Can telehealth provide stop-gap coverage for your hospital?


I recently stumbled across an article about a hospital putting telehealth to an intriguing new use: as a bridge for the the facility in between hiring in-house, on-staff psychologists.

Mental Health Center of North Iowa lost all three of its staff psychologists over the past three months, with no immediate prospects for replacement. The practitioners had joined the staff in 2009, but it took hospital administrators several years prior to that to bring those staff members on board, according to a story published in the Mason City Globe Gazette.

Now, though, MHC has contracted with one psychiatrist in Spencer, Iowa (103 miles away), a psych-certified nurse practitioner in Arizona, and at least two other other NPs in unnamed locations. One of the practitioners is certified for pediatric counseling, a new service that MHC previously was unable to offer, according to hospital officials.

"We're rebuilding our psychiatric services and at the same time expanding them," MHC Executive Director Andy Eastwood, told FierceMobileHealthcare. "So if someone needs to see someone immediately, we'll say, 'Come on in.'".

In talking with human resources and medical staff professionals about this novel solution, their consensus about the plan was positive. Christina Giles, president of medical staff consulting firm Medical Staff Solutions called the idea of using telehealth in this way exciting, noting that it could be particularly helpful in remote centers where physician searches can take months or even years to complete. "It's a complicated process," she said. "And you don't want patients having to go without services."

The approach is a bit like a new national radiology service that is gaining acceptance these days, Dana Brandt, human resources manager for Texas-based Christus Spohn Health, tells FierceMobileHealthcare. The services have radiologists in one central location who provide overnight or emergency review of images to facilities around the country, usually during off-hours such as the weekend or holidays when it can be tough to contact medical staff.

There are a few caveats to such an approach, though, most notably making sure to:

Offer patients a choice: Particularly with psychiatric services, patients can be sensitive about choosing a new provider. If it's an interim measure, it should be couched that way, and patients given the choice to work with the new provider, or wait for the full-time staff clinician to come on board.

Transition patients carefully into and out of telehealth: Some patients might make an instant connection with their tele-psychiatric provider, making it tough for them to transfer back when an on-site physician finally is hired. In this case, be sure you've either 1) set up your telehealth contract to allow patients to stay with the telehealth provider if they (or you) choose to do so, or 2) set the expectation up front that patients will have to transition back to your on-staff therapists when they come on board.

Check out e-prescribing options: Out-of-state physicians could have problems prescribing to local pharmacies. According to the Gazette, MHC continues to work on a protocol to allow its telehealth providers to send prescriptions directly to patient pharmacies.

Perform a full due diligence: With the Centers for Medicare and Medicaid Services' recent relaxation of credentialing/privileging for telehealth providers, the credentialing process should be simpler. In fact, you might see more use of telehealth as this kind of stop-gap coverage as a result. Just be sure you do a complete vetting before signing a telehealth contract, even for a few weeks or months of service.

With all of that in mind, what do you think of telehealth as a tool for use in the hiring process? Does it raise any red flags for you? Or does it just seem like a way to bridge the gap when you're having trouble filling a medical staff position? Let us know! - Sara

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