A hospital in rural South Carolina has found success with a telehospitalist service that has allowed it to avoid hiring locum physicians while posting solid results on metrics like length of stay and readmissions.
When MUSC Health Black River Medical Center opened its doors in January of 2023, the hospital launched a telehospitalist service to care for admissions to its 25 inpatient beds. Instead of trying to hire staff physicians (or more likely locums), the hospital hired a small group of telehospitalist physicians to work with on-site APPs.
A Journal of Hospital Medicine article reviewing Black River’s telehospitalist program said MUSC created the service to offer high-quality care to the community while ensuring “the financial stability of the rural hospital.” The article also noted that since 2005, four rural hospitals have closed in South Carolina, including two hospitals that used to operate near the new facility in Black River.
How the program works
Each day, APPs round on patients before talking to physicians on the phone for “table rounds.” The team reviews patient charts using the hospital’s EHR on the calls and discusses the hospital’s full census. The telehospitalist and the APP then do live video patient rounds.
APPs take care of documentation and billing at the hospital. Physicians provide in-person consults (on certain days) for general surgery, orthopedic surgery, GI and podiatry. Consults for ID, neurology and palliative care take place via telemedicine.
The telehospitalist service typically has a census of about 30 patients. That number includes patients at Black River and at another small rural hospital.
Telehospitalist stats
The authors of the JHM article said that during the hospital’s first 18 months, the telehospitalist service discharged 84% of all the hospital’s admissions. Hospitalists had an average daily census of 14.3, a length of stay of 3.4 days for all inpatients, a mortality index of 0.14 and a 30-day readmission rate of 8%.
Compared to similar size hospitals, the JHM piece said, Black River’s overall performance ranked consistently in the top 25% of hospitals as measured by Vizient, a national health care performance improvement company. And in the first 18 months the hospital was open, admissions grew not only in terms of overall numbers, but in the number of patients covered by Medicare and private insurance.
Community acceptance
The telehospitalist program at Black River was not the Medical University of South Carolina’s first dive into telemedicine.
The MUSC network runs a telehealth center that has received national recognition. The system operates more than 100 different telehealth services in nearly 350 sites and in patients’ homes across South Carolina.
Telemedicine might be old hat for MUSC, but the community surrounding Black River was less familiar with the concept of telehospitalists. The hospital met multiple times with local PCPs to explain how telemedicine would provide high-quality care. The hospital also hosted a gala to introduce the model to business leaders.
Despite those efforts, the authors of the JHM piece said they could have spent more time “gaining the support” of PCPs and explaining how the telehospitalist model would focus on high-quality care and introducing the concept of virtual care to other key stakeholders in the community.
Nonvirtual staff
While Black River went with a virtual model of care for its hospitalist team, the hospital nonetheless experienced challenges with nonvirtual staff.
The JHM article, for example, noted the telehospitalist team’s productivity was at times crippled by nursing shortages. The telehospitalist service could have taken more admissions, but a lack of nursing support drove down their daily census.
Another limitation of the telehospitalist team had to do with procedures. Because APPs can’t do procedures, the hospital reached an agreement to have the onsite emergency medicine physician do urgent procedures like intubations, central line placements and lumbar puncture.
More on the telehospitalist service at MUSC Health Black River Medical Center is available in the Journal of Hospital Medicine review of the program.
