1. Telehealth …..
Improving the Bottom Line
for Emergency Physicians
December 17, 2015
Jeff Jones
Senior Manager
Telehealth Center of Excellence
Subsidium Healthcare
Presented By:
Jay Backstrom
Partner, Telehealth Center of Excellence
Subsidium Healthcare

2. Schumacher Group is one of the largest and fastest-growing
Emergency and Hospital Medicine groups in the nation. We
partner with >5,200 providers who treat 6 million patients
annually.
For over 20 years, Schumacher Group and Hospital Physician
Partners have helped hospitals navigate EM and HM challenges
with data-driven insights and customized strategies to drive
efficiency, cut costs, streamline processes, and improve
outcomes.
We have united to find innovative ways to help hospitals
improve their performance
• Extend quality patient care to a broader population
• Leverage best practices and platforms
• Create greater scale and reduce overhead
• Negotiate favorable terms with payers
• Improve our position in a shifting healthcare marketplace
The Schumacher Group
2

3. Subsidium Healthcare Consulting
Subsidium Healthcare is a premier management-consulting firm focused solely in the healthcare industry
Strategy Technology & Operations
Subsidium Centers of Excellence
Growth Strategies Clinical Revenue Cycle
Optimization &
Execution
Telehealth
Service & Solutions
• M&A, partnership
advisory
• Physician strategy
• Ambulatory expansion
planning
• Patient engagement
• Value based payment
strategy and design
• Revenue cycle
optimization
• Care management
program design
• ICD-10 conversion
• Clinical
documentation
improvement
• Physician Advisory
services
• EHR benefits
optimization
• UM/CM optimization
• Technology selection
and execution
• Pre-merger/ post-
merger integration
planning
• PMO outsourcing
• Telehealth
opportunity
assessment
• Business plan /
financial analysis /
roadmap
• Telehealth program &
services design
• Vendor selection
• Implementation
DesignPlanning
3

4. Agenda
I. Fundamentals of Telehealth
II. Addressing Issues in the Emergency Department
III. Top Applications of Telehealth in the ED
IV. Impacts and Benefits
V. Billing & Reimbursement: Making it Viable
VI. The Patient & Physician Experience: Keys to Success
VII. A Recent Client Experience
VII. Questions
4

5. 5
I. Fundamentals
of
Telehealth

6. Telehealth
What is it?
Telehealth is:
• Patient care services provided over distance using technology to
connect patients with physicians
• A strategy that can:
• Reduce cost of service
• Support margins
• Improve access to care
• Improve quality of care
Telehealth is not:
• A simple telephone conversation
or a fax transmission
• An e-mail or text message
6

7. The Continuum of Telehealth Services
Clinician to Clinician
•TeleED Consults
•Tele-Specialty Consults
•Virtual Conferencing
•eICU
•Virtual Nurse Mentoring
•Clinical Education
•Grand Rounds
7
Consumer Driven
•Patient Web Portals
•Personal Activity Monitors
•Patient Scheduling Apps
•Quality/Price Transparency
Tools
•Geo-tagged Devices
•Mobile Apps
•Social Media
•Online Support Groups
Clinician to Patient
•Virtual Consults
 ED/Urgent Care
 Primary Care
 Specialty Care
•Remote Monitoring
•Telehealth Kiosks
•Virtual Medication
Management

8. Telehealth Services: Examples
• Cardiology
• Chronic Care Management /
Remote Monitoring
• Specialty Consultations
• Dermatology
• eICU
• Education / Grand Rounds
• Emergency Services / Trauma
• Fetal Monitoring
• Home Health / Long Term Care
• Hospitalist Care
• Infectious Disease
• Medication Adherence
• Neurology / Stroke Care
• Obstetrics and Gynecology
• Oncology
• Orthopedics
• Pain Management
• Pathology
• Pediatrics
• Pharmacy
• Primary / Urgent Care
• Psychiatry
• Radiology
• Rheumatology
• Screening Services
• Urology
There are >100 different Telemedicine services. These are some of the more popular
Telemedicine services at health organizations today.
8

9. 9
Increase
Costs
Decrease
Costs
Usually requires volume increases,
without substantial increases in cost
With the
same revenue
Quality
Measures
Increase
Revenue
Increase cost less than
traditionally required
Perform well on
quality measures
Telehealth
Improving the Bottom Line

10. Telehealth Stages of Maturity
Stage 1
Single Service
Focused
Stage 2
Multi-Service
Focused
Stage 3
Program Focused
Stage 4
Market & Care
Delivery Focused
Stage 5
Consumer Focused
• Single service deployed
to address a clinical
need
• Siloed clinical care
delivery model
• Limited clinical and
business benefits
• No org. structure or
governance;
departmental
sponsorship only
• Multiple independent
clinical services to
primarily extend care
• Siloed clinical delivery
care model
• Some tangible business
benefits
• No org. structure.
Limited governance.
Departmental
sponsorship only
• Multiple services
aligned with top
specialty areas focused
on local market
• Services have limited
integration with the
existing care delivery
models
• Program has
measurable value and
provides local market
differentiation
• Central org. structure,
services-driven
governance and
executive sponsorship
• Market-driven,
balanced portfolio of
services extend beyond
local / regional markets
• Services are integrated
within care delivery
models
• Self-sustaining as a
business with metrics-
driven clinical
outcomes and financial
results
• Central organizational
structure, enterprise-
level governance and
sponsorship
• Broad and flexible
menu of services to
address needs
within/outside U.S.
borders
• Expands beyond
provider markets
directly to consumers
• Services can be
integrated within any
clinical delivery model
• Services are
productized to be
packaged and sold to
any health organization
or consumer
• Opportunities to
increase data value and
/ or package services
to other markets
Telehealth: Stages of Maturity
Market Focus Over Past 10–15 Years Target for Leading Health ProvidersCurrent Market Focus
10

11. Telehealth
4 Key Service Models
1. Clinical Model: Addresses the clinical approach, workflow, and
potential barriers to the delivery of quality care.
2. Operational Model: Addresses how the Clinical Model is
operationalized, including practical issues and programmatic
needs (space, location, organization, governance, support,
licensing, new resources, billing, reimbursement, etc.)
3. Financial Model: identifies the costs, revenue, margin, and ROI
4. Technical Model: technical solution design (mobile carts, video
conferencing, peripherals, network adequacy and reliability, EMR
access, etc.)
There are 4 key service models to address with Telehealth initiatives:
KeyFocusAreas
11

12. 12
II. Addressing Issues
in the
Emergency Department

13. Care in the Emergency Department
Common Issues
• Rapid access to ED physician (door-to-provider time)
• Access to specialist care (stroke, psych, trauma)
• Prompt treatment for low acuity patients
• Effective transitions to home / primary care
• Timely admission process
• 30-day readmission issues (high-focus conditions)
• Patient surges (Intra-day, certain days, seasonal)
• Rural access to highly qualified ED physicians
• Affordable Provider coverage model
• Others (triage, hospitalist consultation, etc.)
13

14. Telehealth in the ED
Where and When?
• Before the ED visit
• During the ED visit
• After the ED visit
14

15. Telehealth
“Before” the ED visit
• Clinician-to-patient visit (“direct to consumer”)
– Patient calls the ED with a health issue and the service offered could be:
• Advice only
• Patient care visit
• Clinician-to-clinician
– Outlying hospital calls tertiary center
(ED1 to ED2)
• Transfer, consult, admit, or
discharge?
• Telemonitoring for high-focus
conditions
15

16. Telehealth
“During” the ED Visit
• Provider up front
– Rapid access to ED physician
• Specialty care
– Narrowly defined applications, such as
stroke, psych, trauma
• Prompt treatment for low acuity patients
– Fast track, etc.
• TeleRadiology support
– Immediate primary reads vs. preliminary reads from an after-hours service
• Effective transitions to home / primary care
– Address high risk patients (patient teaching, transition of care issues)
– Address high-frequency patients
16

17. Telehealth
“During” the ED Visit
• Timely admission process
– “Admissionist”
• Patient surges
– Intra-day, certain days, events, or seasonal
• Telemedicine as a solution
• Telemedicine as a bridge, before adding a more costly 10 or 12 hour shift
• Rural access to highly qualified ED physicians
– ED to ED Consultation
– Transfer decisions
• 30-day readmissions (high-focus conditions)
– Focused management of CHF, pneumonia, COPD, etc.,
– Clinical pathways, care coordination, and patient engagement strategies
17

18. Telehealth
“After” the ED Visit
• Clinician- to- patient model
– Specific patient care follow-up
• High focus conditions
• High risk conditions
• Clinician- to- clinician model
– Follow-up of non-transferred
patients
• Specialty Care
• Hospitalist management
18

19. 19
III. Top Applications
of Telehealth in the ED

20. 20
Top Telehealth Applications in the ED
ED Telehealth
Service
Description of Problem or
Opportunity
Use Case(s) Value Proposition
Specialty Care
for
ED Patients
▪ Stroke
▪ Psych
▪ Other (Trauma, Cardiology, etc.)
ED patient requires specialist for time-
sensitive conditions or specialty
consultation.
▪ Optimal outcome for time-sensitive
conditions
▪ Focused consultation for specific conditions
ED TeleConsults
Rural ED consults with tertiary
center on ED patient.
Local ED physician performs a TeleConsult
with remote ED physician or specialist to
address a patient's care and/or
disposition.
▪ High quality, coordinated care
▪ Avoidiance of unnecessary patient transfers
▪ Reduced complications
Provider to Provider Applications
20

21. 21
Top Telehealth Applications in the ED
21
ED Telehealth
Service
Description of Problem or Opportunity Use Case(s) Value Proposition
Low Acuity Patients
Patient Volume Surges
▪ ED Patient volume surges may impact
timely patient care, patient satisfaction, and
provider cost
▪ Low acuity ED patients are especially suited
for telemedicine
For low acuity visits (routinely), or for patient
surges (occaisionally):
▪ Patient video conferences with ED physician
or NP/PA
▪ Medical screening exam, labs, and
documentation in EMR is initiated
▪ Full visit may be completed if appropriate
Rather than requiring additional 8/10/12 hour shifts,
telemedicine coverage incrementally increases
provider coverage, and aligns overall cost with
demand.
Virtual ED Visit
("Before the ED")
Patient contacts ED physician directly before
coming to the ED.
▪ Patients asking if they should come to the ED
▪ Patient seeking care for a treatable condition
▪ Reduce ED volume for low acuity conditions
▪ Patient satisfaction
▪ Reduced cost of care
▪ Less demand on hospital resources
Virtual ED Visit
("After the ED")
High risk/high focus patients may be
discharged from the ED without sufficient
follow-up care and may return, causing
higher ED utilization, higher readmission
rates and avoidable costs.
Utilize NP/PA to connect with patients in
follow-up, insuring that they are appropriately
following recommendations for care.
▪ Improves outcomes for high risk/high focus patients
▪ Reduces hospital costs/penalties associated with
avoidable readmissions
▪ Reduced complications
Admission Support
Patient admissions are time-consuming, may
cause delays, patient dissatisfaction, and
poor outcomes.
Utilize mobile Telemedicine carts to connect
patients with admitting provider
▪ Expedites the patient admisssion process.
▪ Increases patient satisfaction
▪ Reduces ED Length of Stay
▪ Enhances outcomes
Discharge Services
High focus patient populations are especially
vulnerable to poor transitions of care, and
may require additional time and expertise.
Utilize mobile Telemedicine carts to connect
patients with specialized resources for key
transitions of care.
▪ Expedites the patient discharge processes.
▪ Insures effective transition of care
▪ Improves productivity of ED providers
▪ Reduces repeat ED visits and readmissions
Remote Monitoring for
Chronic Condition
Patients
Patients with chronic conditions are frequent
users of the ED, and can drive high
readmission rates and avoidable costs.
Provide remote monitoring for high risk
patients with chronic conditions (e.g. AMI,
CHF, diabetes, COPD) to proactively address
health issues.
▪ Reduces hospital costs or penalties associated with
readmissions
▪ Improves qualty of care and patient satisfaction
▪ Reduced complications
▪ Reduced risk
Provider to Patient Applications

22. Telehealth in the Emergency Department
Qualification Criteria
• Clarification: What problems are we trying to solve?
• 3rd Party Reimbursement: Need to “qualify” the client
location for TeleMedicine reimbursement
(reimbursement varies by state)
• Financial justification/ROI
• Technology: Network
bandwidth at client location
for video conferencing
22

23. Telehealth
Solution Options
23
• Customized solutions can be built by software
developersBuild
Lease • Solution can be acquired (3, 5, 7 year leases)
Borrow
• Some may have mobile cart/ video conferencing
solutions not currently being used in the ED
Refer • To another providers service
• Multiple, proven vendor solutions are currently
available in the marketBuy

24. 24
IV. Impacts
and
Benefits

25. Financial
• Reduced delivery costs
• Increased margin
• Fewer
readmissions/penalties
• Reduced length of stay
• Fewer patient transfers
Quality
• Positive health
interventions at earlier
times in care
• Improved health
outcomes
• More efficient care
delivery
• Reduced or avoided time
in skilled nursing units
Access
• Enhances staffing capacity
to meet patient needs,
including surges
• Improved patient access
to specialists
• Improved health system
outreach
• Earlier patient diagnosis
and treatment
25
Telehealth
Key Benefits

26. Revenue
&
Cost Savings
Telehealth
Financial Areas
26
• Telehealth Clinical
Resources
• Telehealth Support Team
• Annual Vendor Maintenance
& Support
• Costs Associated with Increased
Scale
• Technology
• Integration
• Infrastructure Changes
• Room Redesign / Build out
• Building & Deployment
• Training
• Telemedicine Reimbursement
• Reduced Readmissions / Avoided
Financial Penalties
• Improved Productivity and
Efficiency
• Reduced LOS
• Increased Patient Volume
• Increased Patient Population
/ Market Share Served
• Avoided Care Costs /
Proactive Care Management
• Population Health
Management
• Grants
Opportunities
Ongoing
Expenses
Costs

27. Sample Financial Model
27
1
Unit Amount Quantity Savings 2
Current Staffing Cost Savings 3
Current Staffing @ Client ABC (2 MD's: 1 MD per dayshift and on call @ night) 314,265$ 2 628,530$
Future Staffing Costs
TeleHospitalist Staffing Costs 300,000$ 2 90,000$
Onsite Hospitalists @ Client ABC 150,000$ 2 300,000$
Total Savings: 238,530$ Year 1
Total Clients 1
Total Annual Encounters (Client ABC) 5386
Total Annual Encounters (Abrom Kaplan) 1292
TeleHospitalist TeleMedicine Service Center (TMSC) Unit Cost Quantity Year 1 Total Avg. Daily Encounters (Client ABC) 3.5
TMSC Build Out and Setup 10,000$ 1 10,000$
TeleHealth Workstations (PC, Dual Screens, Camera, Headphones) 10,000$ 1 10,000$
Hospital Costs (Spokes)
Mobile TeleHealth Cart (includes PC, camera, ext. cables, cabinet, etc.) 21,858$ 1 21,858$ Traditional Model Hospitalist Compensation (Client ABC) ######## #
Hand Held HD Camera (Horus Scope: ENT, eye, dermatology, etc.) 5,635$ 1 5,635$ Traditional Model Hospitalist Compensation (Client ABC) ######## #
Digital Stethoscope 515$ 1 515$ Avg. NP Compensation 150,000$
Vendor Implementation and Training Services 10,000$ 1 10,000$ Avg. TeleHospitalist MD Compensation 300,000$
Total Capital Costs: 58,008$ TMSC Staffing Cost Distribution (based on % of total encounter volume) 15%
Annual Depreciation Expense (5 yr. Amort) 11,602$ Maximum Encounter Capacity per TeleHospitalist 22
Maximum Encounter Capacity per On-site NP 15
Technology Related Costs Full Time Max (# of hours/month) 180
TeleHealth Workstation Cisco Video Conferencing Licenses 750$ 1 750$
Mobile TeleHealth Carts Cisco Video Conferencing Licenses 750$ 1 750$
Mobile Cart Vendor Support and Maintenance (15%) 28,008$ 1 4,201$
Personnel Costs
IT Support Resource (1 per year/per 10 sites) 65,000$ 10% 6,500$
IT Service - Support for Carts (20% of total cart costs) 10,000$ 1 10,000$
SG TeleHealth Medical Staff Credentialing Specialist 45,000$ 5% 2,250$
Licensing and Credentialing
Physician State License Costs 1,000$ 4 4,000$
Physician State Credentialing Costs 500$ 4 2,000$
NP State License Costs 500$ 2 1,000$
NP State Credentialing Costs 500$ 2 1,000$
Total Operating Costs: 32,451$
Total Costs: 90,459$
Depreciation Expense 11,602$
Net Operating Margin 194,477$
Net Cash Flow 148,071$
Key Variables
Costs
Capital $
Operating $
Input Data
Client ABC
Savings Assumptions
Year 1 TMSC staffing costs are distributed to this hospital on 15 to 1 ratio.
Client does qualify for TeleHealth Medicare reimbursement.
Client Staffing:
- Traditional Hospitalist Staffing: 2 MD's rotating 7-on, 7-off for dayshift
- New Staffing: 2 NP's for dayshift & 2 physicians 24/7 in TMSC

28. Telehealth
Top 5 Drivers of Financial Success
28
1. Fully understand the Telehealth reimbursement in your service areas:
• Medicare
• Medicaid
• Commercial payers
• State regulations on Telehealth
2. Leverage NP/PA staffing models where possible
3. Early success is critical for driving increased volumes/revenues
4. Leverage a hub and spoke model to maximize physician utilization and
optimize costs
5. Measure and manage success:
• Define financial success prior to go-live
• Create daily and weekly reports to measure results and progress
• Manage results; optimize quickly

29. V. Billing and Reimbursement:
Making it Viable
29

30. Telehealth
Current State of Reimbursement
Reimbursement for Telehealth services has been rapidly increasing, especially
within the last couple years:
30
Medicaid
• Reimburses in most states (47 states reimburse for live
video Telehealth services. 16 states reimburse for remote
patient monitoring).
• Many states have different requirements that determine the
scope of coverage for Telehealth (e.g. type of services to be
provided, location of providers, etc.).
Medicare
• Reimburses for TeleHospitalist services in rural
and underserved areas
• Must meet specific billing requirements

31. Telehealth
Current State of Reimbursement
31
Commercial
Payors
• 29 states have passed Parity Laws mandating Telehealth
reimbursement
• 14 additional states have proposed Parity legislation for
approval within the year with other states expected to follow
• There are 36 states with a combined 100 bills on Telehealth
under consideration and Telehealth provisions are included in
national congressional bills
• Regardless of state parity laws, many large payers have
independently added policies for Telehealth reimbursement

32. Private/Commercial Coverage of Telehealth
State Parity Laws Mandate Reimbursement of Telehealth
Note: 8 states have proposed/pending Parity law legislation for approval this year.
Source: ATA’s State Telemedicine Policy Center (October 2015)
3232

33. 33
State
(Support of TH)
TH Parity Law
in Place
When?
TeleMental
Coverage
TeleHome
Coverage
Remote
Monitoring
Store &
Forward
State
(Overall Score)
Defined by
State
Informed
Consent Req.
Physician-
Patient
Encounter
Live Video
Reimb
TelePresente
r
Email /
Phone / Fax
Reimb
Cross-State
Licensing
Licensure &
Out of State
Practice
Medicaid
Program
Location
Defined
Online
Prescribing
State
(MD Composite Grade)
Alabama X X Y U Alabama Y Y Y N N Y N Alabama
Alaska X X X X Alaska Y N Y N N N N Alaska
Arizona X 2013 X X U X Arizona Y N Y N Y Y N Arizona
Arkansas X Arkansas Y N Y N N Y N Arkansas
California X 1996 X X California Y Y Y N N Y N California
Colorado X 2001 X X X Colorado N Y Y N N N N Colorado
Connecticut PPB Connecticut N N Y N N N N Connecticut
Delaware X Delaware Y N Y N N Y N Delaware
District of Columbia X 2013 District of Columbia N N N N N N N District of Columbia
Florida PPB Florida Y Y Y N N Y N Florida
Georgia X 2006 X Georgia Y Y Y N N Y N Georgia
Hawaii X 1999 X Hawaii N N N N N N N Hawaii
Idaho X Idaho Y Y Y N N Y N Idaho
Illinois PPB X X Illinois Y N Y N Y Y N Illinois
Indiana X X Indiana N Y Y N N Y N Indiana
Iowa PPB Iowa N N N N N N N Iowa
Kansas X X X Kansas Y Y Y N N N N Kansas
Kentucky X 2000 X X X Kentucky N N N N N N N Kentucky
Louisiana X 1995 X X Louisiana Y N Y N N N Y Louisiana
Maine X 2009 X Maine Y Y Y N N N Y Maine
Maryland X 2012 X Maryland Y Y Y N N Y N Maryland
Massachusetts PPB X X Massachusetts N N N N N N N Massachusetts
Michigan X 2012 X Michigan Y N Y N N Y N Michigan
Minnesota X X X X Minnesota Y N Y Y N Y N Minnesota
Mississippi X 2013 X X X Mississippi N N N N N N Y Mississippi
Missouri X 2013 X Missouri Y Y Y N N Y N Missouri
Montana X 2013 X Montana N N Y N N Y N Montana
Nebraska PPB X Nebraska Y Y Y N N Y N Nebraska
Nevada X Nevada Y N Y N N Y N Nevada
New Hampshire X 2009 New Hampshire N N N N N N N New Hampshire
New Jersey X New Jersey N Y Y N N N Y New Jersey
New Mexico X 2013 X X New Mexico N N N N N N N New Mexico
New York PPB X X X New York Y N Y N N N N New York
North Carolina X North Carolina Y N Y N N Y N North Carolina
North Dakota X North Dakota N N Y N N Y N North Dakota
Ohio PPB Ohio N N Y N N N N Ohio
Oklahoma X 1997 X X Oklahoma Y N Y N N Y N Oklahoma
Oregon X 2009 X Oregon Y N Y Y N N N Oregon
Pennsylvania PPB X X X Pennsylvania Y Y Y N N N N Pennsylvania
Rhode Island PPB Rhode Island N N N N N N N Rhode Island
South Carolina PPB X X X South Carolina Y N Y N N Y N South Carolina
South Dakota X X X South Dakota Y N Y N N N N South Dakota
Tennessee X 2014 Tennessee Y Y Y N N N N Tennessee
Texas X 1997 X X X Texas Y N Y N N Y N Texas
Utah X X Utah Y Y Y N N Y N Utah
Vermont X 2012 X Vermont Y N Y N N Y N Vermont
Virginia X 2010 X Virginia Y N Y N N Y N Virginia
Washington PPB X X X Washington Y N Y N N Y N Washington
West Virginia PPB X West Virginia Y Y Y N N Y N West Virginia
Wisconsin X X Wisconsin Y Y Y N N N N Wisconsin
Wyoming X Wyoming Y Y Y N N Y N Wyoming
Legend
State is NOT supportive of Telehealth
State is somewhat supportive of Telehealth
State is mostly supportive of Telehealth with some
challenges
State supports the use of Telehealth
American Telemedicine Association
State Telehealth Coverage & Support
33

34. Billing & Reimbursement Requirements
• Eligible Providers:
– Physician
– Physician Assistant & Nurse Practitioner
– Nurse Midwife
– Clinical Nurse Specialist
– Clinical Psychologist
– Clinical Social Worker
– Registered Dietitian or Nutrition Professional
• Eligible Facilities:
– Office of a Physician or Practitioner
– Hospital, including a Critical Access Hospital (CAH)
– Rural Health Clinic
– Federally Qualified Health Center
– Skilled Nursing Facility (SNF)
– Hospital-based Dialysis Center
– Community Mental Health Center
To bill Medicare, Medicaid, & most private payers for approved Telehealth services, the following criteria
must be met:
• The patient must be located in a non-Metropolitan Statistical Area (MSA) or a Health Professional Shortage
Area (HPSA)
• The patient must be treated by an eligible provider (see below)
• The patient must receive care via Telehealth in an eligible facility (see below)
• The appointment type must be for Telehealth encounters that uses the ‘GT’ modifier on all claims
• In the electronics comment, document “Services Provided by Telehealth”
34
Medicare Billing Requirements:

35. Federation of State Medical Boards
Interstate Medical Licensure Legislative Status
35
Source: Federation of State Medical Boards
As of Sept., 2015
Legend
Blue – Compact is Enacted (11 states)
Orange – Compact is Introduced (8 states)
Grey – No Compact Status (31 states)
35

36. 36
VI. The Patient & Physician
Experience:
Keys to Success

37. The Patient/Physician Experience
Keys to Success
• The art of “good video bedside manner”
– Engaging presence over video conferencing
• Screen and recruit physicians who align with a
Telehealth environment:
– Perform recruiting/screening interviews via video
conference
– Ability and interest in working remotely or in a
Telehealth Service Center
– Appetite for after hours/weekend duties
• Establish and train nurses as advocates
– To help evangelize Telehealth and assist
with patient adoption and consent
37

38. The Patient/Physician Experience
Keys to Success
• Environmental impacts related to the patient experience:
– Proper lighting to enhance video experience
– Manage noise and extraneous activity
– Background should be comforting - as if they were in a physician office.
Consider:
• Art work or hospital name/logo in background
• Avoid dark wall colors in background
• Avoid views of other computer monitors
– Network access if using mobile carts (e.g. WiFi, fixed network cable
connections, etc.)
• Patient acceptance of Telehealth solution
– Bedside confidence of nurse or physician
– Ease of use for video conference and peripherals
– Accessibility to patient (e.g. mobile carts, wall mounted equipment, fixed
workstations, mobile devices/tablets, etc.)
– Video conferencing solution must be optimized to perform at a level that
best replicates a face-to-face encounter
38

39. 39
VII. A Recent
Client Experience

40. SG’s TeleHospitalist Service with Lafayette General
TeleMedicine Service Center
(Lafayette, LA)
Patient Rooms
Abrom Kaplan Memorial Hospital
(Kaplan, LA)
Patient Encounter Data into Cerner EMR
Secure Audio/Video Conferencing
SG’s TeleHospitalist service has been deployed at 2 of Lafayette General’s hospitals: Acadia General Hospital and Abrom
Kaplan Memorial Hospital. This is a ground-breaking TeleHospitalist service in the state of Louisiana.
SG / Lafayette General
TeleHospitalist Service Deployment
Patient Rooms
Acadia General Hospital
(Crowley, LA)
Projected Value:
• New HM service coverage
• Reduced cost of care delivery
• Quicker response rates
• Consistent coverage
• Medical staff satisfaction
• Reduced physician recruiting demands
40

41. TeleHospitalist: Impact on Client HM Programs
Opportunities TeleHospitalist Service Changes Impact & Value
Recruiting • Improved recruiting for sites that have a
small candidate pool
• Increased use of on-site NP / PAs
• Enhances and simplifies recruitment
• Reduces recruitment and staffing costs
Provider Retention • Remote staffing of undesired shifts (nights
& weekends, on call)
• Reduction in non-care “distractions”
• Heightens focus on care
• Reduces burnout and attrition
• Improves work / life balance
Demand / Capacity
Balance
• Alignment of provider capacity with service
demands
• Back-up for patient care surges
• Better utilization of resources
• Optimized coverage models
• Distributes provider costs across sites
Care Coordination • 24x7 provider access for admissions
• Eliminates need for ‘bridge orders’
• Prepare discharges for next day
• Closer care team coordination
• Daily quality audits
• Reduces LOS in ED and HM
• Expedites admission times
• Expedites patient discharges
• Supports care quality
• Improves documentation
Patient Experience • Reduction in admission delays
• Immediate access to hospitalist care
• Remain in community for care
• Improves patient satisfaction
Strategic Alignment • Distribution of provider services to locations
with highest need
• Provide specialized services locally
• Patients managed locally vs. transferred
• Positive community impact
• Supports hospital financially
41

42. Telehealth
Lessons Learned
• Establish an executive sponsor, physician champion, and dedicated core
Telehealth team to drive the project
• Coordinate directly with the leading commercial payers in your state to
confirm their reimbursement policies for Telehealth
• Develop a detailed, “bottom-up” financial model to accurately forecast
revenue
• Measure and manage success:
– Define success prior to go-live (quality, operational, and financial metrics)
– Create daily and weekly reports to measure results and progress
– Manage results; optimize quickly
• Thoroughly test the technology solution – including the network – to resolve
issues in advance
• Focus on optimizing the patient experience to support adoption
42

43. Questions
43

44. Jay Backstrom
Partner, Telehealth Center of Excellence
Subsidium Healthcare
jbackstrom@subsidiumhealthcare.com
Jeff Jones
Senior Manager, Telehealth Center of Excellence
Subsidium Healthcare
jjones@subsidiumhealthcare.com
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