Whitfield Regional Hospital in Demopolis used to transfer six to eight patients each day, usually in critical situations, to larger hospitals in Birmingham or Tuscaloosa.
Thanks to a partnership with the University of Alabama Birmingham hospital system, Whitfield got access via telemedicine to UAB specialists in several fields.
“Now, we transfer almost no one … we can keep those patients,” said Doug Brewer, chief executive officer at Whitfield. “It has changed our hospital drastically.”
“… It’s not an understatement to say it has changed how we care for people in rural Alabama, at least our area.”
The use of telemedicine — connecting providers to patients remotely through technology — has increased more than tenfold since COVID-19 arrived in Alabama and will remain once the pandemic abates, experts say. In March, as the pandemic began to reach the state, Blue Cross and Blue Shield of Alabama expanded its coverage of telehealth services.
But there’s another significant connection between small and large hospitals through telemedicine that could help save Alabama’s struggling rural hospitals, of which more than a half dozen have closed in recent years.
“I think hospital-to-hospital telemedicine does have the potential to save some rural hospitals, in that it will allow them to keep some patients they otherwise would refer out,” said Dr. Don Williamson, leader of the Alabama Hospital Association. “Once you start referring out patients, you lose that local loyalty and that local support.”
Whitfield’s use of telemedicine didn’t start with COVID-19, but with the lack of doctors. A shortage of physicians and no critical mass of patients makes retaining specialists, like a nephrologist or a critical care pulmonologist, difficult for Whitfield.
“It doesn’t mean that there isn’t a huge need for their services, it just means that there might not be enough patients for them to make a living,” Brewer told Alabama Daily News.
“By the time COVID hit, we had four 24/7 services from UAB,” Brewer said. “We had nephrology, which means we can take care of renal failure patients. We had neurology, which means we became a regional stroke center. We have infectious disease, very important when you’re talking about COVID. And fourth, and this is probably the most important for COVID, we had critical care pulmonology already in place. We had an internal medicine hospitalist here at the hospital 24/7, but that hospitalist needs the support of a critical care pulmonologist when they’re caring for COVID patients for instance, so by the time COVID hit, we were in a position where had it been, you know, even six or eight months earlier, we would have to transfer every patient. But instead, we’ve been able to treat on an in-patient basis well over 250 COVID patients. In fact, as we speak (in early December), I think I’ve got 16 (COVID patients) and five (on ventilators). So that’s five that don’t have to be at UAB or another larger hospital someplace. It’s been a game changer.”
At the time of the interview, Brewer said his hospital had no available beds. He said the telehealth connection has made Whitfield a much more important part of combating the pandemic — and the same could happen at other small hospitals.
This month, hospitalizations due to COVID have peaked, there were 2,337 Alabamians hospitalized Sunday, according to the Alabama Department of Public Health. That’s nearly three times the number from two months ago and about 700 more than July’s previous highs.
Eric Wallace, medical director for telehealth at UAB, said telemedicine is saving lives in multiple ways during the pandemic. One of them is by keeping patients at Whitfield where they can get the care they need and saving UAB’s beds for those who need them more.
It’s good for patients too, Brewer said, because it means they don’t have to be transferred away from their families who may not be able to travel to Birmingham.
Local care means Whitfield’s nurse practitioners can provide local follow-up care in an effort to prevent return hospital stays.
“It’s really made a difference, not only in emergent care, but in long-term care for our patients and our community,” Brewer said.
Keeping those patients at Whitfield has increased revenue for the hospital 35 percent to 40 percent. Brewer said Medicare and Medicaid reimbursements aren’t based on the number of patients a hospital has but how sick they are.
Brewer advocates for Medicaid expansion to help rural hospitals stay afloat. He said larger hospitals stay profitable by offering procedures that smaller ones just can’t offer.
Since 2011, more than a dozen hospitals in Alabama have closed, most of them in rural areas.
“Eighty percent of rural hospitals are operating in the red in Alabama,” Wallace said. “What happens with the rural hospitals when they’re in the red — they cut services and then they’re in the red and then they cut more services and then eventually they have no service and they go out of business.
“So the only way to save them is actually to deliver affordable services through telehealth that they can access,” Wallace said. “Whitfield should be a model for others. They are delivering more services and getting more patients and more revenue.”
Hospital-to-hospital telemedicine is a trend that will continue, Williamson said, citing examples in other states.
The University of Mississippi Medical Center in Jackson operated a virtual emergency room, connecting specialists with rural hospitals around the state. In St. Louis, Williamson said he visited a hospital that has no patients but banks of computer screens where ICU physicians monitor patients in multiple locations.
Williamson said he sees the possibilities of expanding telemedicine use between hospitals to include ICU assistance and ER assistance.
“It clearly already has a role in behavior health,” he said.
But for some hospitals, it is not yet an option.
“The big challenge is we have these huge deserts — and they’re largely in west Alabama and the Black Belt — where we just don’t have broadband connection,” Williamson said. “… In order to make telemedicine work, you’ve got to have a better broadband pipeline than we do.”
Williamson said telehealth could make a difference for many hospitals, but for the smallest facilities with the fewest physicians, it’s an investment that may not make sense.
“It will be different from hospital to hospital, but I think there will be opportunities, and it absolutely could help preserve some of the rural health infrastructure,” he said.