4 Ways e-Consults Benefit and Create Value for Fee-for-Service Health Systems

While health systems are rapidly adopting telehealth platforms to support value-based care arrangements, these solutions also create significant value for traditional (fee-for-service) lines of business. In particular, e-consults benefit both the patient and provider by enhancing quality of care, efficiency and experience.

While healthcare spending is higher in the U.S. than in many other countries, the U.S. isn’t leading its peers in clinical outcomes. In fact, it was ranked last place among the 11 countries for health outcomes, equity and quality, despite having the highest per capita health earnings. Although hospitals are only one component of a health system, they are facing huge barriers in achieving quality and efficiency improvement.

“Our expenses continue to rise, while constraints by government and payers are keeping our revenues flat.” In an explanation letter, Brigham Health president Dr. Betsy Nabel offered his insights and views to employees on the topic in 2017. He stated that the hospital will “need to work differently in order to sustain our mission for the future.”

Here are four ways an e-consult platform can create significant value for health systems:

1.      Increase specialist capacity: In 2017, The Association of American Medical Colleges (AAMC) projected a shortage of up to 104,900 physicians in the U.S. by 2030—61,800 of those being specialists. This evolving shortage in specialist doctors is exacerbating capacity challenges within health systems. A Merritt Hawkins study across 4 medical specialties (cardiology, dermatology, orthopedic surgery, and obstetrics and gynecology) in 15 major metro areas found appointment wait times increased 25 percent from 2014 to 2017—with some of the longest wait times spanning up to 165 days.

Within the many systems that have long wait lists for some or many specialties, e-consults can help improve “right patient, right setting, right provider” care. Specifically, e-consults help higher acuity patients obtain timely specialist appointments and care, while enabling lower acuity patients’ needs to be addressed quickly with specialty guidance. As a result, health systems reap multiple e-consult benefits. They are able to provide access for and treat a greater portion of their total patient volume more quickly and effectively, build relationships in the provider community for future referrals, and enhance experience for patients.  

Providing this “right time, right place, right provider” care also improves specialist revenue streams by ensuring appointments are filled by patients with higher acuity levels most appropriate to be seen in person.

2.       Help to overcome geographic access hurdles: Many systems serve patients in large catchment areas, which may include many rural sites. Rural residents have greater travel distances and transportation difficulties in reaching healthcare providers for both general and specialty care. There are 134 specialists per 10,000 people in urban populations, but just 40 specialists per 10,000 people in rural areas. E-consult platforms enable health systems to help patients overcome geographic obstacles to access high-quality care.

3.       Formalize and streamline curbside consultation practice: Many centers (especially academic sites or those who serve as the only specialist center in a certain geography) are overwhelmed by curbside consult calls to their specialists from PCPs throughout the health system. Most of these consults are undocumented and do not generate any compensation for their specialists, causing unnecessary time pressures and workload burden.

E-consults are an optimized solution for PCPs to receive timely, documented and complete specialist insight, without overwhelming health system specialists. For specialists, e-consults enable them to:

·         Document complete case responses on their own schedule—no last-minute phone calls or being called out of a patient room!

·         Get reimbursed, whether it’s by the e-consult provider’s contract or Medicare

·         Reliably address providers’ follow-up questions and clarifications.

4.       Mitigating effects of no-show rates: Health systems struggle with no-show rates. A 2016 retrospective study showed an average rate of just under 20 percent. These no-shows negatively impact health systems in many ways, including decreased clinic productivity, increased patient appointment wait times and lost revenue.  A study at a family practice residency clinic showed that no-shows and cancellations represented 31.1 percent of scheduled appointments and 32.2 percent of scheduled time. The same study also revealed that, over the course of a year, total revenue shortfalls could range from 3 percent to 14 percent of total clinic income.

E-consults benefit both patients and providers in a variety of ways. They are proven to reduce no-shows by appropriately triaging cases and making sure those with specialist appointments have clinical needs requiring a face-to-face specialist visit (i.e., clinical needs that cannot be met in some other manner).

For Medicaid patients specifically, no-show rates can be as high as 40 percent due to factors including: geographic proximity, Medicaid acceptance, and health literacy. For this population specifically (1 in 5 Americans), e-consult platforms increase and expedite specialist access for low-acuity cases and help avoid the need for many patients to even see the specialist. In turn, this increases specialist capacity for patients with higher acuity/complexity problems. And by increasing awareness of higher-acuity patients that are in need of escalated specialist care, health systems are better able to “close the referral loop” to ensure these patients get scheduled for their appointments (often challenging within this patient population because of the impact of numerous social determinants of care).

Further reading: How eConsults Aid FQHC Reimbursement, Maintain NCQA guidelines, and Support the PCMH Model

Chris Jaeger, M.D., is the advisor for ACO and health system strategy at AristaMD

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