Telemedicine Credentialing by Proxy: What Hospitals and Telehealth Companies Need to Know

From the National Law Review:

Hospital-based telemedicine services continue to rapidly expand across the country, allowing providers to deliver care to rural areas and better allocate the staffing and availability of specialist physicians such as neurologists and emergency medicine.  However, despite the uptick in telemedicine services at hospitals, many medical staff offices still use the traditional “primary source verification” process to credential physicians.  For example, in the Foley & Lardner 2017 Telemedicine & Digital Health Survey Report, only 33% of respondent hospitals or provider groups use telemedicine credentialing by proxy.  The traditional credentialing process is far more time-consuming and costly than credentialing by proxy, and hospitals (particularly originating site hospitals that receive/purchase telemedicine services) should consider  how to take advantage of the streamlined credentialing by proxy process offered by both CMS and the Joint Commission. At the same time, non-hospital telemedicine companies and provider groups (i.e., the distant site providers delivering/selling telemedicine services), should consider structuring their operations and processes to allow the use of credentialing by proxy with their clients.  It can reduce the onboarding and go-live time from several months to several days, thus allowing telemedicine providers to start delivering services much more quickly.

EHR Time Exceeds Patient Face Time in Family Practice Visits

From Medscape (hat tip: Dr. Menadue):

The mean length of visits, excluding resident precepting, was 35.8 minutes. Mean face-to-face time per visit lasted 16.5 minutes compared with an average 18.6 minutes of EHR work per visit. More discrete time breakdowns included 2.9 minutes in the EHR before going into the exam room, 2.0 minutes of EHR work in the room, and 7.5 minutes of nonface time, most of which involved EHR work. Physicians also spent an average 6.9 minutes of EHR time outside regular clinic hours, although this finding is limited by estimates reported by the physicians rather than direct observation.

More than half of the visits (64.6%) involved outside EHR work, and the physicians worked in the EHR in the exam room during 73.4% of the visits. Yet faculty physicians and second- and third-year residents had similar amounts of total time and total EHR time, ranging from 33.1 to 38.2 minutes for the former and 17.4 to 20.5 minutes for the latter.

AHA, national organizations ask Anthem to rescind emergency room and imaging policies

From Healthcare Finance:

Having won their fight on another payment policy last week, the American Hospital Association and two other national organizations are asking Anthem to rescind its coverage policies for emergency care and advanced imaging services.

In a February 27 letter to Anthem Vice President and Chief Clinical officer Craig Samitt, MD, the AHA, American College of Radiology and American College of Emergency Physicians, criticized Anthem for enacting the reimbursement policies without provider input or what they called concern for patient safety.

Evaluating psychiatric readmissions in the emergency department of a large public hospital

From Dovepress:

Introduction: Hospital emergency departments (EDs) around the country are being challenged by an ever-increasing volume of patients seeking psychiatric services. This manuscript describes a study performed to identify internal and external factors contributing to repeated psychiatric patient admissions to the hospital main ED.

Methods: Data from ED visits of patients who were admitted to the Parkland Memorial Hospital ED (the community hospital for Dallas County, TX, USA) with a psychiatric complaint more than once within a 30-day period were evaluated (n=202). A 50-item readmission survey was used to collect information on demographic and clinical factors associated with 30-day readmission, as well as to identify quality improvement opportunities by assessing related moderating factors. An analysis of acute readmission visits (occurring within 3 days of previous discharge) was also performed.

Results: Patients readmitted to the ED commonly present with a combination of acute psychiatric symptoms, substance use (especially in the case of acute readmission), and violent or suicidal behavior. The vast majority of cases reviewed found that readmitted patients had difficulties coordinating care outside the ED. A number of moderating factors were identified and targeted for quality improvement including additional support for filling prescriptions, transportation, communication with family and outside providers, drug and alcohol treatment, intensive case management, and housing.

Conclusion: Many of the resources necessary to reduce psychiatric patient visits to hospital EDs are available within the community. There is no formal method of integrating and insuring the continuity of community services that may reduce the demand for psychiatric and related services in the ED. While agreements between community service providers may be challenging and require considerable vigilance to maintain equitable agreements between parties, this route of improving efficiency may be the only available method, given the current and projected patient care needs.

Balanced Crystalloids versus Saline in Noncritically Ill Adults

From the New England Journal of Medicine:


Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU).


We conducted a single-center, pragmatic, multiple-crossover trial comparing balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) with saline among adults who were treated with intravenous crystalloids in the emergency department and were subsequently hospitalized outside an ICU. The type of crystalloid that was administered in the emergency department was assigned to each patient on the basis of calendar month, with the entire emergency department crossing over between balanced crystalloids and saline monthly during the 16-month trial. The primary outcome was hospital-free days (days alive after discharge before day 28). Secondary outcomes included major adverse kidney events within 30 days — a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) — all censored at hospital discharge or 30 days, whichever occurred first.


A total of 13,347 patients were enrolled, with a median crystalloid volume administered in the emergency department of 1079 ml and 88.3% of the patients exclusively receiving the assigned crystalloid. The number of hospital-free days did not differ between the balanced-crystalloids and saline groups (median, 25 days in each group; adjusted odds ratio with balanced crystalloids, 0.98; 95% confidence interval [CI], 0.92 to 1.04; P=0.41). Balanced crystalloids resulted in a lower incidence of major adverse kidney events within 30 days than saline (4.7% vs. 5.6%; adjusted odds ratio, 0.82; 95% CI, 0.70 to 0.95; P=0.01).


Among noncritically ill adults treated with intravenous fluids in the emergency department, there was no difference in hospital-free days between treatment with balanced crystalloids and treatment with saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SALT-ED number, NCT02614040.)

Uber Health: Scheduled Transport for Appointments

From Axios:

Uber has launched a new service that will allow hospitals, clinics, nursing homes and other health care organizations to order and schedule car rides for patients. Uber is not charging a fee to use the service. The health care providers only have to pay for the ride.

Why it matters: Uber sees a huge untapped market in the roughly 4 million people who skip or delay health care visits every year because they don’t have reliable transportation. Hospitals, doctors and other providers could be eager to pay for those rides if it means more on-time appointments and fewer no-shows — which translates into more revenue in their pockets.

IL Lawmakers approve revamp of hospital Medicaid funding program

From the Tribune:

A long-awaited redesign of a program for distributing Medicaid money to hospitals across Illinois was approved Wednesday by state lawmakers.

Gov. Bruce Rauner is expected to sign the legislation, which revamps the $3.5 billion hospital assessment program that provides more than half of hospitals’ Medicaid funding.