Should your hospital/health system implement its own telehospitalist program or go to an outside contractor?
Written by Sarah Suleman and Andrew McWilliams
Once your hospital or hospital system has made the decision to adopt the telehospitalist model, it needs to decide next whether to provide the telehospitalist service using its own in-house staff and resources, or to bring in an outside contractor. This post describes the major pros and cons of each approach, as well as some contracting best practices to be aware of should you decide to go the outside contractor route.
First, some definitions. An in-house telehospitalist service is staffed by hospital employees, integrated with hospital IT systems and managed by hospital administrators who are responsible for resolving any technical, quality control or provider related issues that arise. An outside contractor is a company that works in partnership with the hospital to ascertain its needs and provides the services of telehospitalists as part of a customized, cost effective solution. Provider, technical and quality assurance issue are the the responsibility of the outside vendor.
Pros and Cons of Outsourcing telehospitalist Services
There is no one-size-fits-all approach to providing telehospitalist services. Each hospital will have to weigh the pros vs. the cons of the in-house vs. outside contractor approach in deciding which one to take. The pros and cons fall under a number of headings, as described below.
Access To A Larger Talent Pool
When hiring a telehospitalist directly, you may only have access to a small local talent pool, particularly if your hospital is located away from a major urban center. This may mean you have to compromise on qualifications. If you have specific requirements or if you need specialized help, outsourcing gives you access to talent in other regions, even other parts of the world.
Lower Personnel Costs
Outsourcing can reduce the expenses associated with bringing on new employees, e.g.:
- Search and recruiting
- Healthcare and other benefits
- Payroll taxes
- Increased need for workers in management and HR positions
Rural hospitals in particular may have an unpredictable daily patient census. Outsourcing permits hospitals that have cyclical or fluctuating requirements for telehospitalists to bring in additional resources when they are needed.
Hospitals that choose to outsource inevitably give up some degree of control over their telehospitalists. There are various reasons for this diminished control, including the fact that the outsourced telehospitalist is a contractor rather than an employee of the hospital, and moreover is probably working from a remote location.
A well-written contract will provide the telehospitalist services provider with specific guidance regarding the goals want the program to accomplish. The telehospitalists contracted for should come with a project manager who knows the team well enough to manage it effectively.
Communications are not always an issue, but can be a significant drawback of the outsourcing model. Issues to delve into include:
- Does the contractor have access to a reliable internet connection?
- What time zone does the telehospitalist live in and how does this fit with your business hours?
- What is their preferred method of communication? Phone, email, text messaging?
Despite all the benefits of outsourcing, it is only a good thing if your hospital is receiving the quality you need and expect. Anything less, and the arrangement will be a disappointment.
This doesn’t mean you cannot successfully outsource telehospitalist services, but you need to discuss your quality expectations with the contractor in advance and make sure they are reflected in the contract.
While outsourced telehospitalist services can bring important benefits, you should take steps to ensure that they do not have a negative effect on the hospital’s culture. A positive work culture contributes to a high level of productivity and positive health outcomes, so you want to avoid taking any steps that could run counter to the culture.
Start by finding a vendor that is a good fit for your hospital’s culture, i.e., the way ins stakeholders interact to provide patients with the best-quality care possible. Next, discuss your outsourcing decision in advance with staff who could be impacted, particularly nurses. Hospital administrators should participate in training alongside staff, in order to anticipate any problems before they arise and assure staff of their commitment to the program’s success.
In theory, outsourcing should give your hospital access to a state-of-the-art technology platform, without having to develop its own technology from scratch or else rely on legacy systems.
Over-Dependence on the Supplier
If the contractor’s telehospitalist service deteriorates, or if the price gores up, you may be tempted to take the telehospitalist activity back in-house. The downside of doing so is that it can take time to reach the level of performance you used to enjoy, particularly if the contractor has been providing these services for a relatively long time.
Best Practices for Outsourcing
Finding the right vendor for outsourcing telehospitalist services is easier said than done. The following are some best practices that, if followed, can help to make the contractor relationship a productive and successful one.
- Have clear goals and objectives for your relationship with the contractors.
- Don’t necessarily go with the cheapest vendor. Select the vendor with a reputation for quality that best matches your needs and organizational culture. A solid choice will offer a balance of value and quality.
- Perform your due diligence and check vendor references and search online for complaints, etc. Ask for additional references from trusted colleagues.
- Insist on robust project management, a clear plan and regular updates.
- Own the project by staying involved. You don’t need to micro-manage the telehospitalists, but make sure the project remains aligned with your timeline and goals.
- Require the vendor to have a plan in place to respond to outages and emergencies quickly.
- Get key decision makers within your organization involved and onboard early. Make sure you have buy-in and support on the decision to outsource telehospitalist services.
- Determine management and organizational changes that might be necessary to support outsourcing relationships. The hospital may need to assign new management roles or restructure teams to enable oversight of the partnership.