Employment isn't the only option. Cedars-Sinai ran into similar problems with private neurologists not wanting to come in on nights and weekends to evaluate stroke patients and identified a subgroup of neurologists for a stroke panel. In exchange for participation, the hospital told the physicians they would keep patients they saw during call if they didn't already have a neurologist.
Key No. 4: Adopt telestroke
If certification requirements and other market forces continue along the current path, the landscape of stroke care will start to resemble a series of hubs and spokes, says Catto. Comprehensive stroke centers that perform surgeries and more advanced interventions will serve as a hub, and most other hospitals will become certified as primary stroke centers to handle initial responses.
But the web of stroke networks will be virtual, as well. Telestroke technologies allow larger stroke programs to build relationships with smaller hospitals in rural and suburban areas through video consultations and other remote forms of treatment. "Telestroke provides the kind of framework where good quality can be provided. From a cost analysis perspective, it allows people to stay local to have faith in their hospital locally, if they don't need to transfer," says Likosky.
Telestroke networks are as much about relationships as technology. Swedish has telestroke agreements with two hospitals within its health system, as well as four others outside the network. In each case, formal agreements exist to build trust between the hospitals and answer any questions that could impede the care process.
The referring hospitals, or "spokes," typically need a few questions answered before they're willing to let another hospital see its patients via telemedicine, says Likosky: "Can you help me but not subsume me? Can you respect my need to keep patients at my medical center? Can you help train me?"
The "hub" hospital has its own set of concerns, primarily centered on making the technology work and working through the reimbursement challenges and cost-benefit analysis. Physicians at the hub hospital may need a guarantee that they'll be reimbursed for consulting on a patient at another hospital, and doctors and administrators at the outlying hospital want to make sure they aren't just sending business to a potential competitor.
Like most technologies, telestroke isn't for everyone. Beaumont Hospital looked into the technology but decided it wasn't worth the investment, in part because neurologists at the potential referring hospitals thought they could handle stroke cases without tele-assistance, but primarily because of market conditions, says Catto. The Michigan Stroke Network nearby already had about 35 of the state's hospitals in a telestroke system, so for Beaumont to add additional hospitals to its telestroke network—which would have been the only way to make it cost effective—it would have had to cross state lines.