Lessons of COVID-19 for Hospital Medicine

Hospitalists were on the front line in the response to the COVID-19 pandemic.?A huge surge in volume of the hospitalizations, with the majority of patients being managed on the medical floors, stretched hospital medical teams to the breaking point.???Hospitals were forced to look for ways they could continue to provide the highest quality care, while keeping their care teams as safe as possible.??Telehospitalist services were a key strategy for achieving these goals, e.g. by remotely

·??????Evaluating and admitting COVID-19 patients from the ED?

·??????Covering COVID-19 patients on floors and ICUs

·??????Providing oversight to rapid response teams

·??????Rounding from home by quarantined hospitalists

Now, as the pandemic shows signs of winding down, hospitals have the opportunity to consider the long-term lessons of the pandemic for their hospital medicine departments.

Financial Impacts

In 2021 hospitals experienced a 30% higher labor cost per adjusted discharge than in 2020.??Hospitals across the U.S. experienced shortages of doctors and nurses needed to treat COVID-19 patients. These shortages forced hospitals to rely on staffing firms where increased demand for health care personnel drove a steep rise in prices.?

As a result, more and more hospitals became aware of telehospitalists’ potential role in reducing overall operating costs.??The average telehospitalist’s salary is at least 27% lower??than an on-site hospitalist’s (not counting reduced hospitalist recruiting and onboarding costs), generating savings that can be applied to other hospital needs.??The use of telehospitalists can also make a positive contribution to the hospital’s top line in the form of increased revenues due to higher ADC.

Burnout

Long before the pandemic, the crowded work days, frenetic pace, time pressures, and emotional intensity of hospital work already placed hospitalists at high risk for burnout.??Burned-out hospitalists are more likely to quit their practice, and burnout can negatively affect care quality and patient safety.??Pre-pandemic, hospitals were having some success in stanching the outflow of hospitalists, as the nationwide turnover rates for hospitalists had been trending downward for more than a decade.?

However, COVID-19 added to many hospitalists’ already high levels of stress, by increasing their workload even further and adding the risks of catching the disease themselves and watching their colleagues get sick and even die from the disease.???Relatively few hospitalists quit during the pandemic, but now that the worst appears to be past, a significant number are again questioning their commitment to their work, considering whether to leave or at least reduce their hours.??

Once again, hospitals are being challenged to find ways of attracting and retaining hospitalists. In the post-pandemic era there is likely to be a greater number of clinicians interested in telehospitalist work as a way to lessen the strain of their jobs and restore a better work-life balance.???For their part, a growing number of hospitals are likely to view telehospitalist services as their best bet to meet their hospitalist needs.

Alternative Care Settings

The COVID-19 pandemic accelerated the trend towards treating some non-acute patients outside hospitals.??Even before the pandemic, small-scale “hospital at home” programs had demonstrated that hospitals could safely manage many more “inpatients” at home through a combination of home visits by mobile care teams and telehealth technologies, coordinated by a telehospitalist.

Facilitating Telehospital Medicine

While increasing the need for telehospitalists, the COVID pandemic led government agencies to waive or relax many of the regulations that otherwise complicate the process of setting up and running a telehospitalist practice, such as reimbursement limitations and rules that affect the ability of telehospitalists to practice across state lines.??Most of these flexibilities were only granted temporarily for the duration of the COVID Public Health Emergency (PHE).??

At the time this article was written in October 2022, the??PHE was on the verge of expiring.??The PHE is likely to be extended at least until early 2023, but the future of key telehealth flexibilities such as reimbursement and licensure needs to be resolved soon.

Several bills have been introduced in Congress that would extend most of these flexibilities for at least two more years.??However, these bills are only stopgaps, and their passage is not assured??Until there are some decisions about making the telehealth flexibilities permanent, it will be difficult for hospitals to make long-term plans to integrate telehospital medicine fully into their practice.