With the news that UnitedHealth Group is ending its telehealth offerings, Amwell and Teladoc have seen their stocks plummet more than 50% in the past year, Walmart is shuttering all 51 health centers and its virtual care services and Optum is shutting down its virtual care unit after a three-year run, it’s easy for the headlines to be reduced to: telehealth is dead.
But, like so many topics today, the reality is so much more nuanced – and it’s up to the people on the ground to lift the curtain that bifurcates everything into an ‘all or nothing’ narrative.
First, it’s important to paint a clear picture of healthcare in the U.S. For those living in or near a big city, it can be hard to imagine a lack of access to quality healthcare. But the reality is that more than 66 million Americans live in rural areas, and 30 million live in “healthcare deserts” where they lack access to services needed to maintain or improve their health.
People in these areas are generally older in age and more likely to be in poorer health compared with people living in more urban areas. As a result of their lack of access, they often have to travel greater distances to receive care when a facility closes.
Today we face a risk of increasing that number of people unable to access consistent and quality healthcare in America. In fact, nearly 200 rural hospitals in the U.S. have shut down since 2005. The 1,800 rural hospitals still open regularly receive critical care patients, but often can only offer inconsistent after-hour or weekend care, forcing patients to transfer to health facilities more than an hour away. This is highly disruptive to the continuity of care and comfort for the patients and their families and also means a financial loss for the hospital.
While we are seeing the complexity of America’s healthcare system play out in headlines about the future of direct-to-consumer (i.e., outpatient) virtual care, the ability to provide telemedicine to acute patients in rural hospitals around the country is not only impacting the quality of care those patients receive, but it is having a significant impact on those hospitals’ bottom lines – in some cases, keeping them in business.
We need to stop conflating telemedicine and ambulatory care
With the headlines focused on the future of direct-to-consumer (DTC) telehealth, there is a lack of discussion about how the virtual care market is evolving away from commoditized models to meet far more pressing challenges, such as enhancing and expanding specialty care services, solving the physician shortage and keeping rural hospitals’ doors open.
Just a few years ago, Piggott Health System, a rural hospital in Northeast Arkansas, recorded an annual census of approximately 3,500 patient visits to its emergency room, with few options to increase those numbers. Facing a shortage of specialty providers, they simply could not provide the critical care necessary for many of the patients that were showing up in their ER. This is not a problem unique to Piggott; only 10% of America’s doctors practice in rural communities, many of whom are primary care and family physicians. As a result, Piggott often found themselves transferring patients to hospitals far from their homes and families, disrupting the continuity of care and comfort levels and driving financial losses for the hospital.
So instead of accepting the status quo – and the inability to bring/attract specialty providers to rural Arkansas – Piggott brought the patients to them, via telemedicine. By providing teleCardiology, telePulmonology, teleInfectious Disease and most recently, teleNeurology
through telemedicine, the health system nearly doubled its annual census of patients to 7,000, an increase that is in contrast with the aforementioned nationwide trend.
Virtual care that improves patient outcomes and access to care is here to stay
The results telemedicine has delivered for Piggott confirm its force. Since deploying the program, the facility has increased clinical capacity and expanded services, reducing costly transfers and caring for more patients locally. The results have been overwhelmingly positive for the small-town community, which relies on the critical access hospital to provide high-quality, local specialty care without transferring patients hundreds of miles away to more extensive facilities in Little Rock or Memphis.
For rural hospitals across the U.S. without the staff needed to provide care for the critical patients who come to their ER, the job of on-site teams often becomes one of quickly identifying which patients cannot be treated and therefore need to be transferred to another hospital. No matter how busy they are, they have to – almost instantly – assess a patient’s acuity in order to make an assessment of each patient's health. If a transfer is needed, a patient might be one or more hours away from receiving the critical care they need by a dedicated critical care staff. (Studies have shown a higher mortality rate and longer hospital length-of-stays for patients who had to be transferred between hospitals.)
We know – and have numerous case studies around the country that show – telemedicine broadens patients' access to high-quality acute care, improves outcomes and delivers a wider range of services that would otherwise be inaccessible in their rural communities. And, it does so within financially sustainable models of care that work for rural health systems and their patients.
The best results occur when a system aligns telemedicine to existing healthcare strategies, and administrators and providers move beyond their comfort zones. The reality is, an acute telemedicine program can effectively span a system’s entire care ecosystem. When all the right pieces are in place, a strong telemedicine program benefits the organization’s bottom line, improves outcomes for patients and creates a much-needed legacy of high-quality care inside their communities.