Recent Developments in Telehospitalist Services

Written by Andrew McWilliams

Where did telehospitalist services originate, and where are they likely headed? Other blog posts in this series have mostly dealt with the specifics of setting up a telehospitalist service, but an understanding of the historical context in which telehospitalist services have developed, including recent development in the field, is also important to obtaining the maximum benefit.

Growth in unfilled hospitalist positions

The number of hospitalists has grown exponentially, from virtually zero 20 years ago to an estimated 60,000 today. Despite the growth in the supply of hopitalists, an increasing number of hospitalist positions are going unfilled.

According to the Society of Hospital Medicine (SHM), as many as 11% of hospitalist jobs nationwide are going unfilled. Half of hospital medical groups (HMGs) serving children only, half of HMGs serving both adults and children and nearly three-quarters of HMGs serving adults only reported having unfilled positions during at least a portion of 2020. An earlier (2018) report by the placement firm Merritt Hawkins & Associates indicated that the firm had seen a 25% percent increase in the number of client searches to fill hospitalist jobs over the previous year.

Decline in hospitalist turnover

In years past, one of the biggest drivers of hospitalist searches was extremely high rates of turnover among hospitalists. The reasons for the historically high turnover rates are not hard to find. A hospitalist’s job is demanding and stressful, and some hospitals have not been sufficiently sensitive to work-life balance, while failing to provide new hospitalists with mentoring or opportunities for professional growth. The result has been, all too frequently, physician burnout and job dissatisfaction.

However, hospitalist turnover rates have declined by as much as half for some type of practices in recent years. The declining trend is a good indication of the progress that hospitalists are making towards getting the work-life balance issue right and addressing other quality of life and professional issues that drove hospitalists to leave their jobs.

Increasing hospitalist compensation

Nor does the issue appear to be solely one of compensation. The market has responded to the shortage of hospitalists in the form of increasing competition. SHM’s 2020 State of Hospital Medicine Report showed that average hospitalist compensation increased from $215,000 per year in 2010 to nearly $308,000 in 2020.

However, in addition to increasing the financial attractiveness to physicians of hospitalist employment, the rising rates of competition have given hospitalists an incentive to employ their hospitalists as efficiently as possible and maximize their returns, as well as take a new look at alternative ways of providing hospitalist services, such as telehospitalists.

COVID-19

Hospitalists have been on the front line in the response to the COVID-19 pandemic. A huge surge in volume of hospitalizations, with the majority of patients being managed on the medical floors, has stretched hospital medical teams thin. Hospitals have been looking for ways they can continue to provide the highest quality care, while keeping their care teams as safe as possible. Telehospitalist services are a key strategy for achieving these goals, e.g. by remotely

• Evaluating and admitting COVID-19 patients from the ED
• Covering COVID-19 patients on floors and ICUs
• Providing oversight to rapid response teams
• Rounding from home by quarantined hospitalists

Fortunately, while increasing the need for telehospitalists, the COVID pandemic has led government agencies to relax many of the regulations that have complicated the process of setting up a telehospitalist practice, such as reimbursement limitations and rules that affect the ability of telehospitalists to practice across state lines. While the relaxation of many of these regulations in principle is only temporary, it is expected that it will become permanent after the pandemic ends.

Growth in number of telehospitalists

Telehospitalists still fill only about 4% of the estimated 60,000 hospitalist physician positions in in the U.S. This leaves a lot of room for growth as hospitals and physicians realize the advantages of the telehospitalist model.

Growing opportunities for telehospitalists in post-acute care

The opportunities for telehospitalists are not limited to hospitals. As the ability to manage patients remotely advances, and existing inpatient beds are occupied by sicker patients, telehospitalists are starting to manage the treatment of patients in skilled nursing facilities, long-term acute care settings, and ultimately at home. This trend is expected to continue, as robust health services networks develop that make it possible for hospitalists to manage patients outside the hospital with accountability.

Delivery systems will need to create robust networks of home health and home services to actively manage patients with accountability. This provides an opportunity for hospitalists to manage acutely ill patients in less intense settings of care, and the emergence of telehealth will help facilitate this.

New business models

As the demand for telehospitalist services has increased, new business models have emerged, including the following:

• A large hospital-based hospitalist program that provides telehospitalist services to other hospitals within an existing health care network (such as Kaiser Permanente, Intermountain Healthcare, government hospitals)
• A large hospital-based program that provides telehospitalist services to a smaller, unaffiliated hospitals such as critical access hospitals that employ nurse practitioners or physician assistants on site but cannot recruit or retain their own full-time hospitalist coverage. The critical access hospitals pay a fee for the service and retain the billings to third party payers.
• Third-party (typically commercial) services that organize, provide and/or support telehospitalist services, including
• Locum tenens-like telehospitalist services contracted for short periods of time when coverage is needed for vacations or staff shortages.
• Nocturnist services to cover overnight hospitalist shifts while preventing onsite physician burnout Night-shift/on-call support for current onsite hospitalists to ensure 24/7 access for patients while preventing onsite physician burnout
• 24/7 services to help hospitals and health systems achieve more efficient physician scheduling at significant cost savings. 24/7, “on-demand” access to hospitalist care for facilities with no onsite hospitalist physicians

New telehospitalist specialty?

Hospitalists are typically internal medicine or family practice trained physicians. In a Feb. 6, 2018 article in JAMA (“Is it Time for a New Medical Specialty?”), Drs. Michael Nochomovitz and Rahul Sharma argued that rapid advances in technology and the practice of telemedicine mean that a new physician specialty, the “virtualist”, should emerge. Other observers disagree, on the grounds that the growth of telemedicine means every care provider will need the skills and ability to provide healthcare services through online care delivery channels. Thus, the emphasis should be on providing hospitalists with training in the needed online skills rather than establishing a new medical specialty board.

Tags: Telehospitalist ,Services ,Hospital ,Impact ,Recruiting