Dr. James Backstrom, CMO, ACMH Hospital, sat down with Dave Zynn, CEO, Infectious Disease Connect, at the 2023 SHM Converge Conference held in Austin, TX on March 26-29, 2023. In their featured presentation, “Building a Successful ID Inpatient Telehealth Program that Benefits Hospitalists,” they discussed the many ways telemedicine is improving care in a rural, community hospital. Following their talk, Dave and Dr. Backstrom answered several questions from the audience.
If you missed this presentation, listen to the podcast recording
Q: What platform do you use for the synchronous tele-ID consults? Do hospitals have to use proprietary software, equipment or technology?
Dave Zynn: ID Connect is largely agnostic to the types of tele-consult hardware and software we use. While we typically use the Vidyo platform, which provides secure cloud-based connectivity for seeing patient, we are open to using other systems that hospitals may already have in place. The most important point of compatibility is having our clients and ID clinicians use the same electronic stethoscope. Other than that, being agnostic has been actually very beneficial as many hospitals are trying to standardize the equipment they’re using.
Q: When ID Connect’s ID physician examines a patient, are there other shared diagnostic tools?
Dave Zynn: In addition to the electronic Eko stethoscope, our teams of tele-presenters and ID clinicians use an Otoscope and a digital camera.
Q: How are the tele-presenter nurses trained to support tele-ID?
Dr. James Backstrom: The equipment training is straightforward so most of the educational time centers on the types of exams that ID Connect’s doctors will do.
In essence, the tele-presenters at ACMH have become our ID nurses. They’re doing the statistics and they’re generating the reports that need to be generated for the state and for us. It’s a comprehensive job for them, but they can also partition out parts of the work. For example, I have one new tele-presenter trained each quarter, so when one nurse takes time off, there’s someone else that can cover the role. There are some places that I’ve talked to in my travels that schedule their tele-presenters around different services, so they basically train individual nurses on each floor. I like the single person tele-presenter staff model so that person becomes a direct report to me and I’m engaged with the practitioner and patient population that has ID problems. I’ve also developed a personal relationship with most of the ID people and the pharmacy people as well. We’ve become a team service.
Q: Does your hospital use ID Connect to cover pediatric ID cases?
Dave Zynn: ID Connect does offer pediatric ID services to a few of our clients. We are looking to expand this support throughout 2023 as we know there is a tremendous shortage of pediatric ID specialists.
Dr. James Backstrom: Our hospital gave up in-hospital pediatrics some time ago although we have the largest pediatric practice in Pittsburgh. We have an affiliation with UPMC, so many of their outpatient pediatric questions are answered by the UPMC docs, which they are affiliated with.
Q: How much time does it take for your ID doctors to answer a consultation request and is there continuity with the same ID provider when following patients? Do they see patients daily or does it get moved around?
Dave Zynn: We have a 24-hour SLA, but we typically are responding to a consultation request within hours. We also work with tele-presenters to schedule several appointments together if we are doing live audio-video consults so that we can be more efficient with his or her time. ID Connect assign a small team to service a hospital so that our staff and the hospital staff get to know one another. In building these small teams we account for time-off and unexpected illnesses so we can rotate people on or off, and they do a great job of handing off. We absolutely follow each patient. We often do our rounds electronically, meaning we’ll go into the EMR as much as is needed if we’re looking for a lab or expecting something else. We regularly go in and look at the hospitalist’s notes to ensure continuity. We hear often that our notes are very, very detailed and include a full game plan – not just an immediate assessment.
Dr. James Backstrom: There’s an education component that goes into working with physicians and their patients, so the end result can be actually self-destructive in some ways. What happens is our hospitalists become very good at dealing with certain ID cases they weren’t necessarily very good at before. For example, we’re having some issues with Lyme disease in Armstrong County, and we learned an awful lot about some of the odder diseases and by working with ID Connect we learned we were not making the correct diagnoses. Now I can tell you my hospitalists, are Lyme disease experts and they don’t consult them on these cases very much anymore. While it costs me money, the patient gets great care, and that’s often because of ID Connect’s through approached to ID – which includes things like very detailed notes. More importantly it is because of the constant conversation that is going on between all our staff members.
Q: Does your service also operate outside of the hospital in the post-acute area, in the SNF, inpatient rehab, LTACHs?
Dave Zynn: Yes, we do work with outpatient facilities. What we’re doing more and more is proving OPAT-like follow-up when patients leave a hospital. For example, if a patient leaves the hospital on an IV antibiotic, we will be their telehealth support when the patient is moved to an outpatient or a transfusion center on behalf of the hospital.
Q: How often do you do patient and provider engagement surveys, and have you published them. Do you know if this type of tele-ID actually helps with patient satisfaction and the provider satisfaction?
Dr. James Backstrom: We have the data, and we should get together with ID Connect and do a little bit more publishing. From my own experience, tele-ID receives the highest scores in our facility, so I wanted to verify what exactly was happening. I round on patients myself. I’m not the type of CMO that’s answering an email 30 seconds after it comes, because I’m walking the halls. Additionally, since the tele-presenter is my direct report, I really wanted to know what they’re doing. So once our patient satisfaction data came out, I began to go back into those patients myself and ask, “How did that go?”
Repeating that exercise over the last six months has verified to me at least, unless they’re frankly lying to my face, and I don’t think they are, people are so happy with their tele-ID consults because of the dedicated time each doc spends with them. If I could consolidate all the patients’ comments, the most consistent mentions are related to time. They feel like they’re attended to and they really care. That’s very valuable to a patient. Our hospitalists are horrendously busy, and everything is about getting the EMR taken care of, getting the scripts done, getting the discharge summary done, talking to case management, and then talking to the insurance company. There isn’t as much focus on the patient by either the doctor or the nurse as they would like.
By bringing in telehealth, and specifically bringing in ID Connect whose entire focus is the patient because that’s what they’re there for. For the patient it’s unique. I think it’s become unique that they would get to spend that much time with their doctor, even if it’s on-screen. I think we’re going to find that this has actually been the paradigm shift that has occurred from pre-pandemic to now. As a telehealth guy, having spent 15 years in teleradiology, I guess I’m not surprised at that because I saw this same level of high patient satisfaction in my previous life. I don’t think I would have predicted that tele-ID was going to generate the same kind of positivity. I hoped it would, and to date, it has far exceeded any expectations. It’s been a great experience.
Q: With PHE expiring in May, how’s that going to affect tele-ID providers seeing patients virtually in terms of billing and RVUs? What is the financial impact?
Dave Zynn: In the most recent federal budget, a lot of the telehealth related billing allowances were expanded for two more years. We just did an analysis of telehealth billing, and on the private side we’ve also seen more insurers reimbursing telehealth at surprisingly slightly higher rates each year. Again, I think that’s part of the adoption. I think everyone throughout the entire healthcare system is seeing the benefits from telehealth, and I really don’t expect the reimbursements to go away. I think there’d be a public outcry if they did.
Dr. James Backstrom: And I would say this, it’s imperative that the docs, you and me, get out there and get on committees. I’m on pretty much every quality committee that I can get inserted into, and I’m on one of the boards of an insurance company we work with. Now, I’m not doing that because I like it, because actually I don’t. It bores me to tears. But these people need to be educated, and they don’t know what they don’t know. I think one of the things all of us who have adopted tele-enterprises can do for our insurance colleagues is to basically make them understand the cost savings that we are bringing to bear on some pretty expensive services.
If I have to pay for a doc, I have to increase my rates. If I have to keep people in the hospital longer, I’m not doing it as efficiently. If I’m not doing quality antibiotic prescribing and monitoring, I’m costing someone money. What better way to do ID than to aggregate talent and teams to come in and basically solve the problems that one doc probably doesn’t have the capacity to solve. I think we’re getting past this ego thing. As a doctor, I know some things and I’m good at some things, but there’s a lot of stuff I don’t know and I’m not good at – and ID care is one of those things.
We are admitting that what we need is another talented partner who I really respect who can bring those pieces in. But the more we can figure out ways in medicine to aggregate as a team and bring in talented people to solve specific problems, I think we’re going to provide better medicine at a better cost. This type of care delegation just isn’t in our nature at this point. Training has to change.