• Marcia M Ward, Kimberly A S Merchant, Knute D Carter, Xi Zhu, Fred Ullrich, Amy Wittrock, and Amanda Bell.
• Marcia M. Ward ( marcia-m-ward@uiowa.edu ) is a professor in the Department of Health Management and Policy, University of Iowa, in Iowa City.
• Health Aff (Millwood). 2018 Dec 1; 37 (12): 2037-2044.

AbstractThere 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.

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