- An effective telemedicine platform will not only improve outcomes and reduce wasteful spending, but give smaller, rural hospitals the expertise to treat more of their patients and reduce stressful transfers to larger hospitals.
That, in essence, is what Intermountain Healthcare’s neonatal telehealth program is doing. And one of its program leaders says the connected care platform is helping not only the health system’s youngest patients, but also those caring for them.
“We’re raising the level at all of the hospitals,” says Stephen Minton, MD, the medical director of neonatology at Intermountain's Utah Valley Hospital in Provo. “And that level of care … is significantly better than it was before.”
The Salt Lake City-based health system launched its neonatal telehealth program in 2012-13, and now has four hub hospitals in a hub-and-spoke telemedicine network connecting with 19 hospitals throughout the Rocky Mountain region. The program is designed to make Intermountain’s neonatal care experts available through a virtual care network to rural hospitals when a newborn presents with breathing issues – which happens in one of every 10 cases, while one in every 100 requires life-saving resuscitation.
Intermountain’s program was detailed in a study published in the December issue of Health Affairs. Authored by Minton and colleagues Jordan Albritton, Lory Maddox, Joseph Dalto and Erick Ridout, it analyzed NICU cases during 2015 and found that the telehealth program reduced the chances of a newborn needing to be transferred by almost 30 percent. That amounted to roughly 67 fewer transfers in a year, and a savings of $1,220,352 for the health system.
“Transfer avoidance benefits local hospitals, payers, and patients,” the study points out. “By helping keep patients in community hospital beds, telehealth supports the financial viability of rural and suburban hospitals. Because families typically share in health care costs, avoiding a transfer would likely result in direct savings for the parents of a newborn.”
Minton says the benefits go much further.
The platform not only gives staff at these rural hospitals access to specialists, he says; it enables Intermountain to better train that staff to treat the patients they’re seeing.
Nurses in an NICU environment need to be well-versed in some 30 knowledge areas, but those in smaller facilities don’t see many NICU cases, nor do they get the time or opportunity to train. With a virtual care platform, that training is available.
“We become their mentors and their partners,” says Minton. As proof, he notes that nurses tested on their acuity score around 12 percent prior to joining the telehealth program, and score around 88 percent after they’ve become part of that program.
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“Proponents of newborn telehealth also argue that access to specialist support improves the quality of resuscitation and creates just-in-time educational opportunities that generate a halo effect that improves overall care quality,” the study notes. “With a focus on early identification and resuscitation of a neonate, clinicians’ knowledge is advanced beyond the immediate resuscitation. Knowledgeable, skilled clinicians help avoid potential complications, thereby reducing downstream health care costs.”
There’s another benefit as well. Better training and access to specialists helps to reduce stress on NICU staff. Minton notes that the department – one of the most challenging in the health system – can see PTSD rates in staff as high as 30 percent.
An effective telemedicine platform, as noted, also reduces the need for transfers, which can be stressful for all involved.
“Avoiding transfers eliminates potential risks from handoff communication errors and the hostile, high-altitude environments encountered in Utah,” the study notes. “Newborn transfers also remove families from their local communities, increasing travel and lodging costs, limiting family bonding and social support, and potentially reducing wages because of time off work.”
Minton says the transfer, in many cases, is a symptom of the old way of doing things.
“We’re not patient-centered very well,” he says. “What happens is the same mistakes are made over and over again, and we come in on our white horse and ride to the rescue. … We need to get away from the idea of centralized care and create a better network.”
While the Intermountain program has proven its value, Minton and his colleagues stress that there are challenges to keeping this program sustainable – challenges that affect pretty much every hospital and health system in the country, and which threaten telehealth adoption.
“Despite decreased transfer costs, increased access to neonatal specialists, and improved newborn care in community hospitals, payment policies and reimbursement models often prevent providers from receiving payment for telehealth services,” the study notes. “As a result, community hospitals, physicians, and families experience economic benefits of keeping stable neonates in their community hospitals when indicated, while large integrated health care systems such as Intermountain Healthcare are left to cover costs associated with telehealth services with reduced NICUs.”
“Organizations that invest in health care are essentially punished for doing what is right, which limits the widespread adoption of telehealth services,” the report continues. “These competing incentives create obstacles that at best distract providers from focusing on the fundamentals of medicine and at worst jeopardize adherence to part of the Hippocratic oath: ‘First, do no harm.’ In contrast, studies have shown that policies that require insurers to pay for telehealth are associated with increased adoption of telehealth services.”
Reimbursement issues aside, Minton has high hopes for the program. He wants to expand the telehealth platform to better integrate parents at the point of care, first by bringing them into the NICU and then by transitioning that care platform back to the home.
“We don’t just admit babies – we admit families,” he says.