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Providing After-Hours Healthcare with Telehealth

Providing After-Hours Healthcare
It’s Friday evening. You’ve been feeling tired for the last few days and on your commute home today your throat began to feel swollen and painful. It’s time to make a decision: do you go to the urgent care clinic a few blocks away? Or do you wait until Monday when you can call your primary care provider (PCP) and then wait a few more days for an appointment?

If you’re like many patients, you probably head to urgent care – hoping for a quick diagnosis and potentially some medication that could have you in better shape for an important Monday meeting.

The Reliance on Fast Food Care

Access to healthcare is usually thought of in terms of insurance and location. If patients have healthcare coverage and they live in an area with reputable hospitals and private practices, then they’re considered to have reasonable care resources – and mostly they do. But those resources are often limited to office hours, which don’t always work for patients. They may wake up feeling sick on a Saturday morning or fracture their hand playing basketball one night. They may have a hard time getting away from their jobs. Their PCP may not be able to fit them in for three weeks.

A Commonwealth Fund study found that 51 percent of U.S. adults struggled to get health care at nights and on weekends without visiting the emergency room. So it’s not surprising that urgent care centers and their extended hours have become attractive to patients. These centers have become the fast food restaurants of the medical world, promising care on a walk-in basis – without an enormous emergency room bill or a long wait for an office appointment.

It sounds so convenient. But there are repercussions for both provider and patient in the urgent care scenario:

  • The patient’s care is fragmented. The PCP loses visibility into other diagnoses and prescriptions; sometimes the urgent care physician refers the patient to another provider or network, so the PCP loses the patient.
  • The patient typically pays a higher fee. While urgent care bills are usually less than an emergency room visit, they’re often far higher than a standard office visit.
  • The patient is exposed to other sick people and germs.
  • Providers lose the revenue they would have earned from the office visit.

Telemedicine After Hours

Telemedicine can solve these challenges when providers make one change: offering after-hours care. Consider the most common reasons patients go to urgent care, such as colds, the stomach flu, sinus infections, sore throats, conjunctivitis or burns. Providers can leverage virtual health from their homes to treat these conditions during evenings and weekends. Their patients can bring them their non-emergency medical needs at any time, instead of visiting a retail clinic, urgent care center or Direct-to-Consumer telehealth app.

PCPs, physician groups and health systems using telemedicine for after-hours care are finding it boosts revenue and patient retention for several reasons:

Care continuity.

Patients want to receive care from the doctor who knows them best – their PCP. Keeping care in practice means the patient sees the provider who has access to their medical history and understands the context of their bigger healthcare story. A stranger at the urgent care center won’t have that information or level of trust.


Patients don’t schedule their urgent care visits; they walk in when something unplanned has happened. But while urgent care centers offer evening, weekend and holiday hours, the patient still needs to get dressed and leave the house, and potentially find out they need a referral or emergency room visit anyhow. A virtual visit with a PCP offers a personal medical consult without the patient having to leave home late at night or when they’re in pain.

Cost savings.

Urgent care center visits are more expensive than standard appointments for several reasons: the centers tend to be located in central retail space and the walk-in appointment model offers less certain revenue. With many patients struggling to pay high deductibles and rising out-of-pocket costs, a PCP telemedicine visit is often more friendly to their budget.

Preventing Hospitalizations

In addition to increased revenue, inpatient facilities are finding after-hours telemedicine can help prevent avoidable hospitalizations and readmissions.

For instance, one skilled nursing facility used after-hours telemedicine for bedside patient assessments. Because PCPs weren’t available on-site after hours, the 365-bed SNF used telemedicine on weekends and weeknights. Remote physicians collaborated with nurses to evaluate fever, chest pain, shortness of breath or other changes in 313 patients. Over a year, 83 percent were treated on-site and 91 avoided hospitalizations. The estimated cost savings exceeded $1.55 million; approximately $500,000 of those savings went to a managed care Medicare payer.

Given the consumerization of healthcare, after-hours telemedicine is likely to become a common and appealing selling point for patients. Providers can drive additional revenue, protect patient retention and still maintain a work-life balance by offering extended hours from home. Telehealth’s flexibility has already solved challenges regarding patient location; by eliminating time as an obstacle, providers can take another step toward dissolving barriers to quality care.

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