Access to providers is a challenge across healthcare. The industry faces severe provider shortages – exacerbated by a terrible burnout problem.

This is not news. But finding successful solutions to access problems is. And that is what FirstHealth of the Carolinas has done, using telemedicine technology.

Three components to the program

The health system's Virtual Provider program has a few components to it.

First, the program offers an initial access point for patients who present to the Convenient Care clinics or emergency rooms and who do not have a primary care provider, said Stephen Kapa, administrative director of telehealth services at FirstHealth of the Carolinas.

"We focus on those patients who have chronic conditions that are unaddressed or unmanaged," he explained. "We strive to provide each patient the right care at the right time, and this program serves that purpose. We typically see patients who are candidates for this program who have unmanaged hypertension and diabetes."

These patients often present to the ER or a Convenient Care clinic for these issues as the chief complaint or, often, they are found 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 onsite provider

While the patient is still in the ER or Convenient Care, the onsite provider will contact the virtual provider. The onsite provider can have blood drawn or other tests ordered, which can be reviewed during the virtual visit. This work in the clinic helps ensure the efficiency of the follow-up virtual visit.

"Once the ER or Convenient Care provider enters an order in the Epic EHR for the virtual provider, the patient’s visit is then scheduled," Kapa said. "The virtual provider connects with the patient, usually the next day, and determines a treatment plan. The provider works with the patient to establish a primary care physician and assists in scheduling the first in-person appointment.

"If the patient needs follow-up before their scheduled in-person visit, the virtual provider can see the patient again until they can be seen in-person," he continued. "Typically, the virtual provider only sees the patient one time. The virtual provider does not carry a patient panel."

The second component of the program sees the Virtual Provider act as a virtual float provider during staff shortages.

"When a provider is out of the office with an illness or on FMLA, the virtual provider can cover those patients who are willing to be seen by a virtual provider," Kapa explained. "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 is able cover multiple clinics across our multi-county footprint."

Annual wellness visits

And the third component of the program sees the virtual provider assisting PCPs by completing Medicare annual wellness visits for patients. The Virtual Provider program helped the health system achieve a 72% completion rate for Medicare annual wellness visits in 2022.

The virtual provider program is run through the Epic platform and Epic tele-video.

"This is a new way of looking at throughput and patient access," Kapa commented. "As with anything new, we experienced some skepticism from staff; however, the program has been up and running since June 2022. We started off slowly, with under 100 work relative value units generated in the first few months.

"However, when staff began to see the value of the service and how it helped with patient access, clinic load and the usefulness of patients still being able to be seen when a provider was out of the office, it started to gain momentum," he added.

Promoting the program

FirstHealth of the Carolinas made a concerted effort to promote the program with all the relevant stakeholders, including the staff in emergency rooms and Convenient Care clinics and the 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 made an effort to ensure this program could be worked into the regular workflow with providers and clinics. The wRVU numbers have slowly and steadily increased, and over the last three months, we have generated more than 500 wRVUs each month.

"Key metrics we have seen include billing more than 500 wRVUs per month, a 72% completion rate of Medicare annual wellness visits for the entire health system, and decreased time for a patient to access a visit with a primary care physician," he continued. "Virtual Provider sees patients within 24 to 72 hours as opposed to sometimes weeks."

In this era of medicine, provider organizations always are looking for ways to do more with less, Kapa noted.

Advice for peers

"Telemedicine helps to a large extent by leveraging technology," he said. "You will need to put time and effort into not only developing a program that works for your unique health system, but you will also need to promote it throughout the system and help people understand why it is beneficial to them.

"Once you do those things, it will start to take 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 of one of FirstHealth’s rural clinic locations, said Angela Walling, a nurse practitioner at FirstHealth's Family Medicine clinic in Vass, North Carolina.

"The virtual provider refers patients to clinics that have shorter wait times and that are convenient to a patient’s home," she explained. "We added two new providers to the practice to accommodate the growth from 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 out of the office and makes sure they don’t feel my absence at all."