Telemedicine Won't Make Traditional Healthcare Services Extinct

As the retooling of the healthcare industry with telemedicine capabilities advances, the technology is supplementing rather than supplanting traditional modalities of medical service delivery.

As a veteran of the newspaper business, I have experienced the fear and loathing of outsourcing firsthand: market-driven consolidation of an industry and the rounds of layoffs that follow.

The outsourcing of some medical services through the use of telemedicine appears to be moving in a kinder and gentler direction.

Bloomington Radiology of Normal, IL, started contracting telemedicine services from Eden Prairie, MN-based vRad about eight years ago. A measure of handwringing at the radiology practice accompanied the deal, says Practice Administrator William Wilson. "It was a nervous move for a variety of reasons, but it's turned into a source of supplementing the practice," he says.

For Bloomington Radiology, the partnership with vRad has boosted staffing of the practice and expanded the range of services the practice offers.

The ability to rely on vRad radiologists to cover shifts on nights, weekends, and holidays has been a significant business gain for the practice, Wilson says. "It provided an opportunity to provide services 24/7… and costs far less than having an in-house person cover those shifts."

With a telemedicine partner, Bloomington Radiology is capable of providing more services with fewer staff radiologists, he says. The practice peaked at 15 staff radiologists several years ago, but employs 11 physicians now while delivering a 10% increase in service volume. The vRad partnership also helps control staffing costs, Wilson adds. "We know exactly what our costs are going to be with vRad… The work gets done. There are no 'I'm sicks' and no 'I quits.'"

With vRad radiologists available at all times, Bloomington Radiology is providing patients every kind of subspecialty exam except advanced pediatric care, he says. The practice provides services at three hospitals, including a facility that treats a high volume of neurology patients, and the ability of vRad to expand Bloomington Radiology's neurological exam capacity has become crucial to the practice's success. "That demand is really hard to handle, but vRad helps us meet [it]."

Despite all of telemedicine's advantages, Wilson says there will be limits within radiology for the foreseeable future. "I'm a huge advocate of outsourcing, but it has to be proper outsourcing." It is critically important, he says, for radiology practices to have staff radiologists working closely with their local hospital partners. "Relationships are everything in this business. You have to be careful in outsourcing the group's functions."

Telemedicine's Scale, Scope, and Efficiency
With 350 physicians, vRad provides services to 2,000 healthcare facilities in the United States and 10 other countries, according to Chief Information Officer Shannon Werb.

The majority of vRad clients are radiology practices that need "subspecialty coverage in the middle of the night," he says. "We're the market leader. We have made considerable investments in technology. We provide the complete service 24/7."

The telemedicine outfit provides more than clinical services, says David Trachtenberg, vRad's chief solutions officer. "We're more than a clinical provider; we provide insights for our clients," he says.

vRad has access to a wealth of radiology exam information and collects data that allows clients to track performance metrics and compare that data against their peers. "We're an information provider to help clients make better decisions, whether that's on the cost side or the revenue side… Clients are actually managing their service lines with the information we're able to provide them," Trachtenberg says.

'We're Active. We're Involved.'
Bloomington Radiology uses vRad analytics to help show its hospital partners how they can improve their performance. vRad tracks key metrics such as exam volume, which can identify hospital physicians who are ordering the most radiology exams. "It shows that we're active; we're involved," Wilson says.

The scale, scope, and efficiency of vRad's services generate financial gains for health systems, hospitals, and radiology practices, Trachtenberg says. "We're able to deliver services in a much more cost-effective manner because of our scale," he says, noting the costs associated with recruiting and paying full-time subspecialists such as neuro-radiologists. "We provide [that expertise] on-demand."

Benjamin Strong, MD, who serves as vRad's chief medical officer, says the telemedicine outfit offers a uniquely broad range of clinical services, including 24-hour coverage for several hospital neuro-stroke centers. "It is very important to these hospitals to have this service… It is an unreasonable expectation that hospitals and radiology practices will have the full gamut of services," he says, "We run the whole gamut."

Telemedicine for Language Interpretation
Atlanta-based Northside Hospital health system began ramping up its use of virtual remote interpretation (VRI) on iPads last December. "We've been heavily using this technology for almost a year, says Interpretation Services Coordinator, Darrin Bearden. "Because we’ve only used the technology for a year, we can’t yet attest to the financial benefits – but I do know we are more efficient."

In a partnership with Clearwater, FL-based Stratus Video Interpreting, Northside started using VRI in the health system's Atlanta hospital emergency department about three years ago to help serve patients who communicate in American Sign Language. "Last December, we introduced 145 iPads all at once," he says.

A decline in the average duration of interpreter encounters with patients shows that the VRI service has improved efficiency. The hospital tracks the duration of in-person, telephone and VRI interpretation encounters. "I've seen the average duration go down five minutes. We did the same amount of work [on iPads] in less time."

Northside operates three hospital campuses and "is currently purchasing physician practices all over Metro Atlanta. We're also purchasing imaging centers," Bearden says. Sending an interpreter to an off-campus physician practice is usually not cost-effective when accounting for the costs of travel, parking, and waiting for the physician visit to begin. "It's not cost-effective for us to send someone. [With VRI], we're only paying for what we really need. It reduces that down-time cost."

'Looking for the Balance'
With Stratus offering VRI for 17 languages and Northside serving a patient population that speaks 90 languages, the health system has no plans to stop hiring staff members to conduct in-person interpretation. Bearden says there will always be a need to have staff interpreters.

"It's an enhancement to our services. Traditionally, we had the telephone and the in-person. Obviously, those are two extremes… I do not want to get rid of the in-person interpreters. In-person communication is a more caring, empathetic approach. I'm looking for the balance between the video and the in-person interpreters."

As telemedicine matures in the years to come, the outsourcing balancing act is likely to play out in every sector of the healthcare industry.