Telehospital Medicine Obstacles and Pitfalls (Part 1)

Written by Sarah Suleman and Andrew McWilliams

You’ve analyzed the clinical and financial dimensions and decided that telehospitalist services are the right solution for your hospitalist needs. You’ve taken the first steps, e.g., evaluating different technology platforms, analyzing the impact on workflows, organizing staff training. You may even have had conversations with one or more potential contractors. Everything may seem like it’s on track to implementation of a telehospitalist program at your hospital—or is it?

This blog post is the first of two posts that discuss some of the unintended obstacles and pitfalls that can prevent your hospital from reaping the full benefits of its telehospitalist program, and steps you can take to avoid them. In this post, we cover concrete issues such as reimbursement, licensure and credentialing, and electronic health recovers. In a followup post, we will address less-tangible issues such as interpersonal issues (the “human touch) and common misperceptions about telehospital medicine

Reimbursement

Before it changed the rules temporarily in response to the COVID-19 pandemic, Medicare did not reimburse professional fees for telehospitalist visits, and most other payers followed Medicare’s example. Under the Public Health and Medical Emergency Declarations and Waivers for the pandemic, Medicare has started reimbursing hospital televisits that involve real-time audio and video telecommunications between clinician and patient at the same rate as in-person interactions.

The problem is, nobody knows for sure whether or for how long these liberalized reimbursement policies will remain in effect. At some point, the pandemic will end or at any rate become a less serious public health threat, while Medicare telehealth reimbursement policies have been in a state of flux for some time.

These is some cause for optimism regarding the continuation of Medicare telehospitalist reimbursements. For one thing, Medicare already pays for other virtual specialty services such as telestroke. In addition, many states have enacted telemedicine parity laws, which require private payers to pay for all health care services equally, regardless of modality (audio, video, or in person).

However, the uncertainty makes it difficult to model the direct financial impact of telehospitalist services in terms of potential professional fees generated. To avoid any unpleasant surprises down the line, your financial expectations concerning the potential benefits should explicitly recognize their sensitivity to the policy environment. Ideally, the telehospitalist program should generate enough financial benefits (e.g., increased inpatient census, various operating efficiencies) to justify its existence, whatever reimbursement policies are in effect.

Licensing

Virtually all states require physicians providing telehospitalist services to be licensed in the state of the patient receiving care. Of course, licensing and credentialing are intended to safeguard patients by ensuring that telehospitalists are in compliance with state regulations and hospital policies. However, licensing and credentialing are time-consuming administrative processes that can become a burden to smaller hospitals that contract with telehospitalists based in another state.

Some states and associations are working to streamline the license application process and increase the portability of medical licenses, through initiatives such as the Interstate Medical Licensure Compact. Some states have also developed out-of-state telehealth licenses in order to facilitate the licensing process.

Hospitals that are in the process of implementing telehospitalist programs need to make plans for meeting interstate licensing and credentialing requirements, unless they plan to use only in-state hospitalists. If they plan to contract with an outside company to provide them with telehospitalist services, then it becomes the contractor’s responsibility to deal with licensure issues.

Rural hospitals seeking to simplify the telehospitalist credentialing process should investigate the “credentialing by proxy” method approved by the Centers for Medicare and Medicaid Services and The Joint Commission. Credentialing by proxy allows community and Critical Access Hospitals to rely on the credentialing process of distant telehealth sites.

Electronic Health Records

Over 95% of U.S. hospitals use a certified EHR platform to provide better continuity of care, simplify data collection, decrease overhead costs, and reduce mortality rates for the chronically ill. A telehospitalist requires remote access to the hospital’s electronic health EHR system for data review, documentation, and placing orders if needed.

However, there are over 500 different EHR systems in use at various locations. Telehospitalists, who may provide coverage at multiple hospitals, must have a deep understanding of the EHR system used by each hospital, and be able to shift among these systems at a moment’s notice.

Hospitals can assist telehospitalists by providing tools, guidance and summaries of the requirements of the particular EHR system in use there. Telehospitalist contractors may make similar resources available to physicians operatin under their umbrella.

Continue Reading Part 2

Tags: Telehospitalist ,Services ,Hospital ,Impact ,Recruiting

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