In the Coronavirus era, the Importance of Combining Remote Telehealth with Physical Presence

When Hospitalist Medicine was first introduced around the early nineties, medical malpractice companies were unsure of how to underwrite, rate and manage the risk.

Over time, by taking chances and using internal medicine rating equivalents, the specialty proved that quality of care was improving and claims were not presenting at the rate anticipated.

Hospital administrators, surgeons in the community, and primary care groups all began to partner with the specialty. The elusive goals of increasing access to care, improving quality and decreasing cost seemed to be achievable, at least in theory. One of the challenges for hospitalist groups was determining how to sustain their business model and how to provide Medical Malpractice Insurance.

This staffing responsibility more closely, if not exactly, resembled emergency medical groups. These groups are committed to providing a medical doctor trained in hospitalist medicine to be physically present at all times at these facilities.

Medical malpractice policies for emergency medical groups had long established that using rating calculus that contemplates patient visits and levels of acuity was more commensurate with the actual risk of a lawsuit.

As these emergency medical groups grew and expanded, they needed a malpractice policy that could affordably onboard additional physicians. Emergency medical groups, some urgent care centers, anaesthesia and radiology, and now hospitalist groups began to count consultations, procedures, radiology reads and patient visits to develop premiums with creative roster-structured malpractice policies.

Hospitalist groups will often grow non-contiguously, practicing in different states.  This requires that the malpractice carriers and underwriters understand how to bring groups together, build rosters, and appropriately rate and cover these professional medical entities.

As the rating became more sophisticated, so too did the complex management of patients. Groups like aVera, IHC and other hospitals groups are beginning to understand, especially now in the Coronavirus era, the importance of combining remote Telehealth with physical presence to enable hospitalist medicine to continue its effect on the delivery of health care.

In rural communities, many local providers staff both a hospital and clinic. Use of Telehealth with hospitalists can enhance the quality of care and bring needed attention to so many hospitalized patients, especially during these times of unexpected and sudden surge.

In addition, the increasing complexity of patients requiring hospital care has created a need for these specialists to oversee their management while in the hospital.

Combining telehealth with hospitalist care Since the launch of this new method, the industry has seen significant results:

• Reducing by almost half the number of times that local providers had to come in while on call or working in the clinic.
• Averaging less than 10 minutes of wait time for an M.D. presence.

This hospitalist group gives a good summary of the value of using telehealth in this specialty:

“We support local providers and nursing staff by providing real-time access to expert internal medicine consultations – including admission, overnight and urgent support – and compliance with evidence-based practices, quality and EMR documentation standards.”

The use of telehealth with hospitalist medicine provides more available devaluation, reduces the number of transfers to tertiary care facilities, improves efficiency, actually increases admissions, and facilitates referrals to labs and participation in clinical trials.

Hospitalist services are ideal for critical access hospitals, and can also support community hospitals, regional hospitals and health systems. 

Whether mono-state, multistate, single or several physicians full or part time, the medical malpractice policies can manage the risk and provide ample coverage, including tail, at sustainable premiums.

A medical malpractice policy ensuring hospitalist groups using Telemedicine needs to include a separate limit providing technical errors and omissions liability. The reality is no hospitalist group can do its job without effective consistent functioning of their technology. Errors in technology have the same effect as an error in diagnosis, mistreatment or omission. Hospitalist malpractice groups with telehealth should include easy onboarding, provide tail to the canceling doctors and implement separate limits to cover the delivery and the data responsibility.

The Doctors Insurance Agency has professional liability agents throughout the West Coast to manage our clients in 44 states, numbering 4000 physicians and 400 facilities.

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