Access. Quality. Cost. In 1994, William Kissick introduced us to these three facets of the “Iron Triangle” of health care. The theory that we can only master two, but never three, of these issues simultaneously seems apparent to anyone in the practice of medicine today. In rural America, home to 60 million people, Critical Access Hospitals (CAHs) are acutely aware of the difficulties of providing quality, affordable care to all of their patients.
CAHs are small hospitals that provide a high level of emergency and inpatient services to their patients from rural communities. They often face unique budget issues and physician shortages which their counterparts in urban settings can avoid simply through economies of scale. Subspecialty help is sometimes nonexistent, attracting new physicians to rural areas is often problematic, and patients can be forced to travel long distances to access certain services.
Further burdening the 1300 plus CAHs in the United States is the impending physician shortage of the next several years. The Association of American Medical Colleges predicts a total physician shortfall of between 40,800 and 140,900 by 2030. Mid level providers are expected to make up some of the loss, but in an inpatient environment with sicker patients, oversight by a physician is still essential.
Enter telemedicine. A solution to the Iron Triangle, right? Not so fast. In the rush to market for many telemedicine providers, poorly implemented service and push for profits has stifled the goal of CAHs to use telemedicine as a solution. But some have proven that a cost-saving telemedicine model can maintain quality while improving access to care.
Beam Healthcare, a physician-owned telemedicine company, has implemented a proven model for shared physician services at CAHs and soon at Skilled Nursing Homes. At a CAH in southern Wisconsin, Beam’s team of night telemedicine hospitalists worked seamlessly with daytime, in-house physicians. Year to year, there was no increase in patients transfers or decrease in patient satisfaction versus the prior year’s traditional on-site nocturnist physician coverage. Beam Healthcare is unique in that it is able to provide high quality care accredited by The Joint Commission at a lower cost and overhead through its economy of scale business model.
Patient access and quality care were maintained or improved, while costs decreased. While there is no total solution to the Iron Triangle of Health Care, this properly implemented telemedicine solution is making great strides. This is good news for America’s Critical Access Hospitals, at a very critical time of changing healthcare.