Rural health care, already struggling, took another hit last week when Dartmouth Health, facing a budget deficit of $63.5 million, announced it will be closing two telehealth services that provide live video medical advice to five rural Vermont hospitals, including Brattleboro Memorial Hospital (BMH) and Grace Cottage Hospital in Townshend.
The cost of the Tele-ED and Tele-ICU services, “at our current scale, without external support, are simply unsustainable,” Audra Burns, a spokesperson for Dartmouth, the New Hampshire-based health network, told VTDigger.
The Tele-ED service acts as a long-distance emergency department. The Tele-ICU acts as a long-distance intensive care unit. They connect Dartmouth’s physicians and critical care nurses with a patient’s bedside team.
“Usually, when this is used at BMH, it is in the situation where a patient presented with a life-threatening condition,” Dr. Aida Advic, the hospital’s chief medical officer, told The Commons.
One call establishes a live video link.
“With tele-emergency medicine in particular, [Dartmouth’s physicans] are directly linked into the room where our emergency room team is on the ground, already performing medical care necessary to the life-threatening condition,” Advic said.
Generally, tele-heathcare providers act to support the care already being done by BMH, she added.
“They are documenting what’s being done,” Advic said. “And they are starting to arrange for logistics of transferring a critically ill patient, arranging for ambulance or helicopter and finding a bed in an intensive care unit in a bigger hospital like a tertiary care center. So they’re sort of a tool that our team on the ground can use to help with logistics of caring for a critically ill patient.”
When it began, Dartmouth Health touted the service as reducing mortality rates and the length of stay in the ICU. The network also said it reduced the need for a patient to be transferred, allowing them to stay in a less-expensive local setting.
The news of the cost-cutting shutdown caused a bit of panic in observers who depend on Grace Cottage and BMH for their healthcare.
As of Aug. 24, a website advocating for social change, Change.org, collected almost 550 signatures on a petition to urge Dartmouth to reconsider.
“Grace Cottage Hospital in Townshend, Vermont, runs its entire emergency department with physician assistants and nurse practitioners, with no in-house emergency physician on staff,” the petition text reads. “Their safety net has always been a video link to specialists at Dartmouth-Hitchcock Medical Center, ready to help make life-or-death calls in real time. Now that link is being cut.”
Grace Cottage will definitely be looking to contract for long-distance medical services from other providers, said Charma Bonanno, its senior director of development, marketing, and community relations, on Aug. 21.
She said the hospital “is evaluating an alternative because it is a great benefit to rural hospitals.”
Obviously, if a patient in a Townshend ER were to need specialized medical help, the doctor called upon by video link could just as easily be in Anchorage, Alaska, as in Lebanon, New Hampshire.
“But they still have to be licensed to practice in Vermont,” Advic said.“They still have to follow licensure and processes outlined by the Vermont Medical Board.”
And, in fact, Dartmouth Health’s own Tele-ED model uses in-house physicians during regular working hours but transfers remote coverage to the South Dakota-based telehealth provider Avel eCare on nights and weekends, Grace Cottage’s chief medical officer told VTDigger.
And though BMH has used the service for life-threatening cases, the hospital has used the tele-emergency medicine services “very infrequently over the last year,” Advic said. “So I do not foresee a major operational impact.”
The use of the service “very, very infrequently” is due to a number of issues, she said.
“One of them being that with this particular tele-medicine service, Dartmouth was never really able to get it off the ground in a sort of consistent 24/7 fashion,” Advic said. “It was sort of offered in spurts and for limited times, so it was kind of hard to keep track for the teams on ground.”
Since Dartmouth has not set a date to eliminate the tele-services, there will be no immediate decline in service.
“They notified us that they are discontinuing without a specific date in mind yet,” Advic said. “But they have other telemedicine services that they are continuing at this time that we use at BMH.”
BMH is evaluating its next steps.
“Because we were just notified literally less than a week ago, we are evaluating our current reliance on it,” Advic said. “We will continue to evaluate how often we use the service and what would be next acceptable partner for the service if we think that is still beneficial to our ED team and our patients.”
This News item by Joyce Marcel was written for The Commons.