This poses a significant challenge for lower-volume suburban and rural hospitals, where some providers can go a year without needing to use skills associated with newborn resuscitation. The impact? Expensive patient transfers—$18,000 per baby—that increase the opportunity for communication errors and place additional stress on providers, families, and the sustainability of community hospitals.
To address this challenge, Intermountain Healthcare added a neonatal video-assisted resuscitation (VAR) program to its telehealth platform. Benefits of the program make a strong case for neonatal telehealth, but it is hardly a risk-free investment. Here are three things to know about Intermountain's program:
1. VAR can support community hospital sustainability
From November 2014 to December 2015, among the eight hospitals studied, Intermountain's VAR program reduced transfers by 0.7 per facility month and cut a newborn's odds of being transferred by 29.4%. According to a detailed Health Affairs study, this corresponded to 67 fewer transfers over the course of the year and savings of over $1.2 million, given the $18,000 price tag per helicopter transfer.
Reducing transfers can also monetarily benefit individual community hospitals. By avoiding transfers, Intermountain's facilities captured the revenue from these higher-risk cases, increasing the financial sustainability of its community hospitals.
2. VAR programs can lead to direct and downstream quality improvements
Aside from cost savings, VAR offerings can improve care quality by increasing continuity of care and reducing transfer-associated risks. But using VAR can also lead to more comprehensive, downstream quality improvements.
By increasing access and interaction with specialists, neonatal telehealth programs like VAR give community hospital providers continued exposure to specialized skills and trainings for future advanced cases. According to Intermountain neonatology director Stephen Minton, MD, nurses who join Intermountain's telehealth program see test acuity scores jump from 12% to 88%.
3. The success of neonatal telehealth offerings like VAR depends on fostering a culture of collaboration and preparing for an uncertain reimbursement landscape
A VAR investment can be unsuccessful if organizations do not ensure a culture of collaboration rather than competition between system facilities and if they're unprepared to take on potential cost absorption in the event a payer does not reimburse for telehealth services.
Key to the success of Intermountain's program was a vital culture change between hospital nursery and NICU providers that emphasized operating as "one Intermountain neonatal care" system, as opposed to competitively. Proper care protocols and encouraging providers to practice as a team were also highlighted as crucial to success.
Additionally, a major risk of telehealth initiatives is the uncertain reimbursement landscape for these kinds of services. Payment policies and reimbursement models are noted to sometimes prevent providers from receiving payment for telehealth services. This can raise a significant adoption challenge and require systems to prepare to absorb the costs of operating telehealth consults.