Telemedicine in small-town America

Oct. 22, 2014

It may be hard to imagine, but there are hundreds of counties in the United States that are designated not just as rural but as frontier (defined as having fewer than six people per square mile). One of those is the county we serve: Hamilton County, KS. It’s a 55-mile drive from here to the nearest Walmart store. Our hospital is one of more than 1,300 critical access hospitals across America, and many of these facilities are being revitalized by telemedicine.

Like many small hospitals, our service lines had been eroding because we couldn’t make them work financially. When I became CEO here, many patients had to travel between four and five hours each way to either Wichita or Denver to see specialists. For elderly patients, that usually meant a one-night stay in those cities, adding to the cost and inconvenience.

That’s all changed, thanks to telemedicine. Our hospital now has a robot that allows neurologists and other specialists to provide consultations from our tertiary care partners: Swedish Medical Center in Englewood, CO, and Wesley Medical Center in Wichita. With telemedicine, residents in our small community can get the same high-caliber care they’d receive in large metropolitan hospitals. (Ironically, there are more employees at Swedish than there are residents of the town we’re in.)

Our robot may not resemble Data on “Star Trek,” but it’s still an amazing device. It can run an EKG or sonogram for the remote physician in real time, and it can even glide down the hall to a patient’s room on its own. And unlike most sci-fi robots, it can cost-justify itself.

For decades, the mantra at most rural hospitals has been “stabilize and ship.” But that meant, for example, that stroke patients often didn’t get timely treatment. Conversely, many patients got needlessly transported to city hospitals when care could have been provided locally.

Telemedicine has totally changed the economics of care. If our hospital has just one patient per month stay in our facility instead of being shipped out, we’ve more than paid for our robot lease that month.

After launching successful telestroke and teleICU programs, we’ve begun offering remote primary care, pediatric and dermatology consultations. For parents, that means that kids can get same-day treatment instead of having to drive 10 hours roundtrip.

Since acquiring our telemedicine robot, Hamilton County’s clinic volumes have increased a consistent 30 percent over the previous year – and our Medicare outpatient reimbursement has increased by 16 percent based on our last cost report. As more patients get treated locally, our ancillary business has also increased (especially in labs and imaging services).

Financing for telemedicine is very straightforward for a critical access hospital because Medicare reimbursement is cost-based. We currently use the robot in our emergency department (ED) and in our rural health clinic (RHC). Even large hospitals that have outlying RHCs can take advantage of this cost-based reimbursement in justifying the purchase or lease of a robot.

Telemedicine also offers many indirect financial benefits. The technology eliminates the need to pay big bonuses to attract mid-level and specialty clinicians to a town this small. And we don’t have to worry about IT staffing because our vendor, InTouch Health, handles 24/7 robot monitoring, connectivity and support services.

Before telemedicine, consistency of care was becoming a huge problem in American healthcare. You could get better stroke care in San Francisco than you could in rural Sierra County a few hours away. But now small-town America is finally getting the quality care it deserves, and even 25-bed hospitals can afford the technology.

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