A University of Mississippi Medical Center project to develop tele-ICU programs at two small rural hospitals in the state has helped them keep critically ill patients who otherwise would have been transferred to larger facilities, allowing people to stay close to home while increasing much-needed revenue for the facilities.
Copiah County Medical Center is a critical access hospital with 25 in-patient suites and nine emergency department rooms. Greenwood Leflore Hospital recently reduced its bed numbers from 208 and has applied for critical access hospital designation. Its ICU closed after the COVID-19 pandemic.
The hospitals offer snapshots of the challenges of providing specialty services in rural areas in Mississippi and elsewhere in the US, experts said during a UMMC Center of Excellence webinar.
Data show there are 30 specialists for every 100,000 people in rural areas, compared with 263 per 100,000 in urban areas. That creates more pressure on primary care providers and increases ED visits.
A Health Affairs study in 2019 found that among Medicare beneficiaries with one or more complex, chronic condition, lack of access to specialists was a significant factor in the differences in rural vs. urban preventable hospitalizations. Rural hospitals had 40% more preventable hospitalizations and a 23% higher mortality rate.
Dr. Saurabh Chandra, a critical care physician and chief telehealth officer at UMMC, said 53 of Mississippi’s 82 counties are more than a 40-minute drive from specialty services. Tele-ICU care, where patients are evaluated by off-site critical care specialists, is not equally available throughout the state. Hospitals in rural areas turn patients away, transferring them as far away as Texas for care, Chandra said. “You want to keep patients in their own communities,” Chandra added.
UMMC had embraced telehealth years before the COVID-19 pandemic, Chandra said, recognizing its value in the early 2000s. It has programs with partners across the state. “We don’t think about telehealth as in a silo,” Chandra said. “We want to integrate our programs with existing care delivery models and maybe the in-person models to see how we can augment care rather than substitute care.”
More consults, fewer transfers
The tele-ICU programs developed for Copiah and Greenwood are simple by design, Chandra said. They included sending each hospital mobile carts, loaded with telehealth technology, that are moved to the patient bedside when the local physicians deem a critical care consult is needed. The mobile carts connect to specialists, often from out of state, who work with the local physicians to determine the best care for each patient.
Kyle Brewer, UMMC’s telehealth administrator, said only early results are available, at Copiah from November 2023 to May 2024, and at Greenwood from April to August this year. But they show each facility is doing about 30 to 40 consults per month. More patients are able to stay at the facilities, rather than being transferred.
That has meant a $278,821 increase in revenue at Copiah. The numbers from Greenwood are not yet available but show a promising trend. “Sixty-eight percent of the patients who received this tele-critical care service were able to stay at that facility,” Brewer said. “So that’s a very large percentage that we were able to keep at that facility.”
Implementing both programs presented challenges, however. There were issues with provider buy-in and a need for additional training for nurses. One solution was to create criteria that would automatically trigger a tele-ICU consult. There also were high payment denial rates by insurers, mainly due to coding and credentialing and licensing issues, which were resolved. The two hospitals also had to be aware of their inpatient and swing bed limits for patient stays.
Deploying AI to boost care
UMMC IT Director Greg Hall said the next phase is using AI to improve patient care and provide analysis. AI scribes will assist documentation. Sensors placed in each room monitor patients’ vital signs, and AI is used to provide early alerts to physicians and nurses that a patient’s condition may be deteriorating. Hall said sometimes these changes occur slowly over time and while people may not notice, the sensors combined with AI analysis will see it and sound the alarm.
AI also is being used to help analyze if adding a specialist consult into the mix helps financially struggling hospitals keep patients local, which increases revenue. “Keeping an additional patient a month is the difference between them closing their doors or not,” Hall said.
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