Marcia M. Ward (
Kimberly A. S. Merchant is a project manager in the Department of Health Management and Policy, University of Iowa.
Health Aff (Millwood). 2018 Dec;37(12):2037-2044. doi: 10.1377/hlthaff.2018.05103.
There is a chronic shortage of physicians to cover emergency departments (EDs) in critical access hospitals. A 2013 memorandum from the Centers for Medicare and Medicaid Services clarified that a telemedicine physician could fulfill the regulatory requirements for physician backup when advanced practice providers were at telemedicine-equipped critical access hospital EDs but local physicians were not. In a sample of nineteen hospitals, coverage schedules in 2016 showed that seven had begun the use of tele-ED physician backup for advanced practice providers, decreasing local physician coverage in their EDs. These seven hospitals tended to have decreasing ED staffing costs, while the hospitals not applying this policy showed continually increasing staffing costs over time. Telemedicine also provided other benefits, such as improved physician recruitment and retention. In the future, more critical access hospitals will likely use telemedicine to provide physician backup for advanced practice providers staffing the ED.
在提供急诊服务的基层医疗机构中，长期存在医师短缺的问题。2013 年，医疗保险和医疗补助服务中心发布的一份备忘录明确指出，当远程医疗设备配备的基层医疗机构急诊室配备有高级执业医师，而当地没有医师时，远程医疗医师可以满足医师后备的监管要求。在一个由 19 家医院组成的样本中，2016 年的排班表显示，有 7 家医院开始为高级执业医师使用远程急诊医师后备服务，减少了他们急诊室的当地医师覆盖范围。这 7 家医院的急诊部人员成本呈下降趋势，而没有采用这一政策的医院的人员成本则随着时间的推移持续上升。远程医疗还提供了其他好处，如改善医师招聘和留用。未来，更多的基层医疗机构可能会利用远程医疗为配备急诊室高级执业医师的人员提供医师后备服务。
