Nephrology Telehealth, Night Coverage and Other Topics from the ATA Fall Forum

We’ve known for some time that nephrology telehealth is the next big opportunity in telemedicine specialties, and we’ve been preparing for it. Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) receive highly fragmented care, especially in rural areas. Studies show that TeleNephrology can bring specialists where they are needed, and better coordinate their work with primary care physicians. One important U.S. study from 2012 provides the benchmark here.
Our Job #1 as leaders of a telemedicine and hospitalist management company is to respond quickly to the needs of hospitals and stay attuned to their challenges. That’s why we make it a practice to attend the American Telemedicine Association’s annual Fall Forum—not only to share news about our programs with hospitals and physicians, but also to listen to what other industry leaders are saying.

Many of the “hot button” issues discussed came as no surprise at the September event. Others did.

Nephrology TeleHealth: CKD and ESKD Reaching “Pandemic” Proportions

Nonetheless, we were surprised that TeleNephrology had risen so abruptly—near the top of the list of hospital needs we heard about at this year’s Forum. Why the urgency? Here’s our take on it: The rapidly increasing rate of chronic kidney disease in older patients has been described as a “pandemic.” Rates of morbidity and mortality are higher in the ESKD population than in the general Medicare population, and impact other metrics—and costs—as well. A 70-year-old patient with ESKD spends an average 15.5 days in the hospital, according to American Society of Nephrology curricula.

Hospital executives don’t need to consult a textbook on the issue; they know it firsthand. We see a major, long-term opportunity here to partner with hospitals to extend their reach in this area through our nephrology telehealth services.

Staffing Gaps, Night Coverage, Specialty Care

Nephrology care isn’t the only specialty in which hospitals need to expand their coverage today. We saw keen interest at this year’s Forum in all our specialties—including TeleStroke, TelePsychiatry and Tele-ICU. And as always, nocturnal coverage and NP/PA backup are an issue for hospitals across the country, regardless of size.

When we began our telemedicine program eight years ago, our first clients were rural hospitals hit hard by the physician shortage, and frequently overloading their daytime physicians with nighttime call responsibilities. Today, larger hospitals are also looking to telemedicine to solve their night coverage issues. In many of these hospitals, physicians on the swing or night shift are slammed with admissions, and are expected to do double-duty by handling (and documenting) floor calls. The result? A high-stress working environment is made even more stressful. Our TeleCross-Coverage and Surge Protection solutions help hospitals address these problems.

Funding remains an obstacle

When you have a program as transformative as telemedicine, you want to spread it far and wide. Unfortunately, reimbursement remains an obstacle to that mission in the United States. In our September blog, we wrote about how current federal and state law varies widely on requirements for Medicare, Medicaid, and private insurance coverage for telemedicine services. Some services are not reimbursed, or reimbursed at lower levels than in-person physician services.

Government resources for telemedicine funding are available for Critical Access Hospitals (CAHs) to help build bandwidth and infrastructure, but true parity in reimbursement is still a long way away. Meanwhile, we work to get out the message that the tangible and intangible benefits of properly designed inpatient telemedicine programs—benefits like physician retention, increased admissions at night, improved nurse satisfaction, and overall quality improvement—far exceed the issue of reimbursement of professional fees.