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July 2020

Telecritical Care Expands Telehealth From the ICU to Where It’s Needed

By News

During a panel session at the American Telemedicine Association’s recent virtual conference, experts from two large health systems explained how telehealth improves care for complex patients no matter where they are.


By Eric Wicklund

– As healthcare providers launch telehealth programs to improve critical care management and coordination, they’re seeing value far beyond the ICU.

Indeed, as the coronavirus pandemic taxes hospital resources and a growing shortage of critical care doctors becomes more apparent, hospitals and health systems are deploying telemedicine technology to treat patients wherever they’re located.

“This is telehealth at a different level,” said Jeff Guy, MD, MSc, MMHC, FACS, vice president of Emergency and Critical Care Services with HCA Healthcare, a Nashville-based network of some 186 hospitals and more than 2,000 care locations in both the US and UK.

Guy was part of a panel session at the American Telemedicine Association’s weeklong virtual conference last week. Titled “Implementing TeleCritical Care in a Healthcare Platform,” the discussion centered on how the concept of using telehealth to improve care is evolving, to focus more on delivering quality care than where that care is delivered.

A platform that began with a focus on improving care for stroke victims is now much more complex, with networks that allow large hospitals with specialists to reach out to smaller, rural hospitals that treat critical care patients regardless of whether they have an ICU. Through this platform, the large hospital at the center of the network can manage care across the enterprise, delivering specialized care and cutting down on transfers and traffic, while the smaller hospitals can keep and care for their patients on-site.

READ MORE: ATA Leaders Define the Value of Telehealth – And How to Measure It

The concept of connected critical care has led to large networks like HCA, Providence Health in the Pacific Northwest, St. Louis-based Mercy Virtual and Utah’s Intermountain Healthcare, whose medical director for critical care telehealth, William Beninati, MD, was part of the panel.

Beninati pointed out the telecritical care platforms have become a means of standardizing critical care across the health system, giving the tiny hospital in a rural community that same access to care as the big-city hospital. This gives the small hospital the tools to care for more complex patients.

That point is being proven with the COVID-19 crisis. With a telecritical care platform, the large hospital is the hub of a hub-and-spoke network, using a dedicated facility or specialized call center to manage care in the spokes. It can help to balance the patient populations at all hospitals, reducing the need for costly and potentially dangerous transfers, while also helping to cut down on ICU traffic, provider exposure to the virus and even PPE use.

Both Beninati and Guy pointed out that today’s telecritical care platforms are purposefully built to be flexible, as each hospital in the system (and those outside the system who might be able to join the platform) has different needs and capabilities. The telemedicine platform should also be easy enough that a hospital with only the most basic resources can connect.

To that end, Beninati noted that Intermountain has added an asynchronous telehealth program to its roster of services, allowing those with limited access to or need of an audio-visual platform to connect through an online portal.

READ MORE: UMass Memorial Ready to Launch Telehealth Program for NICU Care

This also requires the coordinating hospital to train its specialists to be adept at virtual care.

“This is a very unique skillset,” Guy said. “Because you’re a critical care physician doesn’t mean that, by default, you’re a telecritical care physician.”

Among the challenges to launching and expanding such a platform, Beninati said, is the fear among smaller providers that the telehealth platform “sucks patients out of a community.” In contrast, he said, the services does the opposite, giving those small providers the resources they need to keep patients in the community – not only for in-patient care but also for post-discharge care, including virtual visits with specialists and rehab care providers.

Other challenges include EMR integration – Beninati says Intermountain’s network has to content with several different EMR platforms – and interstate licensure and credentialing, which can be a hassle for health systems spanning several states.

The benefits, meanwhile, include reduced ER traffic at the hub hospital, a steadier care environment at the spoke hospitals, reduced transports (and the clinical and financial toll that they exact), and certain clinical benchmarks like improved sepsis detection and ventilator care, reduced length of stay and a reduced risk-adjusted mortality rate.

READ MORE: Telemedicine in the ICU: How One Hospital Improved Care Management

Guy also pointed out the value in making sure the hub hospitals have a rapport with the care providers, especially the nurses, in outlying hospitals.

FCC adds $198M for rural healthcare providers to boost telehealth services

By News

The Federal Communications Commission (FCC) is adding almost $200 million to a rural healthcare program to help providers buy telecommunications and broadband services.

Rural healthcare providers have been hit hard by the COVID-19 pandemic due to the loss in revenue from canceled or deferred elective procedures and the additional expense of personal protective equipment.

At the same time, telehealth visits have surged as patients seek virtual care options during the pandemic. The Trump administration lowered regulatory barriers for rural areas. Physicians can care for patients at rural facilities across state lines and via telemedicine.


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And in many places—particularly rural areas that have the most to gain from telemedicine and connectivity—broadband remains too expensive, unreliable or simply not available at the speeds required to enable innovations in care.

With an uptick in demand for telehealth services, the FCC’s Wireline Competition Bureau directed the Universal Service Administrative Company to carry forward up to $198 million in unused funds from prior funding years.

RELATED: FCC chief unveils $200M program to boost telehealth services amid COVID-19 outbreak

“In 2018, the FCC took swift action to ensure that the Rural Health Care Program better reflected the needs of and advances in connected care. Looking to the future, we gave providers more certainty by adjusting the cap annually for inflation and allowing unused funds from previous years to be carried forward,” said FCC Chairman Ajit Pai in a statement.

Telehealth is proving to be critical in the fight against COVID-19, Pai said.

Local community health centers, health departments, nursing homes and nonprofit hospitals can use the funds to support the technology infrastructure needed to provide virtual care.

The additional funding speaks to the FCC’s commitment to “ensuring that rural health care providers can continue to serve their communities during this difficult time and well into the future,” Pai said.

Industry stakeholders have called on Congress to fund rural broadband deployment to help address a digital divide that makes telehealth services out of reach for rural patients.

A recent study found that only 38.6% of the people who live more than a 70-minute drive from a primary care physician subscribe to an internet connection capable of handling telehealth services.

The $2.2 trillion Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, earmarked $200 million for the FCC’s COVID-19 Telehealth Program.

To date, FCC has allocated half the total amount, almost $105 million in funding for 305 health providers to build up their telehealth infrastructure in the wake of the COVID-19 pandemic.

RELATED: Industry Voices—Congress can narrow the healthcare gap by closing the digital divide

Interest in the Rural Health Care Program has grown in recent years and funding requests from healthcare providers for high-speed broadband had outpaced the funding cap, placing a strain on the program’s ability to increase access to broadband for healthcare providers, particularly in rural areas, the FCC said.

Two years ago, the FCC adopted rules to address this increasing demand by increasing the annual program funding cap and adjusting that cap annually for inflation.

The FCC also established a process to carry-forward unused funds from past funding years for use in future funding years.

Funding for rural health providers was capped at $604.76 million for 2020. But with additional funds rolled over from previous years, the program will now be able to dole out $802.7 million to healthcare providers, the most in the program’s history, the FCC said.