By Rod Moore
Hospital leaders are increasingly
turning to telemedicine programs to
meet the diverse health care needs of
their local communities. However, launching
a telemedicine program can come with
pitfalls, pushback and problems if not done
strategically and with full leadership and
clinical team buy-in.
Those barriers, amid the growing demand
for telemedicine, has driven the Texas
Hospital Association's search for a reliable
endorsed partner that utilizes advanced
measures to fix gaps and plug holes before
they become an issue. In February, THA
endorsed Access Physicians, a Texas-based,
multispecialty physician group delivering
care through hospital-based telemedicine
“Telemedicine is becoming
a more attractive
option to make up for
shortfalls in coverage of
specialties even in urban
areas,” said Chris Gallagher,
M.D., CEO of Access Physicians. “We can
point to how fast Texas has grown and the
influx of population and the local resources
trying to keep up as much as possible, but it's still a challenge.”
Gallagher said their innovative approach in rural and urban markets has influenced their launch strategies, providing guidance to hospitals to ensure a smooth launch.
The purposeful approach by Access Physcians enables them to determine where and how telemedicine can be integrated to achieve the hospital's goals. Gallagher said, “When it comes to selecting a telemedicine vendor, I think the most important consideration for hospitals is to make sure they find a partner who is collaborative and one they really feel has their patients' best interests in mind.”
Early Pitfalls to Avoid
Potential obstacles begin to emerge for hospitals considering telemedicine early in initial discussions or in the contract phase. That's thanks in part to the high number of hospital departments that need to be engaged. Though the need for a telemedicine solution makes itself known in service lines managed by a small segment of the hospital's leadership, others need to be brought to the table well in advance. Information technology infrastructure, for example, is one commonly overlooked area that can present problems, as hospitals must factor in security compliance that requires a level of leadership and other technical experts that have unique insights and needs.
“Most hospitals in 2019 have done the typical upgrades, like Wi-Fi access points and broadband speeds, that are needed for telemedicine,” Gallagher said. But if upgrades are needed, the costs may warrant a capital request that can delay deployment.
Challenges can extend beyond technology. The legal and compliance component can be tricky when negotiating contracts with partners.
“Because of the unknowns that still exist around telemedicine, that can be daunting for an institution’s legal teams and compliance to handle,” Gallagher said. “There aren’t a lot of resources compared to other areas where there's very clear policy statements or clear regulations (for hospitals).
Gallagher said, "Hospitals will want to ensure contracts have appropriate language and secure policies that drive the telemedicine programs and take into account operations goals and processes envisioned by administrators.”
Pushback Prior to Launch
Ensuring that key stakeholders from across the hospital are on board prior to launch is essential for a successful, stainable program. Pushback to telemedicine can come from members of the medical and clinical teams.
“Telemedicine physicians are (more) dependent on the nursing staff for care,” Gallagher said. “So telemedicine physicians have to be respectful of a nurse's time and be easy to work with themselves. It's a very different type of relationship than a physician who is working in person, because we're so dependent upon them.”
Laying the groundwork for solid working relationships between those physically at the hospital and the medical staff that will be providing care remotely is essential. Access Physicians helps hospitals anticipate needs during training to minimize pushback from providers and help smooth out the rollout phase of a program launch.
“If we feel like the medical staff and nursing staff aren’t properly engaged, if it's not the right thing to do, we will not launch,” Gallagher said, noting their operations shift to help get buy-in across the organization.
Gallagher said that in his team’s more than 120 engagements with hospitals, only twice has a contract not been renewed. Both times were due to not properly anticipating the needs of physicians and nurses in the early stages of the program launch. “As a group, we learned our lesson from making the misstep of moving too fast and not properly engaging the local medical community to be its champions,” Gallagher said.
Lynn Falcone, CEO at Cuero Regional Hospital, said after trying in vain to recruit a cardiologist for two years, hospital leaders decided to pursue a telemedicine option. “We began working with Access Physicians early this year and in less than three months, they’ve seen 50 of our patients, which has allowed us to keep those patients here instead of sending them out of our hospital,” Falcone said.
Falcone stressed the importance of buy-in from nurses and physicians as a key driver in their use of the telemedicine service. “It’s important to know what you want to accomplish with it and find a partner that helps you do that,” Falcone said.
Potential Problems After Rollout
At the rollout phase of a telemedicine program, Gallagher cited other potential challenges associated with a lack of clear objectives for the telemedicine program.
“Hospitals need to know what they are trying to achieve with a telemedicine program,” Gallagher said. “They should begin with the end in mind. They really need to have a few hard, objective clinical metrics that they're going to track and trend, so they can assess the program’s success.”
Gallagher suggests using patient satisfaction and experience surveys as primary data points to track clinical outcomes so that a single negative anecdotal experience doesn’t derail a program.
Naturally, the financial aspect of telemedicine is an important consideration given that hospitals need to ensure the long-term viability and sustainability of their programs. Hospitals must know in advance how they will account for the up-front expense of telemedicine and where the revenue will come from to offset that expense.
“Understanding the different eligibility requirements of telemedicine definitely adds a layer of complexity and a layer of risk to launching a telemedicine program, in order to ensure that it’s going to be a sustainable over the long run,” Gallagher said.
Gallagher said Access Physicians' anticipation of those complexities drove his team to offer hospitals the option of handling billing and reimbursement. That option gave hospitals a more holistic solution than what they had previously seen from other telemedicine providers, explained Gallagher.
Like many other outsourcing decisions, choosing the right partner is often the key to any successful telemedicine program. “It’s important to understand the value that the telemedicine partner or vendor brings to a hospital — it's not only to improve and elevate care, but also to facilitate the growth and development of new programs for the future.”