Telehealth as Workforce Shortage Solution at Medical University of South Carolina

A recent blog post from the National Consortium of Telehealth Resource Centers reminds us that we are approaching a telehealth policy cliff. Without Congressional action, telehealth flexibilities that were first put in place during the pandemic will expire on Sept. 30. Among other things, providers would no longer be reimbursed for telehealth visits delivered to Medicare beneficiaries in their homes. Rural and facility restrictions would return.

The impact of a policy and payment mechanism disruption would be widespread, as telehealth has become a key aspect of health system efforts to expand care. Manatt Health and the National Telehealth Center of Excellence at Medical University of South Carolina (MUSC) worked together on a report focused on describing opportunities for telehealth to address the emerging healthcare workforce crisis.

During a Sept. 10 webinar, Jared Augenstein, senior managing director at Manatt Health, set the stage by describing the scope of the shortage, with societal and demographic trends pointing to an increased demand in care over the next 10 years, without a commensurate increase in care team members. There was a massive increase in the use of telehealth during the pandemic. “It's subsided significantly since then, but there's always been this thought that telehealth can have a significant impact on addressing workforce issues, so we set out to characterize the ways in which that might be true,” he said. One way that telehealth can extend the current workforce, he added, is by allowing a shift from a one-to-one to a one-to-many model. “It enables us to shift work between physician types, for instance, from specialists to primary care providers, or between clinician types, from physicians to advanced practice providers, and it can create efficiencies by moving from synchronous to asynchronous care.”

Telehealth also can help expand the catchment area for care teams, maximizing care team members’ ability to see the appropriate patients, by reducing physical proximity as a barrier,  Augenstein added.

The webinar included a presentation by Emily Warr, M.S.N., R.N., administrator for the Center for Telehealth at MUSC. 

The Health Resources and Services Administration (HRSA) awarded MUSC and the University of Mississippi Medical Center national designations as Telehealth Centers of Excellences (COEs). The COEs focus on the efficiency of telehealth services in rural and urban areas and serve as national clearinghouses for telehealth research and resources, including technical assistance.

Warr started by saying that MUSC is very engaged in this workforce crisis in both trying to keep its operations going, but also thinking about the healthcare leaders and care teams of the future. 

“We are a statewide health system with multiple hospitals and both rural and urban areas across the state, and have grown into that system over the course of the last five to seven years, and have dealt with a lot of the growing pains associated with that,” she said. 

“Telehealth has been a nice tool as we've grown to be able to reach the new hospitals and clinics that we've added to our system across the state,” she said. “She said the Telehealth Centers of Excellence has grown to serve more than 350 telehealth sites across the state. 

One of the first telehealth services they established involved a tele-stroke program. “I think that's probably one of the earliest examples of recognizing that there were not enough neurologists in South Carolina to provide expert stroke care to each rural and urban community in all 46 counties of the state,” Warr said. 

“What MUSC and the Center for Telehealth set out to do was co-locate our neurologists in the Charleston area, but serve the entire state through telehealth. We observed how we could use existing resources to serve the state to improve quality and efficiency. Because obviously, one tele-stroke provider who's on service doesn't have to be in all 46 counties, but could potentially serve a handful of them in a couple of hours from a remote location,” she said. “That was one of our first attempts at managing an already existing workforce crisis within the state of South Carolina about 15 years ago.”

Tele-ICU is very similar in the inpatient space, leveraging the expert care of pulmonary critical care physicians and critical care nurses in rural settings where that expertise is just not available, Warr explained. “This is one of the emerging workforce crisis mitigation strategies in the inpatient space that I think is really important and exciting.”

Warr is an ICU nurse by background,  and she has seen that there are not enough nurses to serve the growing population in a high-quality and meaningful way. “There’s also maldistribution, so figuring out how to use virtual nursing as a tool to serve our entire state is something that we're working on now. We've been able to expand across our system into all of our med/surg units, and are looking into how to get into additional ICUs and EDs and other care locations.”

The goal is to have a centralized group of virtual nurses serving patients across the MUSC system. “Ultimately, the scalable solution really allows you to break through that geography barrier and see patients where they are at the appropriate time when they need you using this virtual tool,” Warr said.

The centralized group of nurses within the Center for Telehealth support brick-and-mortar clinics that want to deploy remote physiologic monitoring for their patients but don't have the staff to be able to manage all the data that comes through. "That's one of our workforce crisis mitigation strategies in population health,” Warr said.

In the ambulatory setting, MUSC has taken a bold leap over the course of the last couple of years and built out a 100% virtual practice. “It's a multi-specialty practice, and the intent there was to solve the problem that we had here in South Carolina, where we didn't have enough endocrinologists or rheumatologists,”  Warr explained. “We went to 100% virtual model supported by a virtual team of nurses and techs and schedulers, and we were able to build out this clinic with medical staff that was hired from other states outside of South Carolina and licensed them in South Carolina so that we could capture that expertise We serve our local demand and our patients with more timely access for those high-demand specialties.”

There are still issues with telehealth, and and it's not a silver bullet, Warr stressed. She closed by describing some of the ways MUSC’s Center for Telehealth and MUSC more broadly is looking to leverage AI to transform care by focusing on workforce efficiency and supporting clinical teams to allow them to spend more time in meaningful interactions with patients and families, and to remove some of those burdensome, time-consuming tasks that were leading to burnout.