Capturing the Facility Fee with Telehealth

The facility fee has historically been an opaque charge, often derided by popular media as a $600 band-aid.  Hospital administrators, however, claim that the facility fee is critical in keeping their lights on and managing for profitability. While hospitals aim to divert low-acuity patients away from emergency departments (EDs), they miss out on facility fees when a patient opts for urgent care via telemedicine applications. .  The profit-earning holy grail for hospitals is the efficiency that combines fast patient throughput with capture of maximum reimbursement.

To date, direct-to-patient (DTP) telemedicine covers millions of lives in America and is available to nearly everyone with a credit card and high-speed internet access for a charge of about fifty dollars.  Yet utilization of DTP primary and urgent care falls well below 10% for the industry.  As a result: patients continue to clog up emergency departments with common ailments that could easily be triaged and treated in lower-acuity care settings.  Telemedicine applications are rapidly evolving across care settings, including EDs.

At several New York Presbyterian/Weill Cornell Medicine emergency departments, Avizia’s telemedicine platform enables physicians to triage and treat low-acuity patients remotely and onsite.  Nurses and physician assistants handle initial screening and, when necessary, provide additional hands-on examinations and basic services while the physician is situated in a separate room.  This arrangement facilitates streamlined efficiency in flowing from assessment to triage to documentation with minimum effort.  The patient, sitting in an exam room with a mounted camera and tablet, can receive orders and scripts that print out like receipts from an ATM.  Thus, patients are seen in less than an hour—rather than waiting for several—while the hospitals still capture facility fees and accelerate the throughput of their emergency departments.  The holy grail of emergency department management achieved.

Telemedicine might be slowly opening care beyond the walls of traditional provider settings for some, but its largest adoption rates and financial gains have occurred in traditional care settings.  Time will tell if the expansive use of telemedicine in hospitals and other traditional care settings will contribute to the proliferation of remote, off-premises consults.  What is clear is that the most successful healthcare IT (HCIT) and healthcare tech-enabled services firms are those that find ways to support the entrenched players of the system, existing payors and providers.

Jacob Grosshandler