WITH MORE THAN 30 years of telemedicine experience, Avel eCare—based in Sioux Falls, South Dakota—currently has 850 customer sites across several service lines in 42 states. Launched in 2017, its telehospitalist service now has close to 40 hospitalists working with more than 60 partner sites across 12 states.
Many of those sites are critical access hospitals that serve as the spokes affiliated with a main hub campus, like the Gundersen program. But Kelly Rhone, MD, an emergency physician who is Avel’s chief medical officer, says her company’s telehospitalists increasingly work with larger hospitals to offload census during surge times.
Some of the hospitals that the telehospitalists work with have APCs onsite, while others may have doctors. The company’s telehospitalists also cover long-term acute care facilities and even a surgical hospital.
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“We feel confident that payment for telemedicine is here to stay.”
~ Kelly Rhone, MD
Avel eCare
Avel eCare’s menu of telehospitalist services is completely customizable. With some partner sites, the service provides only night coverage; with others, telehospitalists may serve as consultants for complex patients during the day. “Or we can round with their APC or physician or do rapid responses or codes and provide transfer assistance.” They can also virtually round without a provider.
“Any place that a hospitalist would be working or needed, and that can look a lot of different ways across the spectrum, we find out how we can help,” says Dr. Rhone. While demand for the company’s telehospitalist services surged during the pandemic, interest remains high, particularly for surge capacity, given that the Medicare payment waiver for telehealth has been extended through the end of this year.
“We feel confident,” Dr. Rhone says, “that payment for telemedicine is here to stay.”
A hybrid hospitalist schedule
Avel eCare does maintain a virtual hospital in Sioux Falls where some telehospitalists work shifts. But many live around the country and work from home—an arrangement that’s not only a big satisfier for those physicians but allows them the leeway to jump online for only a couple of hours to help out a hospital experiencing a census surge.
“Many of our hospitalists actually work at brick-and-mortar hospitals outside of us so they have a hybrid workflow, something I also think people enjoy,” says Dr. Rhone. All the hospitalists working for the company have several years of bedside experience.
Hospitals differ, she points out, in terms of what they have available with labs, radiology and consultants.
Meanwhile, the company’s size and experience give it a good sense of staffing and census. “We look at a hospital’s typical average daily census over several years and also at when admissions come in,” Dr. Rhone points out. “We also know the average amount of time we need to spend on admitting, cross coverage or rounding.”
Another advantage the company brings: Its telehospitalists work on teams with nurses who actually triage the calls coming in from partner hospitals. The nurses also serve as a resource for remote sites’ bedside nurses, fielding any questions they may have. Avel eCare also has a critical care on demand feature that can give remote hospitals access to an intensivist, when needed.
Avel eCare turns all billing for the care provided over to their hospital partners. Some of its contracts are with hospitals only for surge capacity and only on those days that the onsite hospitalists’ census is each above 20.
“We’re seeing more regional hospitals that want intermittent staffing help,” Dr. Rhone explains, “because they may not be ready to hire a whole other physician.”
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 3: Rural admissions and post-discharge visits
Telehospitalists in a Georgia health system cover not only critical access hospitals but post-discharge follow-up with patients at high readmission risk. 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 is Executive Editor of Today’s Hospitalist
