Trends in Telehospital Medicine after the Pandemic

Written by Sarah Suleman and Andrew McWilliams

The pandemic has affected every area of medical practice, including hospital medicine. Now that the pandemic shows signs of ending, we asked ourselves, what impacts on hospital medicine are likely to be permanent?

As this blog post will show, the pandemic has increased the long-term attractiveness and viability of using telehospitalists. Previous posts [cite titles/dates] have described the potential impact of temporarily relaxed rules governing reimbursement for telehospitalist services and licensing of telehospitalists on the future demand for these services, should the waivers be made permanent after the pandemic ends. This post focuses on post-pandemic trends in the structure of U.S. healthcare that could increase the market for telehospitalist services.

Slow financial recovery after pandemic has hospitals looking for cost- saving opportunities

According to the American Hospital Association (AHA), hospital revenues have improved from their historic lows during the height of the pandemic, but still remained well below pre-pandemic levels in early 2021. In January 2021 gross hospital revenues declined by 4.8% from the same time period in 2020. Hospital operating margins decreased nearly 27% between December 2020 and January 2021.

While revenue has decreased, in January 2021 total hospital expenses have increased by 4.5% from the same time last year. Credit rating agencies Fitch and Moody’s both have cautioned that increased costs threaten the financial outlook for the hospital sector and that 2021 will remain a challenging financial environment for hospitals..

One of the major causes behind hospitals’ increased costs has been inflated personnel costs. In January 2021 hospitals experienced a 30% higher labor cost per adjusted discharge than in January 2020. Hospitals across the U.S. have experienced shortages of doctors and nurses needed to treat COVID-19 patients. These shortages have forced hospitals to rely on staffing firms where increased demand for health care personnel has driven a steep rise in prices.

As a result, more and more hospitals are likely to be attracted by telehospitalists’ potential role in cutting overall operating costs. The average telehospitalist’s salary is at least 27% lower than an on-site hospitalist’s (not counting reduced hospitalist recruiting and onboarding costs), generating savings that can be applied to other hospital needs. The use of telehospitalists may also make a positive contribution to the hospital’s top line in the form of increased revenues due to higher ADC. (For further details, see blog post on “The Financial Case for Using Telehospitalists” [date of posting]).

Strains of pandemic lead a growing number of hospitalists to re-evaluate their career paths

Long before the pandemic the crowded work days, frenetic pace, time pressures, and emotional intensity of hospital work placed hospitalists and other clinicians at high risk for burnout. Burnout is a “long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment”, according to the Agency for Healthcare Research and Quality. Burned-out clinicians are more likely to quit their practice, and burnout can negatively affect care quality and patient safety.

COVID-19 has added to many hospitalists’ already high baseline levels of stress, by increasing their workload even further and adding the risks of catching the disease themselves and watching their colleagues get sick and even die from the disease. Like other clinicians, hospitalists want a better quality of work and work-life balance and leave their jobs if they feel unable to cope with the stress, work hours, billing and paperwork.

Hospitals appear to have had some success in stanching the outflow of hospitalists, as the nationwide turnover rates for hospitalists had been trending downward for more than a decade before the pandemic. Now, they face a renewed challenge attracting and retaining hospitalists.

In the post-pandemic era there is likely to be a greater number of clinicians interested in telehospitalist work as a way to lessen the strain of their jobs and restore a better work-life balance. For their part, a growing number of hospitals are likely to view telehospitalist services as their best bet to meet their hospitalist needs.

New care options create opportunities for telehospitalists

The COVID-19 pandemic has accelerated the trend towards treating some non-acute patients outside hospitals. Even before the pandemic, small-scale “hospital at home” programs had demonstrated that hospitals could safely manage many more “inpatients” at home through a combination of home visits by mobile care teams and telehealth providers.

Hospital-at-home programs are common in Canada and the United Kingdom but have never gained traction in the United States due to cultural and reimbursement barriers. However, the pandemic may have irreversibly changed this situation.

While some COVID patients require inpatient care for their infection, most do not and are able to safely care for themselves at home, thereby reducing the risk of infecting others and freeing up overburdened hospital staff and facilities to care for the sickest patients. Throughout 2020, health care teams used virtual care to screen, treat, and follow up with patients in mobile medical trailers, cars, fever clinics, homes, prisons, and skilled nursing facilities (SNFs).

Symbian Health expects this shift in care outside hospitals, emergency departments, and medical pavilions towards SNFs and other community-based care facilities to continue after the pandemic, creating a potential opportunity for telehospitalists to manage such care remotely. Many SNFs, for their part, find themselves in a precarious financial position like that of the hospitals described above.

With a decreasing census even before the pandemic, many nursing homes had little financial cushion to respond to a national emergency. The pandemic required them to divert scarce resources to stop the spread of the coronavirus by purchasing personal protective equipment and COVID tests for residents and staff.

To restore their credibility and increase resident censuses at a time when their financial resources are limited, SNFs need to demonstrate that they can meet residents’ medical needs, while containing. Telehealth technologies, coordinated by a telehospitalist, are an obvious way to achieve these objectives.

Conclusions

The pandemic has thus affected both sides of the supply-demand equation for telehospitalist services. In the future, growing numbers of hospitals and hospitalists are likely to see the telehospitalist model as the ideal solution to the challenges they face.

May 27, 2021

Tags: Telehospitalist ,Services ,Hospital ,Impact ,Recruiting

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