Table 1.

University of Mississippi Medical Center TelEmergency Motives and Benefits

TELEMERGENCY
MOTIVES	BENEFITS	BARRIERS	SOLUTIONS
1. Maintain or bolster access to ED care within rural communities	Local ED care remained in all communities using TelEmergency without a reduction in the volume of care provided.	Scope of NPs previously limited to physician oversight within 15 miles.	UMMC obtained a waiver of this requirement for TelEmergency from relevant MS oversight authorities.
2. Enhance quality of ED care provided within rural communities	Increased access to EM-trained, board-certified physicians and specially trained NPs.
	Achieved a high-degree of satisfaction from patients and hospital administrators.18
3. Stabilize financial performance at financially fragile rural MS hospitals	None of the hospitals using TelEmergency closed.	Historically, telehealth reimbursement was restrictive, particularly for ED care.	A 2013 MS state-level telehealth parity law expanded telehealth reimbursement across all payers.
a. Cut rural ED expenses (e.g., physician staffing, inventory management)	By coordinating ED care through the hub, fewer physicians were staffed.
	The TelEmergency inventory protocols decreased unnecessary inventory held.
b. Concerns for cuts to CAH reimbursement	Improving the profitability of one service line, emergency care, eases concerns for CAH reimbursement changes.
4. Mitigate financial investment by UMMC to achieve prior objectives	Stabilizing access to ED care through TelEmergency was one reason UMMC did not have to make substantial capital investments to acquire those rural hospitals, which may have otherwise closed.
	Led to better downstream population health management.

CAH, critical access hospital; ED, emergency department; EM, emergency medicine; MS, Mississippi; NP, nurse practitioner; UMMC, University of Mississippi Medical Center.