If there’s a silver lining to the coronavirus pandemic, it’s that we've opened the door to new care paradigms and expanded some minds to what can be. I recently had the privilege of leading a panel discussion with my colleague Theo Koury, MD, hosted by Becker’s Hospital Review. Several renowned healthcare leaders joined us, and our conversation focused on hospital viability in an increasingly outpatient world. This article captures a few of the many key insights shared and reflects the spirit of optimism felt by the vast majority of us in healthcare as virtual care grows more prevalent.
A New Paradigm for Hospital Medicine and Virtual Care
For as long as most of us have been practicing, we’ve followed a very provider-centric model of care. This is particularly true in acute care. The implicit message is, "Come to my emergency department (ED) or hospital, and I shall take care of you."
COVID-19 has underscored that we need a new paradigm moving forward. As we craft our pandemic response, we must resist falling into a crisis mentality and seeking only short-term solutions. Instead, we need to wrap our heads around the fact that our solutions will change acute care forever. Everything about our healthcare ecosystem — from our giant beautiful buildings to our hospitals' physical layout, to the skills we teach in medical school — needs to change.
An aspirational goal for health systems is to help patients access the right care in the right place at the right time. Of course, we want people to come to the ED when they have an emergency. But we want them to come because they need to, not because they don't know where else to go. Research suggests that over 70% of ED visits could be safely handled by urgent care clinics or doctors’ offices. New connected care models could help us navigate patients to the most appropriate setting or even treat them entirely by telehealth.
Even services that are traditionally very hospital-centric can lend themselves to virtual solutions. Behavioral health is a great example because people experiencing a mental health crisis tend to present to the ED. So rather than transferring them to inpatient care, we’re creating crisis stabilization units, such as the EmPATH model pioneered by my colleague Scott Zeller, MD. These are short-stay units staffed by telepsychiatrists (usually on-site, but also sometimes working virtually). EmPATH units give patients 23 hours to stabilize, start medication-assisted therapy, and receive community resources referrals. This lifts a huge resource burden from the ED, which will probably see an increasing number of behavioral health visits as the pandemic continues.
“While no one wishes for a pandemic, disruption often drives our greatest innovations. By shifting care toward more connected, patient-centered care models, we are doing our best for our heroic clinicians and the communities we serve.”
Denise Brown, MD
Chief Growth Officer
Care Integration and Team Alignment are Key
The shift to virtual care requires that we make a determined effort to avoid what I call the “hodgepodge effect.” Today’s patients may have several different apps and portals they can access on their phones. But if nothing connects these platforms in the background, we're actively encouraging care fragmentation. As organizations, we need to help patients find the most appropriate access point, whether it’s a telehealth visit or face-to-face encounter. We’ve then got to make sure we close the loop through service integration.
In addition to creating structural processes to reduce fragmentation, healthcare leaders also have cultural and educational work to do. Right now, every part of our system — from reimbursement to ancillary services — is tied to the provider-centric care model. And evolving that will be challenging but also exciting.
The Benefits of Change and Telehealth Services
Virtual care has many benefits for clinicians. To gain buy-in for change, we need to present it as something that makes their lives easier while improving patients' access to medical resources. I like to frame it not as telemedicine but simply as medicine. We’re doing the same things we’ve always done, just in a slightly different venue. And it’s actually a safer venue because we don’t have to be physically next to our patients to treat them effectively.
At the same time, we need to be attentive to the human dimension of change. So many healthcare providers were struggling with burnout even before COVID. We’ve now been masking, gowning, and goggling up for nearly a year. Everybody is on edge, so we want to make sure that our solutions ease that cognitive burden and not add to it.
One of my colleagues shared a great lesson last week. After their team began rounding on hospitalized patients virtually, one patient’s eyes lit up when they were finally able to see the doctor’s face and expression on the iPad screen. Another benefit was that family members could more easily participate in care when consultations were virtual.
In summary, hospitals have transformed themselves in response to the COVID crisis — and this change is largely positive and is overdue. While no one wishes for a pandemic, disruption often drives our greatest innovations. By shifting care toward more connected, patient-centered care models, we are doing our best for our heroic clinicians and the communities we serve.
For additional insights on how hospitals and health systems can better adapt to this new virtual reality of care, please watch the recorded webinar.