Hospitals and the Open-door Transfer Policy: Can We Do a Better Job?
In Dr. Pitt’s latest edition to At the Intersection of Technology and Health, he explores why doctors don’t question hospital transfers, and how patients who are unnecessarily transferred face financial risk. Today, 30% of bankruptcies in America are caused by medical expenses. Telemedicine technology is becoming a valuable alternative to costly hospital transfers.
Historically the phone has been the only option for communication between hospitals. With no other information, the open door policy made sense. But times have changed. Just as you can Skype with friends over long distances, expert care can also be delivered remotely. Such advances are extremely important for credibility between providers and between providers and patients. Video improves relationships and credibility in the care cycle. Enabled by video (a primary tool of telemedicine), centers of excellence could complete their mission, support the outline facility, and still be more selective in which patients they accept for transfer.
This business model has worked effectively for telestroke treatment. Rural emergency room physicians weren’t comfortable initially with the administration of clot busting agents (t-PA) for stroke. But through the use of telemedicine, stroke experts now stand behind rural physicians, helping them decide whether or not to administer t-PA and whether or not the patient is to be transferred. This partnership allows patients to receive a higher level of care, while the number of transfers has diminished. It’s a win-win for both rural hospitals and urban centers of excellence. The same change in process, replacing the phone with video, is widely applicable to all sorts of clinical scenarios.
The healthcare community is built on principles of compassion and a chance to heal. But well-intended efforts that make it easy for patients to get care at tertiary facilities have unintended consequences. Care decisions need to be gauged against the ultimate outcome for our patients. Of course we need to take care of those patients who need tertiary services. However a blanket open-door policy for transfer may not be the right answer in 2016. To save someone who didn’t need saving, while ruining their financial health in the process, is not just a matter of outmoded policy; it is something close to a crime of neglect.
Avizia was acquired by American Well in July of 2018. Information on this page refers to activities that occurred prior to the acquisition and are presented for historical context. Together we provide a comprehensive acute care offering—a full end-to-end telemedicine solution for health systems and their providers.