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Strategies in Scaling Telemedicine
Harsha Gopinath, Corporate Director
Prime Healthcare
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Agenda
1. Prime Healthcare Overview
2. Telemedicine Program Development Process
3. Telemedicine Service Lines
4. Outsourcing and Crowdsourcing the Physician Panel
5. Endpoints, EMR Integration and Billing
6. Clinical Division of Responsibility – Remote vs On-site Providers
7. TMIQ For All
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Prime Healthcare Overview
Prime will continue to acquire hospitals and needs a telemedicine platform that can scale to both current and future operations for multiple telemedicine service lines.
• Prime Healthcare Foundation is a public charity dedicated to improving access to healthcare which holds the non-profit hospitals donated to Prime and provides funding the California University of Science and Medicine and other medical training programs.
• Named by Modern Healthcare as one of the fastest growing hospital systems in the United States.
• Founded in 2001 by Dr. Prem Reddy, a Cardiologist practicing in the Inland Empire region of Southern California.
• Desert Valley Hospital was purchased out of bankruptcy and Dr. Reddy led the first clinical transformation effort to make it viable.
• Prime currently operates 45 hospitals in 14 states, all of which were failing and/or in bankruptcy when Prime acquired them.
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Telemedicine Program Development Process
Needs Assessment/Survey
• Telemedicine survey issued to all Prime hospitals.
• Corporate CMOs and Physician Services teams identify hospital needs.
Corporate Review/Approval
• Does the initiative increase revenue and/or decrease costs?
• CMOs make final decision on approval of new programs.
Implementation
• Weekly program implementation calls for all services.
• Prime works with SOC to coordinate program management activities for all telemedicine services.
Ongoing Review/Management
• Regular review meetings with clinical vendors.
• SOC identification of process or technical issues with TMIQ.
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Smaller Prime
hospitals have low
census ICUs due to
coverage issues and
larger hospitals would
like a back-up.
Prime is actively
adding inpatient
psychiatric beds and
growing the service
line.
Prime is requiring all
hospitals to achieve
Primary stroke
certification.
Neurology Psychiatry ICU
Target hospitals with
significant fluctuation
in volumes (surges)
and those with high
no-see rates.
ER
Telemedicine Service Lines
Other telemedicine service lines include hospital medicine, cardiology, sub-specialty pediatrics, outpatient primary care and a patient app which
supports RPM, CCM and VBC.
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Outsourcing/Crowdsourcing the Physician Panel
Prime uses a variety of staffing sources and models for telemedicine including telemedicine staffing firms, Prime employed physicians and independent medical staff physicians.
• There are over 10,000 medical staff physicians across all Prime hospitals.
• Prime employs over 1,000 physicians through its affiliated medical groups.
• Contracted on-site providers for psychiatry and neurology have the opportunity to join the panels to cover additional Prime sites in a given state.
Specialty Staffing Source Avg Panel Size
NeurologyStaffing Firm/On-site
Providers10
PsychiatryStaffing Firm/On-site
Providers10
ICUPrime
Employed/Contracted2-4
ERStaffing Firm/Prime
Employed6-10
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Endpoints, EMR Integration and Billing
Prime is looking to achieve consistency in delivery of telemedicine services for all hospitals to better support its clinical and operational strategies.
• The SOC Touchscreen cart is the primary device used and other devices will be phased out as those leases and/or contracts expire.
• Prime is using the integrated RCM solution from SOC to support professional fee billing for all telemedicine providers.
• Ensuring consistency at each hospital site for all telemedicine services starts with a standardized service request process.
• EMR integration with Epic and Meditech sites is being done to support the pro fee billing initiative.
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Clinical Division of Responsibility
On-Site Providers
• Should understand the limitations of remote providers as it relates to orders and follow-ups.
• Ensure they are engaged with remote providers so they can better understand the service and get to know the individual physicians.
Remote Providers
• Provide guidelines to Prime hospital on what the providers will do and will not to.
• Support as much doc-to-doc communication as possible with referring physicians.
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Telemed IQ for All
Prime would like to get our hospital leadership teams thinking about the next great telemedicine service line.
In order to do this you must understand Telemed IQ and have little bit of vision.
• Every hospital has different needs and Telemed IQ provides a standardized approach for evaluating programs by specialty.
• Hospitals that have telemedicine experience are now driving the requests and evaluation of new services.
• Prime wants every hospital to take ownership of their telemedicine programs.
