Hospitals, Policy

Telemedicine needs to be mainstream before we can talk health reform

The movement to save Lakewood Hospital outside Cleveland seems misguided.

National Nurses United Bernie Bus

Disclaimer: This is not meant to be a commentary on any presidential candidate, so please save your hate mail, Bernie Sanders supporters. This post is about telemedicine and health reform. 

According to an announcement from National Nurses United, the nursing union’s “Bernie Bus” rolled into Ohio Monday ahead of next week’s primary in the Buckeye State. The group endorsed Sen. Bernie Sanders (D-Vermont) for president way back in August, and has been mobilizing the troops for Sanders ever since.

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Monday, the Bernie Bus stopped in the Cleveland suburb of Lakewood, where the City Council voted in December to close the only hospital in town. Cleveland Clinic-affiliated Lakewood Hospital is supposed to be replaced by a new Cleveland Clinic outpatient clinic with an emergency department, and the union came to town to protest.

The demonstration worked, because the council voted unanimously Monday evening to put the closure of Lakewood Hospital on the ballot in November, according to Cleveland.com. That’s fine. Locals should vote on major decisions for their communities.

The issue I have is with the rationale for opposing the closure.

“There’s a big problem because the city of Lakewood needs this hospital open. They’re putting the bottom line before the 52,000 people who live here. People have to drive far away now to get care, and that’s not right,” Ohio nurse Michelle Mahon said in a statement from National Nurses United.

“We’re seeing the same thing in Ohio that we’ve seen across country with the lack of healthcare access. When it’s harder to get to the hospital, people delay their care,” added Margie Keenan, a nurse from California who has traveled on the bus for weeks.

Yes, access to care is a problem all over the country. But why is the union so hung up on hospital care? Hospitals are expensive and often dangerous, and really should be reserved for the most acute cases. That’s what Cleveland Clinic seems to be doing as it transitions to value-based care by replacing a hospital with an ambulatory center. 

Even though the Cleveland Clinic just reported record income for 2015, it’s still a not-for-profit with a mission to provide the right care, not necessarily the most care. If Clinic leadership were smart, they would be talking up telemedicine and remote patient monitoring as a viable alternative to keeping low-acuity patients in the hospital.

“We know with Bernie, if we had a single-payer system, then public health planning would become a priority,” Mahon added. Perhaps, but if planners were smart, they would include telemedicine in the equation, just like the centrally planned Department of Veterans Affairs has been doing for two decades.

Let’s stop looking at hospitals as the hub of care. That’s so 20th century. Unfortunately, that’s also still the mainstream way of thinking. Until the mindset moves into the 21st century, we will remain incapable of having an honest debate on healthcare reform.

Photo: National Nurses United