoidable if a physician intervenes, there is a clear opportunity for telemedicine to improve processes and strengthen both clinical and financial outcomes.

SNFs vary widely in their physician coverage, with some dependent on a medical director, who may see patients only once a week, and others relying exclusively on advanced practitioners. Having 24/7 telemedicine coverage and access to specialized physicians helps SNFs identify patient issues while they are still easy to address in the SNF and before they require a readmission. Such physician access also helps SNF nurses and allied health professionals triage and more effectively determine if it’s necessary to send patients to the emergency department for evaluation.

If and when decisions are made to transfer a patient to a hospital emergency department for further evaluation, telemedicine can support the continuity of care by bridging the gap between the SNF and the emergency providers. In this role, a telehospitalist can call the emergency medicine physician directly to provide full medical context and additional patient insights.This information allows the emergency medicine physician to make better decisions as the patients arrive. Equally as important, the telehosptialist can communicate directly with the onsite hospitalist team to make better decisions about whether the patient needs to be readmitted to the hospital or be returned to the SNF. Workflow improvements like this are key to the success of value-based payment models as they create efficiency, reduce costs, and help providers deliver care that aligns with the preferences and values of the patients and their families.

The Telemedicine Journey
Many hospitals and health systems have begun their journey in leveraging telemedicine to help them succeed under value-based care.

There are some types of telemedicine care that hospitals can readily implement on their own. In my experience, the threshold is relatively low for hospitals to establish remote specialist consultative services, whereby their specialists are extending their reach into the primary care practices around them.

Hospitals and health systems can frequently accelerate their journey into telemedicine by partnering with a national network of physicians who have deep expertise in developing clinical workflows.The right partner will also make the shift to telemedicine seamless. The technology platform should be web-based and provide an intuitive user-experience. What’s unique about Sound Physicians’ telemedicine program, and pivotal in our successful deployments, is that our platform is configured to meet the specific needs of hospital patients, both during and after their hospital stays, in a highly service-oriented way. In other words, evidence-based clinical protocols are configured in our platform to help ensure that telemedicine providers are delivering the same consistent models of care as our onsite clinicians. Our technology platform is also configured to triage telemedicine queries according to the acuity, service level agreements, and request volume. This allows our telemedicine providers to focus on what’s most important – caring for patients. Bedside nurses, especially, are noting fast and reliable response times, and order accuracy that leaves less room for error.

I think it’s inevitable that the dissemination of provider-to-provider telemedicine will continue to accelerate and play a leading role in managing the episode of acute care. As hospitals and health systems swiftly find their way to value-based care, telemedicine is one very practical solution towards success.

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