Urgent Matters

Dr. Friedman's study can be found here. 

Dr. Waller can be contacted at [email protected].

Kevin is the Chief Strategy Officer for DispatchHealth. He brings nearly 15 years of experience in the healthcare industry as a clinician and in management. Prior to DispatchHealth he was the head of clinical solutions and strategy at an industry leading consumer mobile health app company called iTriage. Kevin has been a board certified physician assistant for over a decade. Over the years Kevin has served as a clinical preceptor for physician assistant students, served on numerous boards and committees including; quality improvement committees, EMR deployment committees as a provider “champion”, and president of the Colorado Academy of Physician Assistants. In addition to his work at DispatchHealth Kevin is an active advisor in the healthcare industry start-up community locally in Colorado providing both business and clinical expertise.

More about DispatchHealth. 

Dr. Rahul Sharma is the Emergency Physician-in-Chief for New York Presbyterian-Weill Cornell Medicine and an Associate Professor of Clinical Medicine. Dr. Sharma serves as the Medical Director of Strategic Initiatives and the Making Care Better Program for New York Presbyterian Hospital-Weill Cornell Medical Center. He also serves as Associate Director of the Executive MBA/MS in Healthcare Leadership program with the Johnson School of Management and is an Associate Professor of Clinical Healthcare Policy and Research.

Dr. Peter Greenwald is a Board Certified Emergency Medicine Physician. Dr Greenwald is Emergency Medicine Telehealth Services Co-Director and Director of Emergency Medicine Telehealth Quality Assurance.

The Wall Street Journal: Can Tech Speed Up Emergency Room Care?

Dr. Tim Peck s the CoFounder and CEO of Call9, a technology enabled clinical services startup. In 2016, Call9 became fully operational in two Skilled Nursing Facilities (SNFs or nursing homes), and treated more than 1,300 patients.

Call9 is an alternative to 911 in SNFs. When a patient in a SNF suffers an acute event, the SNF nurse activates Call9. One of Call9's on-site Clinical Care Specialists (CCSs) then go the the patient's bedside and, within moments, are connected to an Emergency Physician via Call9's HIPAA secure technology platform. The Call9 CCS can then perform diagnostics, take labs, and deliver care under the Physician's direction -- at the patient's beside.

In 2016, its first full year of operation, Call9 received more than 1,300 unique activations and kept patients in their nursing home beds -- as opposed to potentially going to the Emergency Department -- 78% of the time. Call9 has already saved the healthcare system, and the tax payer, millions of dollars -- while delivering comfort to patients and piece of mind to their families. And Call9 is expanding rapidly in 2017.

In late 2016, Call9 signed its first contract with an insurance payor, and since the beginning of 2017, Call9 has signed contracts with three of the five largest insurance payors in New York. This validation of Call9's model will allow it to move into even more SNFs and, most importantly deliver care to even more patients in need.

As CEO, Dr. Peck is responsible for a staff of 30 full-time employees and 40 contract employees. He oversees all aspects of Call9's work from clinical delivery to technology development and maintenance, to business operations and finance. He and Call9's team have positioned the company to go to scale in 2017, potentially delivering life changing and saving treatments to to tens of thousands of patients.  

History/Accomplishments

Peck previously held a faculty position at Harvard Medical School and was the Chief Resident in the Emergency Department at Beth Israel Deaconess/Harvard.

While at Beth Israel, Peck repeatedly encountered the challenge of treating patients who would have had superior outcomes had he and his team been able to treat them earlier. After investigating this problem, Peck learned that 1) despite making up only 0.5% of the population, Skilled Nursing Facility (SNF or nursing home) patients make up nearly 20% of ambulance transfers to the ED, and 2) the average time it takes for a SNF patient to see an Emergency Physician is over 60 minutes. Shortly after learning the scope of the problem Peck set out to solve it.

Call9 decreases the time it takes for individuals to see an Emergency Physician to within moments of an acute event. On-site Clinical Care Specialists are connected to Emergency Physicians via Call9’s proprietary platform to deliver hands-on emergency care at the bedside. Peck’s efforts to develop Call9 coalesced when the company went through Y Combinator’s accelerator program. The company now has 80+ employees and is delivering life saving care at facilities across lower New York.

Commitment to Excellence

Peck's commitment to excellence is clear in every aspect of Call9's work. He has overseen the development of best practices for the on-site Clinical Care Specialists and remote physicians including regular QA/QI meetings and consistent upgrades in the diagnostics at the patients bedside, and the tools at the CCSs disposal to deliver superior care to SNF patients.

In the past, a patient with a UTI and fever in a nursing home would almost invariably trigger the SNF staff to call 911. From there, the patient would be transferred via ambulance to a hospital Emergency Department. The patient would then be sent for a CT scan, and, regardless of the results would almost invariably be admitted into the hospital for a multi-day stay. This whole process costs the healthcare system $36,000, while placing unnecessary stress on the patient and their family, and exposing the patient to the threats to wellness that hospitals can sometimes contain.

In nursing homes that have Call9, that same patient causes the nurse to activate the our Clinical Care Specialists who go to the patient's bedside, are connected to an Emergency Physician and can begin administering care immediately. The patient is then sent for an outpatient CT scan, brought back to the nursing home and monitored for 24 hours+ by the CCS until the fever has dissipated. This process costs the healthcare system $2,000, and delivers significant quality of life improvement to both the patient and their family.

Impact on Community

Every day Call9's service delivers value to nursing home patients and their families. By preventing transfers to the hospital patients are able to remain in their adopted homes. Families are able to avoid the alarm of receiving a call telling them their loved ones are in the Emergency Room. And the escalating health challenges associated with lengthy gaps in treatment delivery are also avoided.

Call9 is fully committed to improving the lives of our patients -- the company's mantra is to always put the patient first. We believe that as long as we follow that guidance all else will fall into place for those we serve.

Dr. Barnett’s research focuses on health care delivery and quality, with a special interest in the delivery of specialty care and evaluating innovations in care delivery. Using tools from network science, his work has shown that hospitals whose patients see a larger number of doctors have higher costs and intensity of care at the end of life. He has also studied patterns of specialty referrals through the US and found that referral rates nearly doubled from 1999-2009. Dr. Barnett’s more recent projects have examined how risk adjustment for socioeconomic and clinical factors influences measurement of readmission rates, and how physician factors affect the delivery of low-value care such as overuse of antibiotics and opiates.

Read the NEJM paper here.

Seth Trueger, MD, MPH, is a member of the faculty at the Northwestern University, Chicago, IL He completed his residency in emergency medicine at the Mount Sinai School of Medicine in New York, and recently completed a Health Policy Fellowship in the Department of Emergency Medicine at George Washington University in Washington, DC. His areas of interest include emergency department crowding and payment reform, airway management, and social media for health professions.

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