Telehealth Orthopedic ER On-Call for Rural Hospitals

Things have gotten tougher lately for community hospitals and other rural clinical facilities.

Becker’s says over the past eight years, 26 states have lost at least one of these facilities. The latest count since the year 2000 is 48 rural hospitals closed, with another 283 in danger.

In many of these rural settings, the community hospital served as the hub of the region, providing not only needed medical treatment, but also jobs.

Today, it’s widely perceived in healthcare circles that our rural community facilities are dying on the vine.

But there is a glimmer of hope found in telemedicine as a model to aid these struggling clinical teams. Orthopedic and other specialty care can now be provided as an on-call service to remove the burden of over-worked healthcare teams while serving as an important benefit to help attract new talent.

Over the past decade, rural hospitals have struggled to remain competitive with larger urban counterparts. As the cost of care delivery has escalated, the tight margins these hospitals managed to squeak by on have narrowed even further. As a result, rural hospitals have less ballast in their revenue cycle to pay highly sought after specialists.

Some of the other factors reflecting the struggles of these important community providers include:

• Rural regions have higher poverty and lower health outcomes than metropolitan areas.
• While about one-fourth of all residents live in rural areas, only about 10% of doctors practice in these settings.
• Medicare payments can be dramatically less than those to urban facilities.
• A national physician shortage is only expected to exacerbate clinical care coverage in rural settings.

Importantly, The Commonwealth Fund suggests that a chronic physician shortage is a strong contributor to the declining health of rural residents:

The scarcity of rural health professionals contributes to increased rates of hospitalizations for patients with conditions such as such as asthma and pneumonia, which might be avoided if patients receive timely and effective primary care.1 The scarcity also may be at least partially responsible for the greater incidence of chronic health conditions such as hypertension, heart disease, and emphysema among rural residents.

But one of the biggest issues faced by rural hospitals is the extensive burden put on the providers they employ to provide the 24/7 on-call coverage to these facilities.

Providing on-call coverage for specialty care is extremely difficult in rural settings. One study showed 74% of emergency room administrators had problems finding coverage for specialty care for their 24/7 departments. This has been a widespread issue for years, but this is especially difficult in rural hospitals that often rely on coverage by specialty providers that are external to their facility.

Simply put, rural hospitals cannot afford to attract the kind of specialty talent that flock to more urban facilities.

This puts a bigger burden on rural physicians that pay the price of being on-call. For these facilities, the problems of harnessing specialists for on-call coverage have negative clinical and financial outcomes for hospitals and providers.

Decreased access to care means the quality of these rural facilities declines. ER patients may have higher wait times for specialty treatment or be required to travel extensively to see a doctor – something they usually cannot afford to do. The problem also causes rural hospitals to lose money on costly patient transfers as well as the obviously lost reimbursement for the cases migrating to competitors.

But most or even all of these problems can be mitigated with telehealth.

“A telemedicine platform that helps emergency departments triage patients just might be the answer to crowded ERs and physician staffing issues.”

mHealth Intelligence

The goal of OrthoLive has always been to provide access to care in new ways that help both doctors and their patients. As an offshoot to telehealth, we offer telemedicine orthopedic ER coverage designed to specifically offset the burdens felt by critical access, community hospitals, or other clinical providers struggling with the necessity of 24/7 urgent care. On-staff providers in rural facilities can split on-call coverage; enhance the quality of care, while improving work/life balance for clinical teams.

Last year, Becker’s reported that two-thirds of the hospitals already offering telemedicine also have this type of expanded coverage. Most planned on expanding these telehealth applications over the next few years.

These types of on-call consults for other specialty services have been going on for years in forward-thinking facilities such as the Mayo Clinic. Their Stroke Telemedicine service, called Telestroke, has been groundbreaking in bringing neurologists and ER clinicians together to provide more effective care faster for vulnerable stroke victims when every second counts.

One study last year showed telemedicine ER consults reduced length-of-stay and improved trauma care at critical access facilities in North Dakota.

ER on-call coverage for orthopedic specialists can consist of a remote consult that can help triage patients or provide a second opinion for rural clinical teams. Screen sharing x-rays or assessing weight bearing on an injured limb can all be conducted via a virtual visit.

Orthopedic telehealth on-call can help rural hospitals capture reimbursement by potentially eliminating some of the outward migration causing revenue cycle hemorrhage in rural ERs. One study showed using the technology in rural Mississippi had clear benefits for the rural facility:

• A 25% reduction in hospital staffing costs;
• A 20% increase in admissions by decreasing the number of patient transfers;

With telehealth parity laws having been passed in most states, provider reimbursement isn’t the big issue it was a decade ago.

Providing orthopedic telehealth to supplement stressed emergency departments eliminates the burden of on-call for hospital teams. It can also provide much-needed support to clinicians that feel isolated when they first go to practice in a small community. Finally, the service also provides evidence-based support with a proven technology to increase access at a time when we desperately need it.

Providing orthopedic telehealth on-call could even help rural hospitals attract more specialists; our service helps relieve the new doctor, allowing for a better quality of life.

OrthoLive is standing by to discuss the benefits of telehealth. Contact us today.