WITH ITS MAIN campus in Gainesville, Ga., Northeast Georgia Health System (NGHS) has an employed hospitalist group that numbers about 100. Within the five-hospital system, three of the hospitals are rural and a group of about 10 or 12 of the hospitalists provide telehealth services to them, as well as take on additional work.
All of those telehospitalists, who work clinically in-house seven-on/seven-off, do telemedicine from home only during their weeks off.
“That’s been beneficial,” says Connor Cooper, MBA, the health system’s administrative director of hospital medicine. “After a few days off, the hospitalists are always telling me that they’re itching to get back to work. Here’s something they can do from home where they don’t have to come in, do a full shift or learn a new patient.”
The telehealth service line, which was launched in 2020, has gone through several iterations. In the first, telehospitalists processed admissions from the rural EDs to allow the providers on the ground in those remote sites to round on patients.
“Expect the productivity for a virtual hospitalist to be lower than one onsite.”
~ Connor Cooper, MBA
Northeast Georgia Health System
That work remained steady until 2022, when the number of rural covid patients went down, allowing in-house staffing in those hospitals to stabilize. The system’s hospitalist leaders then pivoted the telehospitalists to work instead as tele-extensivists, providing virtual visits to patients post-discharge with diagnoses—COPD, for instance, and pneumonia—associated with high readmission rates
Just recently, with census rising again in the outlying hospitals, the telehospitalists—in addition to their virtual extensivist work—are once again handling virtual admissions in the rural facilities.
“I anticipate that helping the rural campuses is going to be a long-term thing, just because volume fluctuates up and down so much,” says Ms. Cooper. “That makes it hard to staff them appropriately on the ground, so virtual is really a great option.”
Once those rural hospitals reach a certain census, “we send out an SOS e-mail to the entire hospitalist group to see if they’ll help with virtual admissions.” Hospitalists sign up at home and earn a per-encounter fee.
As for remote night coverage, a nocturnist at one of the smaller campuses provides that to the other two rural hospitals.
Expanding the service
In terms of expanding the telehospitalist service, Ms. Cooper says the health system’s medical director of virtual health, who is a hospitalist, is now piloting an early discharge program that would team a telehospitalist up with a paramedic.
Going forward, “it would be ideal to have someone work as a tele-extensivist in the morning and then do virtual admissions in the afternoon because that’s when most admissions come through the EDs,” says Ms. Cooper. “But we’re not there yet.” Originally, the telehospitalist doing virtual admissions was being paid for an entire shift.
The tele-extensivist shift was likewise originally conceived of as a full-day shift Monday through Friday, 8 a.m. to 5 p.m. “But we just weren’t seeing enough volume,” Ms. Cooper explains. “The productivity is so variable, and we are still looking for that sweet spot.”
While the onsite providers in the rural hospitals see between eight and 10 patients during a 10-hour shift, “with virtual, you have to remember that it’s not just walking to the ED for a patient,” she says. Instead, the telemedicine carts need to be taken to a patient’s room and nurses need to arrive. “Expect the productivity for a virtual hospitalist to be lower than one onsite.”
As Ms. Cooper explains, the health system has no plans to introduce any telehospitalist services in either of the system’s two large hospitals. “You feel comfortable doing telemedicine for diagnoses like COPD exacerbations,” she says. “In our larger hospitals, patient acuity is definitely higher and hospitalists have to talk with more subspecialists. That’s why we really haven’t moved into the model at our bigger campuses.”
While the telehospitalist service was the first telemedicine line, the health system has since moved into virtual services for the rural campuses in palliative care and infectious diseases. One of the rural hospitals also has a tele-ICU program, and the health system plans to launch that program in another as well.
“We plan to expand those service lines to try to keep more rural patients closer to home,” says Ms. Cooper, “rather than transfer them to a bigger campus 40 minutes away that the family may not be able to get to.”
For more information on telehospitalist services, read our additional case studies.
CASE STUDY 1: A hub-and-spoke model
A health system in the Midwest relies on telehospitalists at its main campus to provide a suite of coverage services to five rural facilities. Read more here.
CASE STUDY 2: Growing interest in surge capacity
A national telemedicine company deploys telehospitalists in rural hospitals and in larger ones to manage surging census. Read more here.
CASE STUDY 4: Telenocturnist coverage
A national hospitalist company opts to outsource virtual night coverage rather than grow its now telenocturnist service. Read more here.
Telehospitalist challenges to expect
Challenges include having to navigate different formularies and figuring out how to spark hospitalist interest in telemedicine. Read more here.
Combining telemedicine with in-person care
A hospitalist enjoys making virtual patient connections while maintaining skills treating higher-acuity patients inhouse. Read more here.
Phyllis Maguire has been Executive Editor of Today’s Hospitalist since 2006. Based in Bucks County, Pa., her health care interests are hospital medicine and long-term care options. She also likes zydeco, hiking, and reading memoirs and romances.
