Can Telehealth Transform On-Call Requirements?

“In the old days, call may have been a practice-growing revenue stream, but for a long time now it’s been a poorly reimbursed time suck for most specialists.”

KevinMD.com

It’s possible that nurses, doctors, and every other clinical professional have grown weary of call coverage.

As far back as 2014, Becker’s reported that finding doctors to provide on-call specialty consults in the ER was a difficult task. They said more than 70% of hospital emergency rooms could not find enough coverage for specialty services. In the intervening four years, the problem has worsened.

Providing call coverage for rural hospitals and for some hard-to-find medical specialties is increasingly challenging. With looming physician shortages, the added burdens of call on a medical staff stretched thin will exacerbate the struggles of hospitals attempting to attract physicians.

From a physician perspective, most of us come out of residency already weary from on-call duties. Call is a necessity, of course, but it intrudes, sometimes deeply, into the work/life balance that we all try to find.

While hospitalists have helped lighten the load in larger facilities, it certainly does nothing for the small independent practice or struggling community hospital.

However, telehealth is now emerging as the latest model to help overburdened physicians and understaffed ERs stretch call coverage in new, more efficient ways.

Using telehealth to improve and extend call coverage offers four important benefits:

• For the doctor, nurse, mid-level, or other clinical providers, using telehealth as an assessment tool increases the amount of information they can gather during the encounter. This could aid in a more accurate diagnosis and potentially keep the clinician from having to head to a medical facility to provide care.
• For the hospital, telehealth on-call allows new ways to extend coverage for hard-to-find specialists. It also has been shown to cut costs. Finally, for rural facilities, where it is harder to recruit talent, providing telehealth on call is a way to lighten the load for physicians, potentially serving as a carrot to attract more providers.
• The patient always benefits from telehealth; customer satisfaction scores increase and patients say they appreciate the reduced time and cost when having the doctor come to their home in a virtual visit.

Becker’s suggests “Specialists often see ED-call coverage as an intrusion into their personal lives and a disruption to their practices.” A feature article in Texas Medicine seconds that opinion and suggests that telehealth is now the best way to improve the lives of physicians and the patients they serve:

Times and technology are changing, and the high-tech trappings of
telehealth are becoming a more popular option for call coverage for
busy and often overworked physicians.

This is a creative solution that uses a technology disruptor to improve access to care while lightening the physician load. This trend is expected to continue as telehealth adoption becomes widespread.

The application of telemedicine is a booming business; Mordor Intelligence predicts the U.S. telemedicine market will reach $66 million by 2021. Call coverage via telehealth technology allows a physician to respond to the patient by providing care without necessarily traveling to the hospital. Sullivan, Cotter, and Associates, Inc. measured the usage of telehealth on-call coverage in 2014 and found that 30% of organizations were already using telehealth in this fashion, giving their doctors the option of staying home instead of traveling to the hospital as part of their patient encounter.

While every after-hours consult may not be handled fully in this way, we know that telemedicine reduces readmission rates and cuts down on ER visits. Providing a telehealth visit allows doctors a way to more appropriately assess patients that may actually keep the patient out of the ER. This could also lessen the number of trips the on-call doctor needs to make to the ER and improve the quality of their life

A study in the Journal of Telemedicine and Telecare showed that a telehealth intervention by an on-call clinical provider reduced annual ER visits by $928,000 in one hospital. With the cost of readmission penalties skyrocketing to more than $26 billion annually, telehealth call coverage provides an additional way for doctors to examine a patient with a video consult instead of just a phone call. This can add to the layer of information ascertained by the clinical visit.

For a smaller independent practice struggling to meet the demands of on-call, telehealth could be an important way to extend care to patients without burning out the physician. Patient satisfaction scores are higher; one study showed that the use of telehealth in the VA improved ratings up to 85%.

But if these benefits are so clear-cut, why aren’t more medical practices also adopting telehealth call service? One of the issues, it turns out, is reimbursement.

But how are doctor’s paid when providing this service?

Historically, hospitals did not pay doctors for on-call, instead, requiring it as part of their employment agreement or hospital privileges. But this, like so many other things in healthcare, has changed. Today, per diem fees are allowed under the OIG, but the layers of complexity for these services and the government’s review of these arrangements have grown more rigorous.

A report in Becker’s suggested that 54% of the organizations currently using telehealth for call coverage are paying 100% of the unrestricted daily stipend. But generally, telemedicine is either non-reimbursable or payable at a reduced rate from the general emergency room department coverage. However, reimbursement for telehealth is increasing and restrictions are being lifted that will allow the technology to expand in the future.

OrthoLive offers call coverage via our telemedicine application for orthopedic providers. We’ve seen our technology help hospitals extend access to needed specialty care for patients in rural hospitals. OrthoLive also helps doctors get their lives back by cutting the number of trips to an office or a hospital ER. Finally, OrthoLive provides the ability to cut overhead costs in the medical practice while also reducing readmission penalties.

If your hospital is struggling to cover orthopedic on call or if your practice wants a more efficient technology for providing 24-hour care delivery, please contact us.