How One FQHC is Using Telehealth, RPM to Alleviate Staffing Challenges

February 02, 2023 - The COVID-19 pandemic spurred numerous crises within the healthcare industry, including severe staffing shortages. Some organizations with limited resources, like federally qualified health centers (FQHCs), turned to telehealth and other virtual care modalities to mitigate the adverse effects of staff shortages and expand access to necessary care.

Healthcare organizations began sounding the alarm about staff shortages in 2020. A May 2022 report from the Department of Health and Human Services shows just how significantly the COVID-19 pandemic intensified healthcare workforce challenges. Between March and April 2020, the healthcare industry lost 1.5 million workers.

Though healthcare jobs have rebounded since then, provider organizations are still concerned about having adequate staffing. According to a Sept. 21, 2021, MGMA Stat poll, 73 percent of medical practices reported staffing as the biggest pandemic challenge heading into 2022.

Among the facilities hit hardest by healthcare staffing challenges are FQHCs. A February 2022 survey of 263 FQHCs shows that 70 percent reported losing 5 to 25 percent of their workforce in the last six months. The survey, conducted by the National Association of Community Health Centers (NACHC), also shows that 15 percent of FQHCs reported losing between 25 and 50 percent of their workforce.

Rainelle Medical Center, an FQHC in Rainelle, West Virginia, is among the health centers facing this intractable issue.

"We are definitely challenged with most medical staff," said Sabrina Ford, director of nursing at Rainelle Medical Center, in a phone interview. "From the physicians to our mid-level practitioner to our nursing department — at all levels of staff, we've had some difficulty, and it seems to be worse after the pandemic…. I mean, I've had nursing positions open for over a year. And we're constantly trying to recruit and staff. Currently, [we] have two nursing positions open and have not had any applicants."

According to the NACHC survey, health centers ranked nurses as the top category where they saw workforce loss. The survey respondents also noted that pandemic-related stressors were a common reason for staff leaving jobs.

For Rainelle Medical Center, these pandemic-related stressors include staff getting infected with the novel coronavirus.

"Just even our staff getting Covid has definitely made it difficult because they're typically out sometimes a week," Ford said.  

The existing job vacancies, compounded by staff taking leave to recover from COVID-19, resulted in the rest of Rainelle's healthcare workers working extra hours to provide coverage.  

The FQHC implemented a telehealth solution in 2020 to help alleviate staff burnout and extend the existing workforce's ability to provide care.

The telehealth solution has helped mitigate staffing challenges in various ways, including by allowing providers to conduct clinical visits virtually from their homes. This has given them the flexibility to attend to personal and family needs, like a sick child, alongside their patients, resulting in fewer canceled appointments, Ford noted.

The addition of telehealth services was made possible by telehealth policy flexibilities enacted during the pandemic that, for the first time, allowed FQHCs and rural health centers to bill for virtual visits.

The organization largely uses telehealth to conduct chronic care visits to remain connected with patients between in-person visits. The patient population is comprised of rural underserved communities where rates of chronic care conditions like diabetes and hypertension are high. The population also includes a large number of Medicare beneficiaries.

"Most of them were very fearful during the height of the pandemic to even come into the office, afraid of contracting the illness…. We were trying to fill medications, but then realized we still needed to have some way to touch base with these patients to make sure that there weren't other things going on," Ford said.

So, in addition to its telehealth solution, the organization also implemented a platform developed by TimeDoc Health for chronic care management. Deployed last December, the platform enables Rainelle Medical Center clinicians to conduct remote patient monitoring (RPM) for various chronic care needs, including hypertension.

The platform enables clinicians to not only gather blood pressure (BP) data between clinic visits and keep an eye on uncontrolled BP but also to make adjustments to medications without waiting for patients to come in for their three- or six-month follow-up visits, according to Ford.

In addition, the platform helps extend the center's workforce.

"Our chronic care management nurses are able to manage a pretty high-volume number of patients — more than what they would've on a daily basis here," Ford said. "They're able to pull up those reports and get those out to providers and then send messages and say, 'Hey, we've got a patient that's running high levels, or blood pressure's been dropping, and [they] may need some adjustment to therapy.'"

Nursing staff from TimeDoc help supplement the team at Rainelle Medical Center. Through the chronic care program, these nurses can help connect patients to resources in their community, such as food banks. The added nursing staff has been a boon for the FQHC, allowing them to care for more patients.

"It's definitely, to me, an added value being able to have additional nursing staff through this platform," Ford said.

But with any new technology implementation, providers at the organization must buy in and fully integrate the technology into their workflow.

At Rainelle, this has been a relatively smooth process as the clinical staff has been receptive to the virtual care deployments. This is primarily because the RPM data has provided a wealth of insights for clinicians.

"There're times [patients] come in the office, and we see elevated blood pressures, but now with remote patient monitoring, we're seeing their blood pressures are kind of normal, so maybe it's just coming into the office that is stressful for them," Ford noted.

With its virtual care resources in place, Ford believes Rainelle has been able to manage care more effectively amid challenging staff shortages, ultimately enabling the organization to expand care access while breaking down patient-facing barriers.  

"I'm very interested to see where these types of technologies can go in the future for healthcare because I do think that we do need to embrace the technology that's out there," Ford said. "It's currently snowing here, and to think that we would ask an 80-year-old patient to get out in a wheelchair or a walker to come to the office to follow up on blood pressure [readings] or something like that — [with this technology] we might save somebody from breaking a hip today."