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[Webinar] Teleneurology: Why it Works for Rural Hospitals
- 2. Duane Miller, MBA, FACHE Mr. Miller is Vice President & CFO of INTEGRIS Bass Baptist Health Center in Enid, OK. INTEGRIS Bass includes 207 licensed beds throughout three facilities. The hospital enjoys the distinction of being the only nonprofit, faith-based Enid hospital, and has served the Enid area longer than any other general hospital. Talbot “Mac” McCormick, MD Dr. Mac is a board-certified internist. He began as a hospitalist in 2003, and has since served in various physician leadership roles. He practiced internal medicine for 20 years, and received his Medical Doctorate from Emory University. I N T R O D U C T I O N S
- 3. As defined by the American Telemedicine Association T E L E M E D I C I N E B A S I C S • Telemedicine allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. • Telemedicine includes a growing variety of two-way remote presence devices that enable physicians to perform real-time consultations with patients.
- 4. T E L E M E D I C I N E B E N E F I T S Provision of care to patients in their home communities. Around-the-clock access to specialty care. Reduced unnecessary out-transfer of patients. Increased admissions, patient volume and revenue. Hands-on access to education and training for NPPs and other staff.
- 5. T H E P H Y S I C I A N ’ S P E R S P E C T I V E : D R . M C C O R M I C K “Telemedicine is most effective when applied where physician resources are scarce and patient care is time sensitive. And it is providing hope to rural hospitals in an era when closure is a very real possibility unless new models of care are deployed.” —Dr. McCormick
- 6. A C C E P T A N C E O F T E L E M E D I C I N E I S G R O W I N G Patients All ages receptive to it, not just younger patients. They appreciate having access to physicians when they need it most. Administrators Appreciate the cost savings, census increases, and viable answer to physician shortage. Physicians Appreciate the work-life balance, 24/7 coverage, quick availability of specialists. NPs & PAs Benefit from having physiciansupport and expertise.
- 7. H O W T E L E M E D I C I N E W O R K S • A cart or robot on wheels with a two-way videoconferencing monitor brings a patient face-to-face with the physician, who is “beamed in” from a distant hospital or other remote location. • The technologycan transmit still images, such as photos and X-rays, for interpretationby the physician. • The technologyenables the physicianto monitor the patient remotely. • Eagle typically assigns its telemedicine physicians in “pods” of 4-6 assigned to a particular specialty or geography. • Our goal is to develop relationships with the onsite staff, and ultimately for staff to consider us their colleagues.
- 8. S P E C I A L I Z A T I O N D E L I V E R S G R E A T E R B E N E F I T S • Teleneurology—Even the most remote hospital becomes a center for quality neurological care. • Collaborative Care—Support NP/PA management by providing access to physicians offsite who can guide and advise staff. • Telenocturnists—An efficient, highly functional alternative to nighttime care in rural hospitals. • Tele-ICU—Offsite ICU physicians provide expert care at ICU bedsides. • Telepsychiatry—Meet the growing demand for behavioral care no matter where you are. • Others—Emergency Medicine, Cardiology, ID, Rheumatology.
- 9. TEL EN EUR O L O G Y: A N ATUR A L EVO L UTI O N F O R TEL EM ED I C I N E Every 40 seconds, someone in the U.S. suffers a stroke. Strokes are the 4th leading cause of death in the U.S. Strokes are the #1 cause of disability in the U.S.
- 10. T I M E I S B R A I N Best-in-class teleneurologist results are impressive: • Average response time of 3.5 minutes. • Average diagnosis and treatment time of 21.8 minutes. • 40% decrease in time from emergency department arrival to admission. • 1 to 1.2-day decrease in hospital Average Length of Stay (ALOS) for stroke patients. • Door-to-drip time < 60 minutes
- 11. T E L E N E U R O L O G Y C A R E A C R O S S T H E S P E C T R U M Teleneurology can cover the entire spectrum of acute neurologic emergencies. • Examples include status epilepticus, coma, and intracranial hemorrhage. • Consultation on all emergency neurological problems, including utilization of tPA. • Additional consultation on ICU patients regarding all aspects of medical management, including reversal of anticoagulants.
- 12. W E L L - Q U A L I F I E D P H Y S I C I A N S Teleneurology physicians are experienced in both acute neurology and telemedicine. • They possess an advanced understanding of working as a part of a cohesive team. • They demonstrate an open and compassionate approach to caring for patients. • Team may include neurologists with additional fellowships in stroke/vascular neurology.
- 13. G E T T I N G S T A R T E D Implementation • Start-up Resources Include: • Site operation setup - Technology integration with hospital - Protocol and process development - Nurse and medical staff in-services • Licensing and credentialing expenses • Clinical leadership consultations
- 14. C A R E I S F I R S T - R A T E A N D I M M E D I A T E “Wherever they are, our physicians can respond within 15 minutes to any patient suffering a stroke or seizure at INTEGRIS Bass, do a diagnosis, prescribe a thrombolytic drug or other medication, and determine the most appropriate level of treatment.” —Herb Rogove, DO, FCCM, FACP, Eagle physician leader for the INTEGRIS Bass program
- 15. I N TEG R I S B A S S C A S E S TUDY: C H A L L EN G ES • Rural hospital in Enid, OK, often transferred patients to Tulsa or Oklahoma City—both 100 miles away—for specialized care. • Looked for a more sophisticated, effective system for treating stroke and other acute neurology patients on-site. • Wanted to ensure any two-way videoconferencing technology was “always on,” readily available when needed, not used as ER coat rack.
- 16. I N T E G R I S B A S S C A S E S T U D Y: E A G L E T E L E N E U R OL OG Y S OL U T I ON • Neurologists are “beamed into” INTEGRIS Bass via two-way videoconferencing. • Keeps patients in their home community. • Facility anticipates $200,000 reduction in locum support costs annually. • Expects additional revenues greater than $55,000 annually by reducing transfers. • Gains more robust optics and instrumentation than previous system.
- 17. I N TEG R I S B A S S C A S E S TUDY: I N TO UC H TEL EN EUR O L O G Y R O B O T • InTouch Health partner provides the remote patient monitoring technology hardware and network. • Remote neurologist can conduct neurological exam, and get a clear picture of patient’s condition. • InTouch system is “always on,” so no time wasted waiting for boot-up.
- 18. S I G N I F I C A N T R ED UC TI O N I N L O C UM S UP P O R T C O S TS “I became an advocate of telemedicine as a result of a reduction of locum support costs for neurology and reduction in patient transfers.” —Duane C. Miller, MBA, FACHE, Vice President and CFO, INTEGRIS Bass
- 19. F UR TH ER D I F F ER EN TI ATES I N TEG R I S B A S S “Patients of all ages like the telemedicine approach, and it further differentiates our facility from others in northwest Oklahoma.” —Duane C. Miller, MBA, FACHE, Vice President and CFO, INTEGRIS Bass
- 20. F I N A N C I A L R O I F O R T H E H O S P I T A L • Typical Stroke DRG: $8,500* • Typical Stroke DRG with tPA administration: $13,000*
- 21. C O M M U N I T Y R O I • Bring best acute stroke care available to community residents • Specialty support for ED, Hospitalist, and Primary Care Providers • 21st century medical care and innovation • Allows most patients and patients’ families to stay in their home community
- 22. T I M E I S B R A I N A recap of the benefits for care of stroke patients: • Average response time of 3.5 minutes. • Average diagnosis and treatment time of 21.8 minutes. • 40% decrease in time from emergency department arrival to admission. • 1 to 1.2-day decrease in hospital Average Length of Stay (ALOS) for stroke patients. • Door-to-drip time < 60 minutes.
- 23. V A L U E • Adele Tickets — $200 • iPhone 6s— $700 • Honda Accord — $31,000 • Walking out of a hospital after a stroke — Priceless