Jason Hallock, M.D., Chief Clinical Innovation Officer
On-call and nighttime physician coverage are two of hospitals’ biggest costs. With the staffing needed to run a specialty program 24/7 and to cover emergencies of any kind, hospitals’ physician costs can quickly become unsustainable.
But what if care didn’t have to be provided that way? What efficiencies could be gained if hospitals were freed from the constraints of eight or 12-hour shifts or contracting for 24 hours of a physician’s time to cover the specialty needs at a single hospital or just a few hospitals?
How Telemedicine Can Help
Enter telemedicine and the powerful concept of being able to maximize a single physician’s time, availability, and expertise across multiple hospitals. The idea is simple: match the demand for care at an individual hospital with specialist supply by contracting for only the time required to actually care for the patients. Then to ensure thoroughness, layer in on-call coverage with defined backup when the patient demand is lower. The magic here is that the physician’s time is shared across multiple facilities, focused on grouping the correct number of facilities together, so that expected work can be completed by a single provider or team of providers.
At Access Telecare we’ve seen how this model functions at a fraction of the cost of locums coverage, and for far less than what one would expect to pay for in-person care and 24-7 on-call coverage, all while delivering clinical excellence, patient and on-site clinicians’ satisfaction, and operational efficiencies.
The value lies in changing the staffing model. The old model is based on an estimate of care needs, with the hospital subsequently “owning” the less productive time of the specialist when patient care needs are absent or not at full capacity. The telemedicine model more closely approximates the portion of time required to care for the patients that will be seen during the period. The specialist’s time is shared with other facilities.
The result is that a single hospital pays much less for inpatient coverage when the coverage is not a full day’s work for a single specialist. With telemedicine, hospitals no longer need to think in whole days or half-days of work as the patient volume is combined with others. If a hospital only needs 1/5th of a teleNeurohospitalist’s time, it can have that, coupled with 24-7 emergency coverage, for less than it would take to recruit and retain an in-person neurologist. In addition, because a single local neurologist can’t take call 365 days per year, it takes two to four neurologists to even consider having on-call coverage.
How it Comes Together to Drive Down Costs
When adding a telemedicine specialty program, a hospital opts to preschedule the days of coverage or times of day for virtual inpatient care. By covering a small portion of the day for new consultations and rounding, a hospital pays only for time devoted to the needs of its own patients.
For brick-and-mortar hospitals, sharing physicians is constrained by geography and the need to travel. In rural areas, the problem is more acute as there may be no other hospital within reasonable distance with which to share a physician at all.
Safely Planning for Surges
Unscheduled care is unpredictable, and unplanned for surges can occur. To guard against coverage gaps, telemedicine makes adding layers of backup coverage easy primarily because hospitals are not constrained by geography. Out-of-hours on-demand work that exceeds what the on-call physician can handle can be transferred to designated backup providers, and the on-call and backup providers will both be covering far more sites than was feasible in-person.
The old saying was if you staffed to predicted volume, you were understaffed half the time and overstaffed the other. Telemedicine eliminates both dissatisfying outcomes with supply-side elasticity engineered through layered on-call and back-up – and efficient care through the sharing of a specialist’s time.
Telemedicine unlocks the optimization of physician time in ways that defy traditional staffing models. The costs of specialist care likely will remain significant for hospitals, and most specialty coverage will require significant subsidization. With acute care telemedicine, hospitals of all sizes can build programs that distribute specialists’ time efficiently and equitably.
If your hospital is struggling with costs and meeting patient expectations for specialty coverage, we can help. Please get in touch with us today to understand the power of telemedicine to deliver value.
