Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 Q: What about telehealth? How are you expanding technology within rural areas and areas with less access? RB: We utilize telehealth right now. We have a certified telehealth stroke program through The Joint Commission. We only have one neurologist that will see patients in our hospital. But if a patient comes to the ED, they can connect in with eight other neurologists that we have a relationship with that can give advice to the ED physician. We think there's still more possibilities to expand telehealth in Virginia, especially with behavioral health. We need to figure out how to get more access to more people. PB: CHI nationally is developing a telehealth platform for us. We are still in the infancy stage of that. [In December], we launched a telehealth initiative with the University of Arkansas for Medical Sciences. Because UAMS is government funded, we assigned a team on how we can blend our two platforms together. We want to see how we can better reach out to [those in rural areas], initially in cardiology and neuroscience. Arkansas still has a lot of hospitals that are independent and unaffiliated, so it is a little bit of a longer process for us to deal with. CB: We have a pretty strong and growing telemedicine practice. It started with our stroke telemedicine program that's now accredited by The Joint Commission, but the most innovative thing is our eICU program, through which we can monitor intensive care unit beds remotely. We can have one physician monitoring 80 beds, for instance. If there's an event, an alert may fire off. A nurse can also go in virtually, look at the monitor, medications and the chart in Epic and decide if any action needs to take place. The physician who is in the "bunker" with her can place orders and give instructions to nurses who are actually in the room. This will allow us to reach out to smaller rural hospitals that don't have the ability to keep intensivists on staff. DK: This is an interesting area. I received an informatics scholarship studying telehealth. For our country, there's still a huge untapped potential for telehealth. Having said that, I'd break it down into a couple areas. There are three main areas for telehealth. One is provider-to-provider telehealth. For PTP, I'm a provider maybe in a rural area, maybe not, but I need help managing a patient. I want to reach out to another provider for their help in managing this patient. Two-way video is a common image that comes to mind. I actually think that's a relatively inefficient way for telehealth. The value of video for telehealth is just not always needed. I see the value in always seeing the patient. A second area is home health or a nursing home. Maybe a patient connects with a provider and has a real-time cardiac monitor or digital scale. That's a big area of growth. But my view is we haven't reaching a tipping point 15 in telehealth in the U.S. yet. There are regulatory and financial barriers. For regulatory, at least in 2012, in most states, your license to practice is geographically constrained. If I lived in Cincinnati, and people who live in Kentucky telehealth me from Kentucky, technically I can't help them. Some states are working on that now, though. Financially, from my view — I'm not an expert — most payors will not pay for anything except for a faceto-face visit. I would argue the last type of telehealth is if I get a call or email about a medical problem, and I give you medical advice I'm liable for. In most medical settings, I can't charge for that. But in the grand scheme of things, if I can't be reimbursed for that, I'm limited in what I can do. Q: Do you see population health management as the key driver behind health IT projects right now? PB: We'll have a deeper data set [through our universal EHR], and we can link that across the continuum so you can move to population health. That's the next step for us. Building deep data in each clinical setting that will help us connect to population health. CB: As healthcare morphs and changes over time with healthcare reform, we are going to be incentivized to manage the population and not admissions and visits. It's more beneficial for us, over time, to keep people from coming in. If we're capitated to cover that patient, it costs us every time they come in. It's also better for the community to keep everyone well. We need to use our tools to interact with patients — how can we prevent events from occurring? We're also going to be penalized for readmissions in the future. The areas we are focused on through technology are diabetes, smoking cessation, behavior changes and congestive heart failure. We need to start interacting with patients differently. DK: Population health management is an important driver of some health IT projects. It follows the paradigm like when you asked about big data. My view is as a society, the healthcare system is still trying to wrestle with how much of our resources should be spent on population-level management versus how much should be based on a face-to-face level. You can see how this dovetails with healthcare reform. As of now, there are not a huge number of financial incentives for health systems to manage populations, but that will be changing. At least at [MetroHealth], it's raised to a higher level, and that will trickle down. Health IT tools will help with this. DS: We've had a focus in the past year around the care continuum, especially certain populations. Like other hospitals and organizations in the industry, we are trying to figure out how we can gain traction in that front. We are targeting specific populations and are looking to mature that. n REGISTER TODAY! Becker's Hospital Review Annual Meeting CEO Strategy, ACOs, PhysicianHospital Integration, Improving Profits and Key Specialties 83 Health System Executives as Speakers Co-Chaired by Chuck Lauer and Scott Becker May 9-11, 2013; Chicago Westin Michigan Avenue, Chicago For more information and to register, visit: www.beckershospitalreview.com/4th-annual-beckers-hospital-review-meeting.html

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