WHEN IT COMES to telenocturnist coverage, one of the country’s largest groups has opted to outsource.
Hospitalist Kimberly Bell, MD, MMM, regional medical director of TeamHealth West Group, says that her program has been covering nights at a hospital in Washington with a telenocturnist on contract from another company for six months.
“That company provides the physicians who do the night work, but those doctors cover multiple sites,” Dr. Bell explains. “They’re not really forthcoming in terms of how many others.”
Being able to rely on a telenocturnist is “100% important,” says Dr. Bell, because it makes more financial sense than hiring a physician to cover nights at a hospital with low volume. (The hospital in question has only about 50 beds.) At the same time, the service line being contracted with has to “actually deliver operationally on what it says it’s going to do.”
“When you bring in an outside telemedicine company, there’s a huge gap in institutional knowledge that they have to grasp pretty quickly.”
~ Kimberly Bell, MD, MMM
TeamHealth
Initially, Dr. Bell admits, there were some hiccups with the arrangement. “Some were related to the telemedicine cart and its communication tools,” she explains, so those needed to be ironed out.
And while telenocturnists in a homegrown program often already know all the consultants, the NPs, and the practice style and culture of their institution or health system, that sense of familiarity isn’t there with an outsourced program.
“When you bring in an outside telemedicine company,” Dr. Bell says, “there’s a huge gap in institutional knowledge that they have to grasp pretty quickly. That makes it a little rocky at the beginning.”
Economies of scale
Despite those challenges, TeamHealth is interested in only turnkey programs to bring in telenocturnists, not developing a telenocturnist program itself.
“You have to have economies of scale,” Dr. Bell points out, “and you need to cover enough practices to make it worthwhile. If you’re hiring one physician for night coverage, you’d need, say, six practices in the same state with high enough volumes to support that hire.”
She definitely believes that remote night coverage is a growing field. “There are not enough providers, either physicians or APCs, to cover nights in all hospitals around the country,” Dr. Bell explains.
She’s also aware that the hospitals that partner with TeamHealth around the country are likewise contracting with telemedicine services in telepsychiatry, telenephrology and teleinfectious disease. The hospital she works with that has the telenocturnist program, for example, also has a contract for tele-ICU.
For the day doctors and APCs who work in that hospital and no longer have to cover nights, having a telenocturnist is a huge satisfier. But that’s only the case, Dr. Bell notes, if the virtual service functions well.
“Doctors don’t want to have to come in and rework what was done overnight,” says Dr. Bell, “or feel like they’re not getting a good handoff.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist
For more information on telehospitalist services, read our additional case studies.
CASE STUDY 1: A hub-and-spoke model
A health system in the Midwest relies on telehospitalists at its main campus to provide a suite of coverage services to five rural facilities. Read more here.
CASE STUDY 2: Growing interest in surge capacity
A national telemedicine company deploys telehospitalists in rural hospitals and in larger ones to manage surging census. Read more here.
CASE STUDY 3: Rural admissions and post-discharge visits
Telehospitalists in a Georgia health system cover not only critical access hospitals but post-discharge follow-up with patients at high readmission risk. Read more here.
Telehospitalist challenges to expect
Challenges include having to navigate different formularies and figuring out how to spark hospitalist interest in telemedicine. Read more here.
Combining telemedicine with in-person care
A hospitalist enjoys making virtual patient connections while maintaining skills treating higher-acuity patients inhouse. Read more here.
Phyllis Maguire is Executive Editor of Today’s Hospitalist
