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Telehealth May Be Rural Healthcare’s Lifeline

Corey Scurlock

December 28, 2022

As a new year dawns, it seems like a stock-taking time in U.S. healthcare. Skyrocketing costs, underwater margins, a depleted workforce and sicker patients have most hospitals and systems thinking existential thoughts about 2023, none more so than rural facilities.

According to a report by the Bipartisan Policy Center (BPC), a Washington, D.C.-based think tank, 116 rural hospitals across 31 states closed between 2010 and 2019. Many of them were small critical access hospitals. Federal Covid-19 relief funding is believed to have prevented additional closures—only two rural hospitals closed in 2021. Now, though, 631 rural hospitals are threatened with possible closure within the next few years, according to the Center for Healthcare Quality and Payment Reform.

As the CEO and founder of an acute care telehealth company, I’ve observed firsthand that workforce needs are one of the primary drivers of telehealth adoption. What was once a staff shortage is now a crisis, particularly in nursing, but also among physicians. From 2020 to 2021, the total supply of registered nurses decreased by over 100,000, the largest drop in four decades. By 2025, there could be a shortage of 200,000 to 450,000 nurses in the U.S.

Rural hospitals are at a particular disadvantage since they tend to have worse workforce shortages than urban hospitals. According to the BPC, “urban areas have 30.8 physicians per 10,000 residents; rural ones have 10.9 physicians per 10,000.” There are also often fewer specialists—such as cardiologists, psychiatrists, radiologists and obstetricians—in rural areas.

Opportunities To Improve Care

Rural hospitals have for years contracted with academic medical centers for remote episodic help with patients with clinically complex conditions, such as stroke and sepsis. To make care more affordable, we’re seeing more rural healthcare leaders embracing telehealth for supplemental care, filling in coverage gaps or for specialized consultations on complex cases so that people get the right care at the right time in the right setting.

In previous articles, I wrote about how telehealth can provide clinical expertise, how telehealth specialists target “hot spots” along the patient care journey and about virtual nursing, in which veteran RNs with specialty expertise guide bedside staff and patients through the care process.

Rural hospitals are in dire need of expert care at patient transition points. Virtual care often starts in what is now the front door of a hospital: the emergency room. Rural and critical access hospitals often have to park patients in the hallway as they triage. A remote intensivist steeped in critical care medicine can track the vital signs of patients and do the intake, often guiding inexperienced staff to the right site of care and helping them through tests, diagnoses and procedures.

Inappropriate patient transfers are a source of inefficiencies and poor-quality care. Patients may be sent to intensive care who don’t need to be. Some can be easily treated in the ER and sent home. Others may need a complex operation, for which a transfer to a level 1 trauma center is needed. Outcomes for ER patients with delayed care are, not surprisingly, poorer.

Maximizing A Stretched Workforce

The BPC examined three evidence-based programs that involve using digital technology—one of which was tele-ICU—to see how they could optimize a stretched healthcare workforce and ensure that patients receive quality care in their local hospitals.

Tele-ICU programs can be episodic, such as enabling two-way audiovisual communication between telehealth providers and local ICUs to get answers to questions, or they can be continuous, where a remote physician has complete access to electronic medical records, imaging systems and other databases to get timely information that informs decisions about a patient’s care.

According to the BPC, “studies have demonstrated that tele-ICU programs enhanced care plans, improved clinical outcomes, reduced hospital transfers, and were associated with increased best-practice adherence.” Telehealth also facilitates the mentoring of young nurses and assesses where there are gaps in current knowledge.

The BPC report mentions a study that found that 27% of hospitals with ICUs have tele-ICU capabilities. Such capabilities can potentially lead to substantial savings: The report cites a 2019 cost-benefit analysis that found that a telehealth ICU program saved $3.14 million over six months by “reducing ICU variable costs per case, decreasing length of stays and decreasing ICU mortality.”

It’s a fairly straightforward story: Remote intensivists can monitor dozens of patients remotely at a time, while tele-ICU nurses can keep track of 30 to 50 patients simultaneously, compared with just three for a bedside RN. Bedside clinicians typically can deal with only one emergency at a time, while remote intensivists can handle up to four codes at once.

A Path Forward

Pretty soon, the pressures of the workforce shortage will likely compel many, if not most, acute care providers to adopt some virtual care across the enterprise. So it’s crucial for rural hospitals to take steps now to ingrain telehealth into their operations and make it part of the fabric of care—that way, it’s there when they need it.

Here are some things for rural hospitals to think about when choosing a telehealth partner.

• There are many entities offering telehealth services, ranging from large academic medical centers to consortiums of providers to vendors large and small. Make sure you have complete trust in your chosen partner.

• Ensure that all of the entity’s physicians are licensed to practice medicine in your state(s). If not, they cannot order tests, prescribe medications or do anything but recommend a course of action.

• Does the telehealth provider have a network of specialists in every area? For example, many vendors lack psychiatrists, who are in short supply nationally amid the explosion in demand for mental health services.

• Make sure your telehealth partner understands patient flow optimization techniques that support level-loading and optimized bed utilization.

Final Thoughts

Through my travels and in conversations with executives across the nation, I’ve found that the word “telehealth” doesn’t sound techy anymore and that the understanding of the benefits delivered by digitally enabled care is more mature. Telehealth is now recognized as a tool that, as part of a strategic process to remedy gaps in care delivery, can be combined with change management to drive real value. Soon, in fact, “telehealth” may be replaced by “health” when we look at the evolution of care through technology.

Dr. Corey Scurlock MD, MBA is the CEO & founder of Equum Medical.

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