Telehealth …..Improving the Bottom Line for Emergency Physicians

December 17, 2015

Jeff JonesSenior ManagerTelehealth Center of ExcellenceSubsidium Healthcare

Presented By:Jay BackstromPartner, Telehealth Center of ExcellenceSubsidium Healthcare

Schumacher Group is one of the largest and fastest-growing Emergency and Hospital Medicine groups in the nation. We partner with >5,200 providers who treat 6 million patients annually.

For over 20 years, Schumacher Group and Hospital Physician Partners have helped hospitals navigate EM and HM challenges with data-driven insights and customized strategies to drive efficiency, cut costs, streamline processes, and improve outcomes.

We have united to find innovative ways to help hospitals improve their performance

• Extend quality patient care to a broader population

• Leverage best practices and platforms

• Create greater scale and reduce overhead

• Negotiate favorable terms with payers

• Improve our position in a shifting healthcare marketplace

The Schumacher Group

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Subsidium Healthcare ConsultingSubsidium Healthcare is a premier management-consulting firm focused solely in the healthcare industry

Strategy Technology & Operations

Subsidium Centers of Excellence

Growth Strategies Clinical Revenue Cycle Optimization & Execution Telehealth

Service & Solutions • M&A, partnership

advisory• Physician strategy • Ambulatory expansion

planning• Patient engagement• Value based payment

strategy and design

• Revenue cycle optimization

• Care management program design

• ICD-10 conversion• Clinical

documentation improvement

• Physician Advisory services

• EHR benefits optimization

• UM/CM optimization• Technology selection

and execution• Pre-merger/ post-

merger integration planning

• PMO outsourcing

• Telehealth opportunity assessment

• Business plan / financial analysis / roadmap

• Telehealth program & services design

• Vendor selection• Implementation

DesignPlanning

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AgendaI. Fundamentals of Telehealth

II. Addressing Issues in the Emergency Department

III. Top Applications of Telehealth in the ED

IV. Impacts and Benefits

V. Billing & Reimbursement: Making it Viable

VI. The Patient & Physician Experience: Keys to Success

VII. A Recent Client Experience

VII. Questions

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I. Fundamentals of

Telehealth

TelehealthWhat is it?

Telehealth is:• Patient care services provided over distance using technology to

connect patients with physicians

• A strategy that can:• Reduce cost of service• Support margins• Improve access to care • Improve quality of care

Telehealth is not:• A simple telephone conversation

or a fax transmission• An e-mail or text message

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The Continuum of Telehealth Services

Clinician to Clinician• TeleED Consults• Tele-Specialty Consults• Virtual Conferencing • eICU• Virtual Nurse Mentoring• Clinical Education• Grand Rounds

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Consumer Driven• Patient Web Portals• Personal Activity Monitors• Patient Scheduling Apps• Quality/Price Transparency

Tools • Geo-tagged Devices• Mobile Apps• Social Media• Online Support Groups

Clinician to Patient• Virtual Consults ED/Urgent Care Primary Care Specialty Care

• Remote Monitoring• Telehealth Kiosks• Virtual Medication

Management

Telehealth Services: Examples

• Cardiology • Chronic Care Management /

Remote Monitoring• Specialty Consultations• Dermatology• eICU• Education / Grand Rounds • Emergency Services / Trauma• Fetal Monitoring• Home Health / Long Term Care• Hospitalist Care• Infectious Disease• Medication Adherence• Neurology / Stroke Care

• Obstetrics and Gynecology• Oncology• Orthopedics• Pain Management• Pathology• Pediatrics• Pharmacy• Primary / Urgent Care• Psychiatry • Radiology• Rheumatology• Screening Services• Urology

There are >100 different Telemedicine services. These are some of the more popular Telemedicine services at health organizations today.

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Increase Costs

Decrease Costs

Usually requires volume increases, without substantial increases in cost

With the same revenue

Quality Measures

Increase Revenue

Increase cost less than traditionally required

Perform well on quality measures

TelehealthImproving the Bottom Line

Telehealth Stages of MaturityStage 1

Single Service Focused

Stage 2Multi-Service

Focused

Stage 3Program Focused

Stage 4Market & Care

Delivery Focused

Stage 5Consumer Focused

• Single service deployed to address a clinical need

• Siloed clinical care delivery model

• Limited clinical and business benefits

• No org. structure or governance; departmental sponsorship only

• Multiple independent clinical services to primarily extend care

• Siloed clinical delivery care model

• Some tangible business benefits

• No org. structure. Limited governance. Departmental sponsorship only

• Multiple services aligned with top specialty areas focused on local market

• Services have limited integration with the existing care delivery models

• Program has measurable value and provides local market differentiation

• Central org. structure, services-driven governance and executive sponsorship

• Market-driven, balanced portfolio of services extend beyond local / regional markets

• Services are integrated within care delivery models

• Self-sustaining as abusiness with metrics-driven clinical outcomes and financial results

• Central organizational structure, enterprise-level governance and sponsorship

• Broad and flexible menu of services to address needs within/outside U.S. borders

• Expands beyond provider markets directly to consumers

• Services can be integrated within any clinical delivery model

• Services are productized to be packaged and sold to any health organization or consumer

• Opportunities to increase data value and / or package services to other markets

Telehealth: Stages of Maturity

Market Focus Over Past 10–15 Years Target for Leading Health ProvidersCurrent Market Focus

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Telehealth4 Key Service Models

1. Clinical Model: Addresses the clinical approach, workflow, and potential barriers to the delivery of quality care.

2. Operational Model: Addresses how the Clinical Model is operationalized, including practical issues and programmatic needs (space, location, organization, governance, support, licensing, new resources, billing, reimbursement, etc.)

3. Financial Model: identifies the costs, revenue, margin, and ROI

4. Technical Model: technical solution design (mobile carts, video conferencing, peripherals, network adequacy and reliability, EMR access, etc.)

There are 4 key service models to address with Telehealth initiatives:

Key

Focu

s Are

as

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II. Addressing Issues in the

Emergency Department

Care in the Emergency DepartmentCommon Issues

• Rapid access to ED physician (door-to-provider time)• Access to specialist care (stroke, psych, trauma)• Prompt treatment for low acuity patients• Effective transitions to home / primary care• Timely admission process• 30-day readmission issues (high-focus conditions)• Patient surges (Intra-day, certain days, seasonal)• Rural access to highly qualified ED physicians• Affordable Provider coverage model• Others (triage, hospitalist consultation, etc.)

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Telehealth in the EDWhere and When?

• Before the ED visit

• During the ED visit

• After the ED visit

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Telehealth“Before” the ED visit

• Clinician-to-patient visit (“direct to consumer”)– Patient calls the ED with a health issue and the service offered could be:

• Advice only • Patient care visit

• Clinician-to-clinician– Outlying hospital calls tertiary center

(ED1 to ED2)• Transfer, consult, admit, or

discharge?

• Telemonitoring for high-focus conditions

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Telehealth“During” the ED Visit

• Provider up front– Rapid access to ED physician

• Specialty care – Narrowly defined applications, such as

stroke, psych, trauma

• Prompt treatment for low acuity patients– Fast track, etc.

• TeleRadiology support– Immediate primary reads vs. preliminary reads from an after-hours service

• Effective transitions to home / primary care– Address high risk patients (patient teaching, transition of care issues)– Address high-frequency patients

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Telehealth“During” the ED Visit

• Timely admission process– “Admissionist”

• Patient surges – Intra-day, certain days, events, or seasonal

• Telemedicine as a solution • Telemedicine as a bridge, before adding a more costly 10 or 12 hour shift

• Rural access to highly qualified ED physicians– ED to ED Consultation– Transfer decisions

• 30-day readmissions (high-focus conditions)– Focused management of CHF, pneumonia, COPD, etc., – Clinical pathways, care coordination, and patient engagement strategies

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Telehealth“After” the ED Visit

• Clinician- to- patient model– Specific patient care follow-up

• High focus conditions• High risk conditions

• Clinician- to- clinician model– Follow-up of non-transferred

patients• Specialty Care• Hospitalist management

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III. Top Applications of Telehealth in the ED

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Top Telehealth Applications in the ED

ED Telehealth Service

Description of Problem or Opportunity

Use Case(s) Value Proposition

Specialty Care for

ED Patients

▪ Stroke

▪ Psych

▪ Other (Trauma, Cardiology, etc.)

ED patient requires specialist for time-sensitive conditions or specialty consultation.

▪ Optimal outcome for time-sensitive conditions▪ Focused consultation for specific conditions

ED TeleConsultsRural ED consults with tertiary center on ED patient.

Local ED physician performs a TeleConsult with remote ED physician or specialist to address a patient's care and/or disposition.

▪ High quality, coordinated care▪ Avoidiance of unnecessary patient transfers▪ Reduced complications

Provider to Provider Applications

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Top Telehealth Applications in the ED

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ED Telehealth Service

Description of Problem or Opportunity Use Case(s) Value Proposition

Low Acuity Patients

Patient Volume Surges

▪ ED Patient volume surges may impact timely patient care, patient satisfaction, and provider cost

▪ Low acuity ED patients are especially suited for telemedicine

For low acuity visits (routinely), or for patient surges (occaisionally):▪ Patient video conferences with ED physician or NP/PA ▪ Medical screening exam, labs, and documentation in EMR is initiated▪ Full visit may be completed if appropriate

Rather than requiring additional 8/10/12 hour shifts, telemedicine coverage incrementally increases provider coverage, and aligns overall cost with demand.

Virtual ED Visit("Before the ED")

Patient contacts ED physician directly before coming to the ED.

▪ Patients asking if they should come to the ED

▪ Patient seeking care for a treatable condition

▪ Reduce ED volume for low acuity conditions▪ Patient satisfaction▪ Reduced cost of care▪ Less demand on hospital resources

Virtual ED Visit("After the ED")

High risk/high focus patients may be discharged from the ED without sufficient follow-up care and may return, causing higher ED utilization, higher readmission rates and avoidable costs.

Utilize NP/PA to connect with patients in follow-up, insuring that they are appropriately following recommendations for care.

▪ Improves outcomes for high risk/high focus patients▪ Reduces hospital costs/penalties associated with avoidable readmissions▪ Reduced complications

Admission SupportPatient admissions are time-consuming, may cause delays, patient dissatisfaction, and poor outcomes.

Utilize mobile Telemedicine carts to connect patients with admitting provider

▪ Expedites the patient admisssion process.▪ Increases patient satisfaction▪ Reduces ED Length of Stay▪ Enhances outcomes

Discharge ServicesHigh focus patient populations are especially vulnerable to poor transitions of care, and may require additional time and expertise.

Utilize mobile Telemedicine carts to connect patients with specialized resources for key transitions of care.

▪ Expedites the patient discharge processes.▪ Insures effective transition of care▪ Improves productivity of ED providers▪ Reduces repeat ED visits and readmissions

Remote Monitoring for Chronic Condition

Patients

Patients with chronic conditions are frequent users of the ED, and can drive high readmission rates and avoidable costs.

Provide remote monitoring for high risk patients with chronic conditions (e.g. AMI, CHF, diabetes, COPD) to proactively address health issues.

▪ Reduces hospital costs or penalties associated with readmissions▪ Improves qualty of care and patient satisfaction▪ Reduced complications ▪ Reduced risk

Provider to Patient Applications

Telehealth in the Emergency DepartmentQualification Criteria

• Clarification: What problems are we trying to solve?

• 3rd Party Reimbursement: Need to “qualify” the client location for TeleMedicine reimbursement (reimbursement varies by state)

• Financial justification/ROI

• Technology: Network bandwidth at client location for video conferencing

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TelehealthSolution Options

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• Customized solutions can be built by software developersBuild

Lease • Solution can be acquired (3, 5, 7 year leases)

Borrow• Some may have mobile cart/ video conferencing

solutions not currently being used in the ED

Refer • To another providers service

• Multiple, proven vendor solutions are currently available in the market Buy

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IV. Impacts and

Benefits

Financial

• Reduced delivery costs• Increased margin• Fewer

readmissions/penalties • Reduced length of stay• Fewer patient transfers

Quality

• Positive health interventions at earlier times in care

• Improved health outcomes

• More efficient care delivery

• Reduced or avoided time in skilled nursing units

Access

• Enhances staffing capacity to meet patient needs, including surges

• Improved patient access to specialists

• Improved health system outreach

• Earlier patient diagnosis and treatment

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TelehealthKey Benefits

Revenue &

Cost Savings

TelehealthFinancial Areas

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• Telehealth Clinical Resources

• Telehealth Support Team• Annual Vendor Maintenance

& Support • Costs Associated with Increased

Scale

• Technology• Integration • Infrastructure Changes• Room Redesign / Build out • Building & Deployment• Training

• Telemedicine Reimbursement• Reduced Readmissions / Avoided

Financial Penalties• Improved Productivity and

Efficiency• Reduced LOS• Increased Patient Volume

• Increased Patient Population / Market Share Served

• Avoided Care Costs / Proactive Care Management

• Population Health Management

• Grants

Opportunities

Ongoing Expenses

Costs

Sample Financial Model

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1Unit Amount Quantity Savings 2

Current Staffing Cost Savings 3Current Staffing @ Client ABC (2 MD's: 1 MD per dayshift and on call @ night) 314,265$ 2 628,530$

Future Staffing CostsTeleHospitalist Staffing Costs 300,000$ 2 90,000$ Onsite Hospitalists @ Client ABC 150,000$ 2 300,000$

Total Savings: 238,530$ Year 1Total Clients 1 Total Annual Encounters (Client ABC) 5386Total Annual Encounters (Abrom Kaplan) 1292

TeleHospitalist TeleMedicine Service Center (TMSC) Unit Cost Quantity Year 1 Total Avg. Daily Encounters (Client ABC) 3.5 TMSC Build Out and Setup 10,000$ 1 10,000$ TeleHealth Workstations (PC, Dual Screens, Camera, Headphones) 10,000$ 1 10,000$ Hospital Costs (Spokes)Mobile TeleHealth Cart (includes PC, camera, ext. cables, cabinet, etc.) 21,858$ 1 21,858$ Traditional Model Hospitalist Compensation (Client ABC) ######## #Hand Held HD Camera (Horus Scope: ENT, eye, dermatology, etc.) 5,635$ 1 5,635$ Traditional Model Hospitalist Compensation (Client ABC) ######## #Digital Stethoscope 515$ 1 515$ Avg. NP Compensation 150,000$ Vendor Implementation and Training Services 10,000$ 1 10,000$ Avg. TeleHospitalist MD Compensation 300,000$

Total Capital Costs: 58,008$ TMSC Staffing Cost Distribution (based on % of total encounter volume) 15%Annual Depreciation Expense (5 yr. Amort) 11,602$ Maximum Encounter Capacity per TeleHospitalist 22

Maximum Encounter Capacity per On-site NP 15Technology Related Costs Full Time Max (# of hours/month) 180TeleHealth Workstation Cisco Video Conferencing Licenses 750$ 1 750$ Mobile TeleHealth Carts Cisco Video Conferencing Licenses 750$ 1 750$ Mobile Cart Vendor Support and Maintenance (15%) 28,008$ 1 4,201$ Personnel Costs IT Support Resource (1 per year/per 10 sites) 65,000$ 10% 6,500$ IT Service - Support for Carts (20% of total cart costs) 10,000$ 1 10,000$ SG TeleHealth Medical Staff Credentialing Specialist 45,000$ 5% 2,250$ Licensing and CredentialingPhysician State License Costs 1,000$ 4 4,000$ Physician State Credentialing Costs 500$ 4 2,000$ NP State License Costs 500$ 2 1,000$ NP State Credentialing Costs 500$ 2 1,000$

Total Operating Costs: 32,451$ Total Costs: 90,459$

Depreciation Expense 11,602$ Net Operating Margin 194,477$

Net Cash Flow 148,071$

Key Variables

CostsCapital $

Operating $

Input Data

Client ABCSavings Assumptions

Year 1 TMSC staffing costs are distributed to this hospital on 15 to 1 ratio.Client does qualify for TeleHealth Medicare reimbursement.Client Staffing: - Traditional Hospitalist Staffing: 2 MD's rotating 7-on, 7-off for dayshift - New Staffing: 2 NP's for dayshift & 2 physicians 24/7 in TMSC

Telehealth Top 5 Drivers of Financial Success

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1. Fully understand the Telehealth reimbursement in your service areas:• Medicare • Medicaid• Commercial payers• State regulations on Telehealth

2. Leverage NP/PA staffing models where possible 3. Early success is critical for driving increased volumes/revenues4. Leverage a hub and spoke model to maximize physician utilization and

optimize costs5. Measure and manage success:

• Define financial success prior to go-live • Create daily and weekly reports to measure results and progress• Manage results; optimize quickly

V. Billing and Reimbursement: Making it Viable

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TelehealthCurrent State of Reimbursement

Reimbursement for Telehealth services has been rapidly increasing, especially within the last couple years:

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Medicaid• Reimburses in most states (47 states reimburse for live

video Telehealth services. 16 states reimburse for remote patient monitoring).

• Many states have different requirements that determine the scope of coverage for Telehealth (e.g. type of services to be provided, location of providers, etc.).

Medicare • Reimburses for TeleHospitalist services in rural

and underserved areas • Must meet specific billing requirements

Telehealth Current State of Reimbursement

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Commercial Payors

• 29 states have passed Parity Laws mandating Telehealth

reimbursement

• 14 additional states have proposed Parity legislation for

approval within the year with other states expected to follow

• There are 36 states with a combined 100 bills on Telehealth

under consideration and Telehealth provisions are included in

national congressional bills

• Regardless of state parity laws, many large payers have

independently added policies for Telehealth reimbursement

Private/Commercial Coverage of TelehealthState Parity Laws Mandate Reimbursement of Telehealth

Note: 8 states have proposed/pending Parity law legislation for approval this year.

Source: ATA’s State Telemedicine Policy Center (October 2015)

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State(Support of TH)

TH Parity Law in Place

When?TeleMental Coverage

TeleHome Coverage

Remote Monitoring

Store & Forward

State(Overall Score)

Defined by State

Informed Consent Req.

Physician-Patient

Encounter

Live Video Reimb

TelePresenter

Email / Phone / Fax

Reimb

Cross-State Licensing

Licensure & Out of State

Practice

Medicaid Program Location Defined

Online Prescribing

State(MD Composite Grade)

Alabama X X Y U Alabama Y Y Y N N Y N AlabamaAlaska X X X X Alaska Y N Y N N N N AlaskaArizona X 2013 X X U X Arizona Y N Y N Y Y N ArizonaArkansas X Arkansas Y N Y N N Y N ArkansasCalifornia X 1996 X X California Y Y Y N N Y N CaliforniaColorado X 2001 X X X Colorado N Y Y N N N N ColoradoConnecticut PPB Connecticut N N Y N N N N ConnecticutDelaware X Delaware Y N Y N N Y N DelawareDistrict of Columbia X 2013 District of Columbia N N N N N N N District of ColumbiaFlorida PPB Florida Y Y Y N N Y N FloridaGeorgia X 2006 X Georgia Y Y Y N N Y N GeorgiaHawaii X 1999 X Hawaii N N N N N N N HawaiiIdaho X Idaho Y Y Y N N Y N IdahoIllinois PPB X X Illinois Y N Y N Y Y N IllinoisIndiana X X Indiana N Y Y N N Y N IndianaIowa PPB Iowa N N N N N N N IowaKansas X X X Kansas Y Y Y N N N N KansasKentucky X 2000 X X X Kentucky N N N N N N N KentuckyLouisiana X 1995 X X Louisiana Y N Y N N N Y LouisianaMaine X 2009 X Maine Y Y Y N N N Y MaineMaryland X 2012 X Maryland Y Y Y N N Y N MarylandMassachusetts PPB X X Massachusetts N N N N N N N MassachusettsMichigan X 2012 X Michigan Y N Y N N Y N MichiganMinnesota X X X X Minnesota Y N Y Y N Y N MinnesotaMississippi X 2013 X X X Mississippi N N N N N N Y MississippiMissouri X 2013 X Missouri Y Y Y N N Y N MissouriMontana X 2013 X Montana N N Y N N Y N MontanaNebraska PPB X Nebraska Y Y Y N N Y N NebraskaNevada X Nevada Y N Y N N Y N NevadaNew Hampshire X 2009 New Hampshire N N N N N N N New HampshireNew Jersey X New Jersey N Y Y N N N Y New JerseyNew Mexico X 2013 X X New Mexico N N N N N N N New MexicoNew York PPB X X X New York Y N Y N N N N New YorkNorth Carolina X North Carolina Y N Y N N Y N North CarolinaNorth Dakota X North Dakota N N Y N N Y N North DakotaOhio PPB Ohio N N Y N N N N OhioOklahoma X 1997 X X Oklahoma Y N Y N N Y N OklahomaOregon X 2009 X Oregon Y N Y Y N N N OregonPennsylvania PPB X X X Pennsylvania Y Y Y N N N N PennsylvaniaRhode Island PPB Rhode Island N N N N N N N Rhode IslandSouth Carolina PPB X X X South Carolina Y N Y N N Y N South CarolinaSouth Dakota X X X South Dakota Y N Y N N N N South DakotaTennessee X 2014 Tennessee Y Y Y N N N N TennesseeTexas X 1997 X X X Texas Y N Y N N Y N TexasUtah X X Utah Y Y Y N N Y N UtahVermont X 2012 X Vermont Y N Y N N Y N VermontVirginia X 2010 X Virginia Y N Y N N Y N VirginiaWashington PPB X X X Washington Y N Y N N Y N WashingtonWest Virginia PPB X West Virginia Y Y Y N N Y N West VirginiaWisconsin X X Wisconsin Y Y Y N N N N WisconsinWyoming X Wyoming Y Y Y N N Y N Wyoming

Legend

State is NOT supportive of TelehealthState is somewhat supportive of Telehealth

State is mostly supportive of Telehealth with some challenges

State supports the use of Telehealth

American Telemedicine Association

State Telehealth Coverage & Support

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Billing & Reimbursement Requirements

• Eligible Providers:– Physician – Physician Assistant & Nurse Practitioner – Nurse Midwife– Clinical Nurse Specialist– Clinical Psychologist– Clinical Social Worker– Registered Dietitian or Nutrition Professional

• Eligible Facilities:– Office of a Physician or Practitioner– Hospital, including a Critical Access Hospital (CAH)– Rural Health Clinic– Federally Qualified Health Center– Skilled Nursing Facility (SNF)– Hospital-based Dialysis Center– Community Mental Health Center

To bill Medicare, Medicaid, & most private payers for approved Telehealth services, the following criteria must be met:

• The patient must be located in a non-Metropolitan Statistical Area (MSA) or a Health Professional Shortage Area (HPSA)

• The patient must be treated by an eligible provider (see below)• The patient must receive care via Telehealth in an eligible facility (see below)• The appointment type must be for Telehealth encounters that uses the ‘GT’ modifier on all claims• In the electronics comment, document “Services Provided by Telehealth”

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Medicare Billing Requirements:

Federation of State Medical BoardsInterstate Medical Licensure Legislative Status

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Source: Federation of State Medical BoardsAs of Sept., 2015

LegendBlue – Compact is Enacted (11 states)Orange – Compact is Introduced (8 states)Grey – No Compact Status (31 states)

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VI. The Patient & Physician Experience:

Keys to Success

The Patient/Physician ExperienceKeys to Success

• The art of “good video bedside manner”– Engaging presence over video conferencing

• Screen and recruit physicians who align with a Telehealth environment:– Perform recruiting/screening interviews via video

conference – Ability and interest in working remotely or in a

Telehealth Service Center– Appetite for after hours/weekend duties

• Establish and train nurses as advocates – To help evangelize Telehealth and assist

with patient adoption and consent

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The Patient/Physician ExperienceKeys to Success

• Environmental impacts related to the patient experience:– Proper lighting to enhance video experience– Manage noise and extraneous activity– Background should be comforting - as if they were in a physician office.

Consider:• Art work or hospital name/logo in background• Avoid dark wall colors in background• Avoid views of other computer monitors

– Network access if using mobile carts (e.g. WiFi, fixed network cable connections, etc.)

• Patient acceptance of Telehealth solution – Bedside confidence of nurse or physician– Ease of use for video conference and peripherals– Accessibility to patient (e.g. mobile carts, wall mounted equipment, fixed

workstations, mobile devices/tablets, etc.)– Video conferencing solution must be optimized to perform at a level that

best replicates a face-to-face encounter

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VII. A Recent Client Experience

SG’s TeleHospitalist Service with Lafayette General

TeleMedicine Service Center(Lafayette, LA)

Patient Rooms

Abrom Kaplan Memorial Hospital (Kaplan, LA)

Patient Encounter Data into Cerner EMRSecure Audio/Video Conferencing

SG’s TeleHospitalist service has been deployed at 2 of Lafayette General’s hospitals: Acadia General Hospital and AbromKaplan Memorial Hospital. This is a ground-breaking TeleHospitalist service in the state of Louisiana.

SG / Lafayette GeneralTeleHospitalist Service Deployment

Patient Rooms

Acadia General Hospital (Crowley, LA)

Projected Value: • New HM service coverage• Reduced cost of care delivery• Quicker response rates• Consistent coverage• Medical staff satisfaction • Reduced physician recruiting demands

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TeleHospitalist: Impact on Client HM ProgramsOpportunities TeleHospitalist Service Changes Impact & Value

Recruiting • Improved recruiting for sites that have a small candidate pool

• Increased use of on-site NP / PAs

• Enhances and simplifies recruitment• Reduces recruitment and staffing costs

Provider Retention • Remote staffing of undesired shifts (nights & weekends, on call)

• Reduction in non-care “distractions”

• Heightens focus on care• Reduces burnout and attrition• Improves work / life balance

Demand / Capacity Balance

• Alignment of provider capacity with service demands

• Back-up for patient care surges

• Better utilization of resources• Optimized coverage models• Distributes provider costs across sites

Care Coordination • 24x7 provider access for admissions• Eliminates need for ‘bridge orders’• Prepare discharges for next day• Closer care team coordination• Daily quality audits

• Reduces LOS in ED and HM• Expedites admission times• Expedites patient discharges • Supports care quality• Improves documentation

Patient Experience • Reduction in admission delays• Immediate access to hospitalist care• Remain in community for care

• Improves patient satisfaction

Strategic Alignment • Distribution of provider services to locations with highest need

• Provide specialized services locally

• Patients managed locally vs. transferred• Positive community impact• Supports hospital financially

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TelehealthLessons Learned

• Establish an executive sponsor, physician champion, and dedicated core Telehealth team to drive the project

• Coordinate directly with the leading commercial payers in your state to confirm their reimbursement policies for Telehealth

• Develop a detailed, “bottom-up” financial model to accurately forecast revenue

• Measure and manage success:– Define success prior to go-live (quality, operational, and financial metrics) – Create daily and weekly reports to measure results and progress– Manage results; optimize quickly

• Thoroughly test the technology solution – including the network – to resolve issues in advance

• Focus on optimizing the patient experience to support adoption

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Questions

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Jay BackstromPartner, Telehealth Center of ExcellenceSubsidium Healthcarejbackstrom@subsidiumhealthcare.com

Jeff JonesSenior Manager, Telehealth Center of ExcellenceSubsidium Healthcarejjones@subsidiumhealthcare.com

Contact Information

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