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January 9, 2018

This 'virtual hospital' has no beds—and could be the wave of the future

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    Virtual hospitals could be the wave of the future, Arthur Allen writes in a Politico profile of suburban St. Louis-based Mercy Virtual Care Center.

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    How Mercy works

    Mercy Virtual Care Center has no beds of its own. Doctors and nurses see their patients on computer monitors that also display patient data and list problems that a computer program thinks clinicians should monitor.

    The virtual center launched at Mercy's flagship hospital in 2006, and it moved into its own space two years ago. "Instead of bright fluorescent lighting, beeping alarms, and the smell of chlorine, Mercy Virtual Care has striped soft rugs, muted conversation, and a fountain that spills out one drop a minute," Allen writes.

    Allen reports that Mercy Virtual sits at the point of convergence of several trends in the health care industry: hospital consolidation, advances in remote-monitoring technology, and new payment structures. According to Allen, new payment structures that incentivize providers to keep patients well might be the biggest driving force.

    Currently, Mercy Virtual is in the black due to Medicare reforms that pay providers for treating an entire illness rather than for individual services provided, Allen reports. Mercy Virtual President Randy Moore explained that the hospital gains revenue on these payments because the center allows the hospital to send patients home faster than average—allowing it to keep the money that would otherwise go toward a longer stay.  

    "Our idea is to deliver better patient care and outcomes at lower cost, so we can say to an insurer, 'You expect to spend $100 million on this population this year. We can do it for $98 million with fewer hospitalizations, fewer deaths and everyone's happy," Moore said.

    Keeping patients out of the hospital

    Mercy Virtual also focuses on keeping very sick patients from entering the physical hospital.

    For instance, nurse Veronica Jones talks at least twice weekly with patient Richard Alfermann, who has chronic-obstructive pulmonary disease (COPD). Alfermann had been hospitalized three times in the year before he entered the program—but hasn't been hospitalized since then, Allen reports.

    According to Allen, frequent remote monitoring creates a sense of intimacy that doesn't exist when patients encounter providers only sporadically. When a patient shows signs that medical intervention may be necessary, a physician can direct home health nurses to examine the patients.

    Moore noted, "A telemedicine visit is never going to be as good as having a doctor and his or her team at your bedside. But 99% of the time we can't make that happen. With virtual we can at least see any patient just like that―rather than tomorrow or next week. And that can be a life or death thing."

    Further, Carter Fenton, an emergency physician who has 450 patients under his care, said, "We always tell the patients, if you feel like you're getting worse, you need to just go to the hospital."

    The ICU

    In addition to keeping patients from having to go to the physical hospital, Mercy Virtual also runs programs to monitor patients who are currently hospitalized. The programs include TeleICU, TeleStroke, TeleSepsis, and TeleHospitalist.

    Allen reports that Mercy Virtual works as a "virtual ICU" in part as a response to the information glut created by technological innovation. While clinicians on the ground are occupied, Mercy clinicians assess the data from patient monitoring machines and monitor for problems. Chris Veremakis, who runs Mercy's TeleICU program, said, "We let the nurses on the floor do their regular work and not be pulled in a million different directions."

    For instance, Mercy Virtual nurse Tris Wegener watches her monitor for a red sepsis flower icon, which appears when the computer program detects potential sepsis in a patient. When she sees the icon, she investigates to determine whether the patient meets sepsis risk criteria.

    Wegener noted, "The nurse on duty might have three other patients. Is she aware of the problem? Sometimes, sometimes not. She might have another patient who's coding in the [ED]."

    How to get a virtual center off the ground

    Allen reports that Mercy's telehealth and remote monitoring mainly encompasses Mercy facilities in Missouri, Arkansas, Oklahoma, and Kansas, though it has partnered with hospital systems at the University of North Carolina (UNC) and Pennsylvania State University.

    Getting virtual care up and running can be challenging, Allen reports.

    "We'll spend time with [providers] and say, 'This isn't Big Brother looking over your shoulders: We're partners," Moore said. He added, "But doctors don't necessarily want other doctors writing their orders, and if they won't accept it, it doesn't work. If a nurse ignores our team because she's too busy and not used to TeleICU, nothing happens."

    But despite initial hesitation, some providers who have tried the system have come around.

    Dale Williams, CMO of High Point Regional hospital, which is part of the UNC system, said, "A decade ago I would have said, 'I don't know that that can work." After about two years with Mercy Virtual, though, Williams said, "I've been convinced. It would be ideal to have a doctor in each unit 24/7, but even then they can't be looking at the analytics the way these people do. They have critical care-trained nurses and doctors looking at this stuff all the time. They can camera in and count the pores on someone's nose" (Allen, Politico, 11/8).

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