FirstHealth of the Carolinas solves access problem with Virtual Provider program
Access to healthcare providers is a challenge across healthcare. The industry is facing serious supplier shortages – exacerbated by a terrible burnout problem.
This is not news. But finding successful solutions to access problems is. And that's what FirstHealth of the Carolinas has done, using telemedicine technology.
Three parts of the program
The healthcare system's Virtual Provider program consists of a number of components.
First, the program provides a first point of access for patients presenting to convenient care clinics or emergency rooms who do not have a primary care provider, said Stephen Kapa, administrative director of telehealth services at FirstHealth of the Carolinas.
“We focus on patients with chronic conditions that are not being addressed or not being managed,” he explained. “We strive to provide every patient with the right care at the right time, and this program serves that purpose. Typically, we see patients who qualify for this program who have uncontrolled hypertension and diabetes.”
These patients often present as a chief complaint to the emergency room or a convenience care clinic, or are often encountered incidentally,” he continued. “When a patient is referred to this part of the program, our provider sees them virtually. within 24 to 72 hours, which removes the barrier of having to wait for an in-person appointment.”
The role of the provider on site
While the patient is still in the Emergency Room or Convenient Care, the on-site healthcare provider contacts the virtual healthcare provider. The on-site provider may order blood work or other tests, which can be viewed during the virtual visit. This work in the clinic contributes to the efficiency of the virtual follow-up visit.
“Once the ER or Convenient Care Provider enters an order into the Epic EHR for the virtual provider, the patient's visit is scheduled,” Kapa said. “The virtual provider usually connects with the patient the next day and develops a treatment plan. The provider works with the patient to establish a primary care physician and helps schedule the first in-person appointment.
“If the patient requires follow-up before the scheduled in-person visit, the virtual care provider can see the patient again until they can be seen in person,” he continued. “Typically, the virtual provider only sees the patient once. The virtual provider does not have a patient panel.”
In the second part of the program, the Virtual Provider acts as a virtual float provider during staff shortages.
“When a provider is out of the office due to an illness or on FMLA, the virtual provider can cover those patients who are willing to be seen by a virtual provider,” Kapa explains. “The benefit of this is that the patients who still want to be seen can be seen in a timely manner. Additionally, the virtual provider can cover multiple clinics in our multi-county footprint.”
Annual wellness visits
And in the third component of the program, the virtual provider assists PCPs by completing annual Medicare wellness visits for patients. The Virtual Provider program allowed the health system to achieve a 72% completion rate for annual Medicare wellness visits by 2022.
The virtual provider program is run through the Epic platform and Epic tele-video.
“This is a new way to look at throughput and patient access,” Kapa said. “As with anything new, we have encountered some skepticism from staff; however, the program has been active since June 2022. We started slowly, with less than 100 working relative value units generated in the first few months.
“However, as staff began to see the value of the service and how it helped with patient access, clinic load and the utility of patients still being able to be seen when a provider was out of the office, momentum began to pick up. win,” he added.
Promoting the program
FirstHealth of the Carolinas has made a concerted effort to promote the program to all relevant stakeholders, including emergency department and convenient care clinic staff and primary care providers.
“We took a boots-on-the-ground approach to this communication,” Kapa said. “We scheduled one-on-one meetings with staff, held department meetings, and hosted town halls. We did our best to ensure this program could be integrated into the regular workflow with providers and clinics. The wRVU numbers are slow and steadily increasing, and for the past three months we have generated over 500 wRVUs every month.
“Key numbers we've seen include billing more than 500 wRVUs per month, a 72% completion rate of annual Medicare wellness visits across the healthcare system, and a shorter time for a patient to access a visit a doctor,” he continued. . “Virtual provider sees patients within 24 to 72 hours, instead of sometimes weeks.”
In this age of medicine, healthcare organizations are always looking for ways to do more with less, Kapa noted.
Advice for peers
“Telemedicine helps a lot by using technology,” he said. “Not only will you have to put time and effort into developing a program that works for your unique health care system, but you will also have to promote it throughout the system and help people understand why it is beneficial to them.
“Once you do those things, it takes on a life of its own and the successes will continue to build.”
The Virtual Provider program has been invaluable in growing the patient base at one of FirstHealth's rural clinic locations, said Angela Walling, a registered nurse at FirstHealth's Family Medicine clinic in Vass, North Carolina.
“The virtual provider refers patients to clinics that have shorter wait times and are convenient to the patient's home,” she explained. “We have added two new providers to the practice to accommodate growth through referrals.
“The program provides an excellent bridge of care for patients in our community, and it has been an integral part of my professional journey at FirstHealth,” she concluded. “It also supports my patients when I am not in the office and ensures that they do not feel my absence at all.”