TELEMEDICINE QUESTION This is a major pivot from my normal LinkedIn posts. I’m seeking input to gather many perspectives/examples that can appropriately be shared. Here is the question. Are rural hospitals (critical access hospitals and Tweeners) better off financially as a result of telemedicine (tele-partners)? Or are they driving down their CMI by triaging and transferring sooner than they used to prior to the tele-partnership(s)? Background: Several CEO/CFO recent conversations with me include the topic of telemedicine and its perceived benefits. I’ve sensed genuine confusion in these administrators being able to articulate the benefit of such partnerships. Working solely in rural healthcare for the last 4 years (and 20 years prior with Top 100 health systems), telemedicine benefit to rural remains a quandary. On one hand, I have observed specialists consulting with rural MDs and helping to answer questions patients may have about next steps in a definitive treatment journey. This is a tremendous comfort for MDs and patients alike. On the other hand, in aggregate, when looking at the financial data behind telemedicine support and a rural hospital CMI, it appears that often there is little evidence to support that complexity in local care is rising as a result of the tele-partnerships. Hmmm … wasn’t that one of the core arguments for telemedicine, to keep care local with remote support from advanced specialists? Looking directly at EMR data within many rural hospitals, I have seen in the data that CMI, a proxy for complexity of care in patients, does not increase, but in fact may decrease with tele-partners coming in. We have also observed in the data that EMS service to transfer patients urban sites of tele-partner medicine seems to rise with tele-contracts. I’m very curious to get others’ perspectives on this topic. This is not intended to take shots at tele-medicine, but rather to have a brief forum on others’ experience with the clinical and financial outcomes of rural hospitals, in particular, CAHs and Tweeners. I look forward to reading your comments!
Related to my previous comment: Another observation on the (B) type scenarios that I laid out, which what I think your question was primarily aiming at: My perception, based on anecdotal observations over the past 15 years, is that tertiary hospitals would prefer to keep their precious beds open for sicker patients (e.g., in 2011 I helped implement a transfer-to-CAH- program for Mayo Clinic's Pulmonary ICU, with virtual rounding at the CAH). I.e., I don't sense (yet) a "let's transfer this patient to us" mentality by tertiary hospitals.
Hi John Wadsworth your question is “are rural hospitals better off as a result of telemedicine?” Focusing on rural hospital challenges, there are value propositions that have been identified and also published upon regarding the benefit of telehealth enabled care models for rural hospitals. Some of the propositions focus on Access to care, others on financial, and some on local community value- in conjunction with National Rural Health Association we presented select published literature on this during a joint webinar with Huron just this week. I’m happy to walk through this data to expand the availability of this information.
So, this raises several questions. Are patients better off? Intuitively, we would say yes but the data actually is not there to answer this in all instances. Should rural hospitals be linked up with larger more urban/suburban facilities to offer needed care and to survive financially? Currently, larger systems that have bought or partnered with rural hospitals often are curtailing services in the rural areas due to staffing availability and financial pressures. They seek to channel patients needing complex care (or even less complex care) to sites where it can be offered most efficiently and cost effectively (from the parent hospital perspective). Tele-medicine helps them, but does little for the rural hospital. States can address this through policy, but it will be tough to determine who pays and who gets the benefit.
Thank you, Karsten, for looping me in on the conversation. John, to your main question I'd like to add to the discussion that there are different service models of telehealth that we need to distinguish for a comprehensive evaluation of inpatient telehealth. The first distinction is the location and practice setup of the TeleSpecialists: A) Virtual-Only specialists with no in-person access. B) Hybrid Specialists with a physical presence in the region. C) In-house Hybrid Specialists (for health systems with rural hospitals) The second distinction is the timing of TeleCare as it relates to the patient's episode. Put simply: 1) Pre-Treatment (ED) 2) In-Treatment (inpatient in rural hospital) 3) Post-Treatment (swingbed) The third distinction is the common specialties that telehealth provides access to: a) Critical Care (e.g., TeleTriage) b) Intensivists (e.g., TeleSepsis) c) Neurologists (e.g., TeleStroke) d) Psychologists/Psychiatrists (e.g., TeleCrisis) e) Cardiology, Pulmonology, Nephrology, Rheumatology, etc. f) Cardiac Rehab, Pulmonary Rehab, PT/OT
There’s no “easy button” in healthcare. Telemedicine offers significant benefits for Critical Access Hospitals (CAHs) and rural facilities, but success requires time, expertise, and ongoing evaluation. If financial or clinical goals aren’t being met—whether in revenue, patient outcomes, or case complexity—then it’s crucial to review and adjust systems and protocols. Partnering with an experienced telemedicine provider can accelerate this optimization. Ultimately, telemedicine enables rural communities to access top-tier care close to home, helping bridge gaps in specialty services and strengthen local healthcare delivery.
Principal at William Hudock and Associates
1moYou pose complex questions. Tele-medicine was conceived to promote access, especially to those who are remote from specialty providers. However, in so doing it can have the unintended consequence of delinking rural patients from rural hospitals. If/when this happens the rural hospitals lose an important source of revenue. Tele-health providers can be quite remote from rural hospitals. Without contractual linkage and appropriate referral patterns the rural hospital can lose revenue by promoting tele-health. Payers (led my CMS) pay more for complex services. Many rural hospitals lack the volume needed to pay for the staffing and infrastructure required to offer these complex services. Tele-medicine only tends to exacerbate this problem. It acts as a channeling mechanism to those providers and through referral those systems that can afford to offer complex care.