Episode Transcript
[00:00:00] Speaker A: Hi, my name's Tim Cohen and welcome to Vital Conversations sponsored by Focus Solutions. Here we talk to leaders throughout all corners of healthcare to find out things that they're doing that are interesting. I'm really pleased to have a good friend as my guest today, Ron Cubitt of telenf. Ron, welcome to Vital Conversations.
[00:00:17] Speaker B: Thanks Tim. Troy, appreciate it.
[00:00:18] Speaker A: Thanks for having me, Ryan. First of all, quick, tell us about telenef. Who are you guys? How's it work specifically in the world of nephrology?
[00:00:27] Speaker B: So telenef's focus is helping rural America. A lot of these patients, since these rural hospitals actually are transferring patients that have nephrology out of their communities. And what we're allowing them to do is keep care local and live their mission statement of taking care of their community versus transferring them out. So it's been a win, win and I'm sure we'll probably talk some more details later.
[00:00:49] Speaker A: When you transfer out a patient who's got kidney disease, oftentimes that involves dialysis. That is a multi time, a week long process. So tell me what happens if I'm in a rural community, need dialysis and have to go to the nearest big city. Is that just totally disrupt the patient's life?
[00:01:08] Speaker B: Oh, absolutely. I mean we're out in Kauai. I mean you're looking at a $25,000 plane ride outside. We were up in Alaska airbanks, they were transferring patients all the way to Anchorage, 400 miles away. I mean it's, you know, and people heal better when they're surrounded by family and friends. And if you're 400 miles away or you were transported by plane or like in one hospital In Arizona, it's 90 miles to Phoenix.
It's better to be surrounded by friends and family.
[00:01:40] Speaker A: Let's talk about then, how does it work? So I'm a rural hospital in rural Kansas or Nebraska or somewhere. How does TELENF work with me? How am I able to keep those patients that I used to have to send to Denver or Kansas City in my community?
[00:01:57] Speaker B: You know, the first thing we do is we analyze actually their market, making sure that this is feasible. And one of the biggest changes that have happened is that the equipment, the dialysis equipment has changed. Now there's equipment that is on wheels that patients are doing within the home. And our whole thesis was if a patient can do it at home, then a nurse can do it in a hospital setting. And especially in rural, you know, the nurses in rural are, you know, MacGyver's of healthcare. Yeah, And. Right, right.
And what we brought on our team is role nurses that have actually done this program before. So you have nurses to work with nurses. So we help train those nurses and get comfortable delivering a service. The other thing we provide is a dedicated nephrologist. We dedicate two nephrologists. One nephrologist is primary, the other one is backup. And that nephrologist is available to the hospital 24 by 7. And we go out even before we sign a contract, meeting with the clinical team, meeting with everybody within the hospital. So now that when a patient comes and a lot of these patients that are on dialysis or you know, have nephrology issues, have a lot of other symptoms and they're bypassed in the hospital today, now they're able to admit the patient and they have access to the nephrologist to answer any questions. And one thing that we've been surprised with a lot of our hospitals is that a lot of the issues that patients are able to keep now are CKD or acute kidney injury as well, versus transferring those patients out. And at our first rural hospital in Arizona, that hospital, the first year they had this program, they admitted and it was a critical access hospital. They admitted 126 patients.
[00:03:41] Speaker A: Wow. That previously had to be transferred out.
[00:03:44] Speaker B: Correct? Correct. And it's a critical access hospital. And what happened was once word got out, other critical access hospitals, rural hospitals started sending their patients. So it was probably one of the first times where a critical inbound referrals. Exactly. And they got patients as far away as New Mexico.
[00:04:05] Speaker A: So if I'm a, if I'm a rural hospital, buy this equipment. I assume it's also getting cheaper that they can buy it. You guys, through both nurses and nephrologists, bring clinical protocols, training and support so that the hospitals, general hospitalists, general med surg nursing staff staff feels equipped to handle these dialysis patients. Like you said, if they're doing it at home, this is obviously a higher level of skill than the home caregiver. And then they've got the bat phone to know we can call anytime.
[00:04:36] Speaker B: Exactly. And we help them like what you're saying as well. We help with policies, procedures, staffing, models and things like that as well.
[00:04:43] Speaker A: Obviously the benefit to the patient, the patient's family is just kind of a no brainer. Right. Those oh folks that would have to travel several hundred miles multiple times a week to go to a metropolitan dialysis center, you can see what that does their life. But I want to talk for a second about the Hospital side, again, obvious benefit for the patient. We've all, we all know the financial pressure that rural hospitals are under. We know that many of them, if they're not going under, are operating with just razor thin margins. I would have to believe that that hospital you just mentioned that kept over 100 patients that they had previously referred out. That's got to have a big positive financial impact for that hospital.
[00:05:25] Speaker B: First year net revenue was 1.5 million. And over the six year period, that CEO, we were talking to him and he said it had an impact of over $10 million. Wow. Over 10 million.
[00:05:39] Speaker A: And again, this is on a, this is on a critical access hospital.
[00:05:42] Speaker B: Critical access, because the other thing that you can fill in is also your swing beds.
[00:05:46] Speaker A: Right.
[00:05:47] Speaker B: A lot of bigger hospitals want to take patients that are in rehab that can go closer to their community and stay in the community. So that is available to them as well. And you were making a statement before the impact? I was at a rural hospital, you know, and the one thing I got to say about rural hospitals, they're not close to airports. I drove six hours for a one hour meeting. Yeah, but it's about relationships. But what she said was the number of family members from that community who have come in personally to thank her by keeping their loved ones in the community.
So we can talk financial, but you know, a rural hospital is about the community first. And when you hear these stories with, you know, the CNO saying, you won't believe the number of people who have come in and just thanked us for being able to do this.
[00:06:37] Speaker A: Well, for those of us that, you know, I grew up in a rural community, those of us that know that world, it's not just the healthcare location, the hospital, even a small critical access hospital is one of the largest employers in town. It's one of the things that, you know, helps center the town. It kind of goes with the schools and the churches and the boys club. You know, it's, it's the thing those communities are built on. So being able to not only keep it there, but keep those facilities more financially solvent is just absolutely huge.
[00:07:07] Speaker B: But if you were in a rural committee, you know, if a community doesn't have a hospital that's like a farmer without a field. Right, yeah, right.
It doesn't survive.
[00:07:17] Speaker A: All right, so today you're doing this model specifically around nephrology, and I assume you're supporting not just dialysis patients, other kind of kidney disease patients that they might have had to transfer out because of lack of specialty domain expertise. You can keep There as well. Is that true?
[00:07:39] Speaker B: That is true. So it has, as one hospital CEO has stated, it's not a silo solution. It impacts all their service lines. Right. As you can imagine from a standpoint of elective surgeries even.
[00:07:52] Speaker A: Right, right.
[00:07:54] Speaker B: To critical access hospitals. After we put in this program, they actually started cardio.
[00:07:59] Speaker A: Interesting.
[00:08:00] Speaker B: And it's, you know, a lot of people have fear of dialysis. Right. You know, the big machines and everything else and you know, the worst case situation. But when in talking to CEOs, you know, when they brought this program up, everybody realized, okay, if we brought this program up, we can probably bring other programs.
[00:08:18] Speaker A: That was going to be one of my immediate questions. You know, if, if I am a internist, hospitalist, I'm the med surg nursing staff. Like you said, they're the MacGyvers. They got to cover a lot of things.
[00:08:30] Speaker B: Right.
[00:08:31] Speaker A: Is there anything that would prevent you from bringing similar nurse physician resources protocols to support other disease states besides kidney? Sounds like no.
[00:08:41] Speaker B: Us personally, no. But what they're doing is they're doing others. The hospital are bringing in other, like cardio is one for sure. They go hand in hand.
[00:08:51] Speaker A: So today we've talked a lot about rural and critical access hospitals. I can imagine there are other markets that could use this same service. What are some other places besides those that you guys are exploring?
[00:09:04] Speaker B: Well, it wasn't even exploring. Right. I always say who you are today is not who you are tomorrow. Right. Your customers will help you find that. So we started off at critical access hospitals and then we moved up to other larger hospitals. And then from there, hospital systems have contacted us. We're in multiple healthcare systems throughout the United States. The other thing we went into is rehab hospitals. And then from there we went into correctional facilities. And as you can imagine, they all have the same issue. And what has evolved and what has changed is the ability of the equipment being portable. And the other aspect is, you know, from a telehealth standpoint, it's more acceptable.
And yet it's not brand new. Because I used to be the president of Colorado Neurological Institute. We were doing telestroke and then when I had my own IT company, we were doing we help Nighthawk Radiology with their data.
[00:09:55] Speaker A: How long does it typically take if you were to stand up a new facility in the training and prep that the nursing staff locally feels comfortable? You know, the first time they're going to take care of one of those dialysis patients, is that a long startup period?
[00:10:09] Speaker B: It's usually about 90 days and the biggest hangup is credentialing the nephrologist at the hospital. Yeah.
[00:10:17] Speaker A: Because you've got a credential. You're tele nephrologist into that state.
[00:10:20] Speaker B: Correct? Correct.
[00:10:22] Speaker A: Ron, you mentioned earlier the dialysis at home movement, and we know there's a lot of push to move a whole bunch of services out of hospitals to the home. And you guys are sort of somewhere in the bridge. Do you see potentially a service like this even expanding to a consumer level, where if I had a loved one at home doing dialysis at home, felt nervous, had a question, you could support that kind of care situation, couldn't you?
[00:10:48] Speaker B: Potentially. Yep. And we're in conversations with some home programs already today.
[00:10:53] Speaker A: Okay, awesome. This is a. This is a fascinating story because you spend so much time. I want to telescope up at a high level before we land. Most people in America live in metro areas. Most people get their health care from metro systems. So we can. We can hear about rural health care in the headlines and kind of gloss over what would be the thing you would say to healthcare people that maybe aren't as tuned into healthcare in rural America that maybe we don't fully understand?
[00:11:20] Speaker B: Well, the one thing is, one, it's about relationships. Right. And two, if you've seen one rural hospital, you've seen one rural hospital.
They're all unique and they're all different, but the ability of the community to get behind it is amazing. I mean, we work in Kansas, because you talked about Kansas earlier, that community, they actually bake sales and other things to actually set up an outpatient. Because we have some of these locations that the patient's driving anywhere three times a week for dialysis. And, you know, we focus on the inpatient, but we have helped them on the outpatient so that they don't have that drive of, you know, three times a week, 60 miles one way. Right. And then another hospital up in South Dakota, he actually has a bus. Everybody comes to the hospital, and that bus drives the 60 miles for him.
[00:12:11] Speaker A: Interesting.
[00:12:12] Speaker B: And the other thing we've helped these rural hospitals on that aspect as well, is that we've helped them partner without other dialysis organizations to take care of their community. I mean, you go into a community, they're bringing in their board, they're bringing in, you know, community members and farmers and that. And I don't have. I used to live in Hawaii. I was a surfer dude. My hands aren't as big as these farmers and truck drivers, and that's. My hand gets swallowed up. But they're so appreciative of us being out there. And, you know, it's touching. It's great.
[00:12:46] Speaker A: Ron, this is a great story. Thanks for taking some time today to not only, you know, tell us about Telenf, but really cool what you guys are doing for, for patients and for our the rural part of our healthcare system that we need to stay alive and stay healthy. So appreciate you being on vital Conversations today.
[00:13:03] Speaker B: Well, thank you, Tim. I truly appreciate it.
[00:13:06] Speaker A: Thanks, thanks.
Thanks for listening to today's episode.
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