Since the COVID-19 pandemic, telehealth has become a household word; Americans have increasingly turned to virtual platforms to connect with their doctors. But what has not become widely known is the role telehealth is playing in hospitals and emergency rooms across the country. From virtual neurology and cardiology to maternal-fetal medicine and behavioral health, specialists are remoting into patient rooms to address life-threatening symptoms—and, in the process, they are reducing transfers, improving outcomes, saving lives, and saving costs.

Over the past decade, we have seen an inversion of the previous physical-first model of delivering care; hospitals and health systems used to prioritize in-person care delivery models, turning to telehealth only when necessary, such as when lacking local service line specialists. Now, they are leaning into a virtual-first strategy for acute patient care, leveraging virtual care wherever possible and looking to in-person care where needed or where it makes more sense.

This suggests organizations are looking at the best delivery approach for their communities, patients, providers, and bottom line and recognizing that technology has the opportunity to improve access to quality care, no matter a person’s zip code.

Expanding services and reducing transfers

Across the country, urban and rural hospitals are leveraging virtual care to provide timely access to quality care. For example, many are leveraging virtual behavioral health providers to provide timely assessments of individuals who present in the ER with acute mental health concerns in order to get them routed to the appropriate care team.

Piggott Health System in Piggott, Arkansas, began integrating virtual care during the pandemic when it was caring for critically ill COVID-19 patients, individuals it previously would have had to transfer. Since then, it has continued to add service lines in an effort to keep patients local and reduce transfers to other hospitals. Today, it has more than 100 initial consultations a month with telehealth specialists. This has led to a reduction in its outbound patient transfers and an increase in its ER visits. Piggott’s ER experienced a boon in capacity by leveraging telemedicine, seeing more than 7,000 visits in 2024—doubling the 3,500 visits reported by the hospital just a few years prior.

Rush Memorial Hospital, located in Rushville, Indiana, turned to telehealth to staff and operate an ICU. Not only was the facility not able to operate a full-time ICU, but surgeons would often avoid performing certain surgeries, knowing critical patients might not receive adequate care. Now, with a two-bed virtual ICU, Rush Memorial is able to open its ICU, offer the intensivist/pulmonologist coverage its patients need, and enable its hospitalists to focus on caring for higher-acuity patients without having to transfer them to another facility.

In addition to specialty physicians, such as cardiologists, hospitalists, infectious disease specialists, nephrologists, and psychiatrists, many hospitals are turning to virtual advanced practice practitioners (APPs). These programs enable the highest and best use of a hospital’s clinical staff, meet and respond to the demands of their specialty/service line, support consistency of care, and improve hospital-patient communication, such as providing education for post-discharge care.

How to determine whether a virtual strategy is right for your hospital

Given the technological advancements of the past decade, hospitals and health systems should look at virtual as simply another care model. The question is—and always has been—how can we deliver the best care and patient outcomes while balancing operating costs and revenue?

To determine whether a virtual care model is right for your organization, start with the numbers. Look at transfers and admissions data to determine the reasons patients are being moved to other hospitals. When you have a picture of which organ system—e.g., the heart, brain, kidney, lungs—is behind those transfers, you can begin to answer why. If it is because you do not have that specialty, begin to determine the percentage you could retain if you did have that specialty available.

For behavioral health, if patients are coming to the ER and waiting for more than two hours to be assessed, a virtual program could have a significant impact on both patient outcomes and an organization’s ability to optimize those critical beds. (Likewise, for behavioral health hospitals, many have the building, the beds, and the staff but have closed entire wings because they do not have enough psychiatrists to meet the demand.)

The bottom line: For hospitals that want to work at a higher capability and optimize capacity, virtual should be a consideration.

Achieving results with a telehealth program

The right people, processes, and technology must be in place for an acute virtual program to be successful and deliver measurable results for an organization.

It is important to ensure the following:

• The right people—from executives to the team on the ground—are involved in the decision and implementation.
• An understanding/agreement that telehealth is one tool in the toolbox, and in health care, it takes multiple arrows to move the needle.
• An effective training process is built into implementation so that every individual not only understands the technology but also the workflow and their role.
• Metrics are clearly defined, with processes in place to measure and report results.

The care must be high quality—just having a doctor on a screen is not enough. A telemedicine provider must have an intentional approach to creating meaningful connections with patients to “break through the screen” for excellent care to occur.

I like to remind those considering this care model: Acute telehealth should not be an expense; rather, the ROI should be measurable and clear. How is it driving down average length of stay? How great was your reduction in outbound transfers, and how has it increased your average daily census? These are clear indicators of success and can be pretty easily tied to financial outcomes that show ROI. On the other hand, one thing I see over and over that is harder to measure is the significant impact these programs have on patients who are able to receive quality care in a timely manner in a hospital close to home. That is one immeasurable metric that has a lasting positive impact on both the patient and their family, as well as an organization’s place in a community.

Ultimately, in health care, our primary goal is to heal people. Telemedicine has risen to prominence as a real solution to make it possible to provide more timely access to high-quality care in a scalable way. Whether your hospital is virtual-first or not, telemedicine is reshaping the future of how care is delivered and should be on your roadmap.

Chris Gallagher is a cardiologist and physician executive.