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population health

The Future of Hospital Medicine: The Tools and Integrations Shaping the Specialty

Posted on Tue, Dec 22, 2015
The Future of Hospital Medicine: The Tools and Integrations Shaping the Specialty

By Francisco Loya, MD
The technologies we are using to improve the delivery of care in hospital medicine are showing great promise – if not outright success. EmCare’s Hospital Medicine team is deploying innovations that improve operational efficiency, enhance quality of care, ease staffing challenges and upgrade billing and coding practices. As these tech tools become more prevalent, I would argue that the future of hospital medicine has arrived, and with it the promise of better care and lower costs.
Operational Efficiency in a VBP World

The value-based purchasing environment has increased pressure on hospital medicine teams. The onus is largely on us to try to prevent readmissions while still being expedient with inpatient care and discharge to help increase patient satisfaction. Through automation, we have been able to reduce wait times for patients, streamline the admissions process and improve rounding and charge capture.
Through technology, we have created a platform for emergency physicians and hospitalists to meet and confer virtually so that the hospitalist may admit patients without having to visit the emergency department. This platform has allowed for a decrease in boarding times by 2.5 hours, an 8 percent reduction in “left without treatment” rates and overall improvement (to nearly 100 percent) in CMS core measure compliance. A by-product of the reduced wait times for patients is an increase in E.D. volume of nearly 27 percent. This has meant more volume for the hospital without any additional strain on resources.
Another technology we use coordinates admissions between hospitals and primary care physicians. This direct admit system is enacted with a click of a button by the primary care physician, who can then complete an online form to admit the patient to the hospital. The platform also generates a “boarding pass” for the patient to bypass the E.D. and go straight to the inpatient floor. Not only does this technology improve cohesion between hospitals and primary care physicians, it also improves patient satisfaction since wait times are reduced. That, in turn, leads to a decrease in E.D. crowding and an increase to the hospital’s referral base.
These tools certainly don’t substitute for human interaction and can’t guarantee improved quality of care, but they do allow for greater control and management over various administrative protocols. The results from these tools have been positive – both for hospitals and patients. Doctors are able to increase their focus on patient care, and most hospital medicine support staff and caregivers say their jobs are easier and more efficient.
Telemedicine Can Ease Staffing Woes

Telemedicine is another futuristic technology that’s growing in use and importance. Hospitalists are benefitting from virtual care and robotic caregivers who can help hospitals meet staffing and practice challenges.
“Five years ago, the technology wasn’t there,” said Angel Iscovich, M.D., a divisional CEO of staffing and innovation for EmCare. “The safeguards for patient privacy to protect encounters conducted over video just weren’t ready.”
Now we have cybersecurity that allows doctors to engage with patients via a video screen and webcam. The practice is easing staffing shortages for hospitals and putting patients at ease since they’re able to meet with highly qualified specialists no matter where those physicians are.
And, patients are responding positively to robot doctors. Robots are slowly taking over rounding duties in some hospitals, acting as nocturnists that provide after-hours care. Companies that provide "robodocs," such as InTouch Health, report that its robots can monitor heart sounds and connect to EMRs to improve care and efficiency. The robots are controlled with a tablet, so a caregiver can operate the robots onsite, or doctors can control the robots remotely for virtual visits. The robots can easily round on the intensive care unit, interface with the equipment and provide more expedient and effective rounding than some of their human counterparts.
Cameras for the “robodocs” provide enough mobility and resolution to offer high-quality care. One doctor, through the use of video screens and robots, can cover multiple facilities while staying in one place. Hospitals can reduce costs by “sharing” the off-site physicians. And patient satisfaction scores have, so far, not suffered because of the technological intermediaries. If anything, early studies show that patients believe the robodocs and tele-visits provide access to quality providers that otherwise would be unattainable.
Bundled Payment Initiative Requires Integration

The Bundled Payments for Care Improvement (BCPI) initiative is a federal government program designed to help manage costs for Medicare patients. BCPI allows disparate organizations to combine services and arrange for payment models that include financial and performance accountability for episodes of care. The program includes four broadly defined models of care to include various combinations of pre-acute care, acute care and post-acute care.
With this recent inducement for organizations to work together, clinical integration is more important than ever. Companies will need to attain certain levels of synergy outside of their own organizations. There are, however, some companies that are diversified enough to maximize the potential benefits of BCPI for themselves, their clients and patients. This type of self-integration tends to be more reliable because they have more control over more pieces of the BCPI integration – they are better able to manage quality of care across the care continuum. Through integrated services – for example, a post-acute care company working with hospitalists – costs are reduced, which increases patient satisfaction, since that patient is less likely to need readmitting and can receive care at home (where the patient generally prefers to be). With the cost offset, reimbursement from CMS can be more meaningful for the hospital as well.
Medical Command Center Provides Remote Care Coordination

Technology is allowing post-acute care companies greater control over the care offered in a patient’s home as webcams and video screens put caregivers face-to-face with patients. Our parent company, Envision Healthcare, has pioneered the Medical Command Center, a new concept that allows healthcare providers to check in with patients to regulate prescriptions, check vitals and confirm operation of in-home medical devices. Medical Command Center staff use their high-tech control rooms to manage care for patients in a number of states and can quickly dispatch a caregiver, such as a mobile integrated paramedic or physician assistant, to a patient’s home when necessary.
These software advancements, tech tools and integrated services are becoming more pervasive as technology advances and providers find new ways to effectively integrate their services. By focusing on operational protocols like admissions, rounding and discharge, along with streamlined billing practices and more seamless care, patients reap the benefits of high-quality personal care provided by caregivers while waiting less, paying less and visiting hospitals and doctors’ offices less.
By embracing the technologies that are available now and those on the horizon, hospitalists create more efficient practices for themselves and their patients, and are better able to focus on patient care, as opposed to the administrative processes that often keep us from the bedside - where many physicians prefer to be.

Francisco Loya
Francisco Loya, MD, MS, is chief executive officer of EmCare Hospital Medicine. In addition to his EmCare duties, Dr. Loya serves on several committees for the Society of Hospital Medicine, including the Practice Administrators Committee, the Hospital Quality and Patient Safety Committee and the Information Technology Committee. As a physician, Dr. Loya specializes in internal medicine. He earned his undergraduate degree at Rice University, earning a B.S. in Biochemistry and Molecular Biology. His M.D. came from the University of Texas Southwestern Medical School in Dallas and his internal medicine residency was completed at Brigham and Women’s Hospital in Boston – an affiliate of Harvard Medical School. Dr. Loya has also earned his Master of Science degree in Healthcare Management from the Harvard School of Public Health. After earning his master’s degree, Dr. Loya created the technology he named CMORx, which is now offered exclusively by EmCare.


The New Healthcare Continuum: How Mobile Integrated Healthcare Is Providing New Career Opportunities for Clinicians

Posted on Mon, Sep 14, 2015
The New Healthcare Continuum: How Mobile Integrated Healthcare Is Providing New Career Opportunities for Clinicians

Imagine a healthcare system where emergency medicine and hospital medicine clinicians use advanced mobile integrated healthcare (MIH) technologies to work in tandem with EMS and medical transport to deliver the right care to patients in the right location and at the right time. This new vision of healthcare is becoming reality; healthcare has gone mobile and not only are people staying in their homes longer, they are receiving in-home care for conditions that at one time might have led to a trip to the ER.

For clinicians, this revolutionary approach to delivering care provides opportunities to grow both as physicians and as leaders. And, it allows physicians to practice medicine in an organization committed to changing the face of healthcare.

EmCare and its parent company, Envision Healthcare, are developing solutions that increase the quality and experience of care while simultaneously reducing costs.

Envision Healthcare provides:

  • In-hospital care through EmCare, a leading physician practice management company
  • Medical transportation services through AMR, the nation’s largest medical transportation company
  • Out-of-hospital care focused on disease management and intervention through Evolution Health, a nationwide leader in such services

Evolution Health uses two state-of-the-art Medical Command Centers, one in Texas and one in Florida, to link mobile resources together, integrating them and coordinating them to respond to a patient’s needs. The Medical Command Centers are physician-led medical practices that provide immediate access to licensed medical professionals who can effectively evaluate the patient’s current condition and match and deploy appropriate resources to meet the patient’s needs. Two of EmCare’s physicians serve as medical directors to provide clinical oversight to the Medical Command Centers.

From Emergency Physician to Mobile Integrated Healthcare Leader

One of EmCare’s physicians involved with the Medical Command Center is Jerry Allison, M.D. Dr. Allison was a medical director for two EmCare sites in California as well as a medical director for AMR in San Joaquin. Two years ago, he was promoted to regional medical director for EmCare and was soon appointed medical director for AMR Dallas and the Texas Regional Communication Center. In this role, he trained critical care paramedics and mobile integrated healthcare paramedics (MIHPs).

Evolution Health’s continued growth allowed Dr. Allison to transition into the role of medical director at the Medical Command Center.  As medical director, he provides leadership to physicians, advanced practice providers, nurses and support staff who care for more than 3,000 patients in the Dallas area, including providing mobile lab and imaging services.

Patients from across the country can call either center to:
  • Ask questions about medications
  • Get medical advice
  • Reach their primary care providers
  • Schedule appointments
  • Request an urgent medical evaluation

The centers also offer remote monitoring for certain populations and can provide telemedicine services through on-scene providers and on-call physicians. Transitional care services can help bridge the gap between hospital discharge and the primary care provider, saving thousands of dollars per patient in readmissions.

“Our goal is to deliver the right care at the right time in the right place,” said Eric Beck, DO, MPH, chief executive officer of Evolution Health. “For many patients that place is the home and not the hospital. One of our practices, our transitional care program, is making a big difference across the country by helping reduce avoidable trips to the emergency department. As a physician, it’s gratifying to know we are leading change in the healthcare system.”

Joe Nelson, M.D., an EmCare physician practicing in Miami, provides similar clinical support to the MCC in Florida. Dr. Nelson was medical director for AMR Florida for 22 years and was an EmCare emergency physician for 14 years.

“Throughout my career I’ve encountered patients who need help avoiding a ‘revolving door’ of repeated ED visits and hospitalizations and a declining quality of life,” said Dr. Nelson. “When Evolution Health offered me a chance to participate as the Florida Medical Command Center and MIH Medical Director, I couldn’t wait to start. I believe the MIH concept is the most exciting change in EMS since the early days of the 1970s.”

The Benefits of Mobile Integrated Healthcare

Envision Healthcare-affiliated providers care for more than 15 million patients each year in thousands of communities nationwide.  Its model provides services that improve quality and coordination of care from the home to the hospital and home again – with the objective of keeping patients healthy and out of the EMS system and out of the hospital. This methodology improves clinical outcomes and lowers the cost of care for payers, while simultaneously enhancing the patient’s experience.

The benefits are significant:
  • For healthcare providers, MIH means access to numerous clinical and support personnel and technologies that improve clinical quality and outcomes.
  • For patients, MIH means care is provided in their preferred setting – their place of residence  – leading to improved clinical outcomes and patient experience.
  • For payers, including Medicare, Medicaid and health plans, MIH means reduced costs and improved patient satisfaction.
  • For hospitals and health systems, MIH means a reduction in avoidable readmissions.

Evolution Health successfully collaborated with a multi-facility hospital system to help reduce its preventable hospital readmissions. Managing more than 1,200 patients, Evolution Health was able to reduce the overall readmission rate to 9.6 percent for all patients admitted to service, regardless of diagnosis or payor source.

“I truly think that the synergies of AMR, EmCare and Evolution Health will have a profound impact on patients, EMS and the delivery of healthcare nationally,” said Dr. Nelson. “This is the beginning of something big, and I’m proud to be part of the organization.”

For more information about job opportunities, visit our Careers page.