Are virtual hospitalist programs here to stay?
Born out of the urgent patient needs of the COVID-19 pandemic and the explosion of medical technology, these programs — sometimes known as telehospitalists — are consistently evolving to meet intense financial pressures and systemic issues facing hospitals. If lessons from COVID-19 taught hospitalists anything, it’s that creativity often yields scalable solutions and innovative growth.
The beauty of these programs is flexibility; they can be shaped to include a broad spectrum of capabilities and packages of services depending on regional care needs and the ability to scale operations. Many use existing technology and IT support. Program architects and visionaries say the model, when utilized and integrated appropriately, has not only improved patient outcomes but has also boosted cross-team collaboration, continuity, and care delivery beyond the hospital’s walls.
“It’s an effective pillar to support patient care and boost efficiencies,” Henry Ellison, MD, medical director of Houston Methodist Hospital’s virtual hospitalist program and assistant professor of clinical medicine, told Medscape Medical News.
Houston Methodist’s program focuses on nocturnal hospitalist care. Ellison also emphasized that virtual care does not entirely replace or supersede the value of boots-on-the-ground doctoring.
"I think it works well, it works safely, and it works equitably when it exists as one part of a piece of care that still remains largely in person,” he said. “We’re not here to replace any in-person care delivery mechanism. But there is an argument to be made that through the virtual care delivery mechanism, the doctor can get eyes on a patient sooner and the surgical team to the bedsides earlier,” Ellison said.
The COVID Connection
Kimberly Bloom-Feshbach, MD, assistant professor of hospital medicine at Weill-Cornell Medical College and a hospitalist at NewYork-Presbyterian, explained the virtual hospitalist program was a direct response to urgent patient needs.
During COVID, “we had a huge surge in terms of acutely ill hospital patients, and at the same time, providers who were getting sick and unable to work, or people who were immunosuppressed or otherwise not engaging in frontline work. In that space, we were forced to innovate very quickly.”
Since then, the hospital’s program has gone through various iterations. Today, it functions as a hybrid medical-psychiatry consultative program.
“In the earlier stages, the program used a team model, where one hospitalist was in person and the second, virtual, listening to the encounter and writing notes and assisting with other tasks. That model became less urgently needed. In our current hybrid hospitalist model, we collaborate very closely with psychiatrists at a behavioral health hospital in Westchester,” said Bloom-Feshbach.
She said a team of nurse practitioners do the frontline consultative work while the hospitalists provide advice and case discussions, help navigate the healthcare system, and review charts — all virtually. But hospitalists also will come on-site for certain procedures that require hands-on attention; for example, patient assessment and a cardiac exam before electroconvulsive therapy.
“I’m still a big believer in the importance of examining patients. There’s a lot of power in an in-person encounter I think we need to hold onto,” said Bloom-Feshbach. “At the same time, to be able to leverage expertise of one person across multiple sites can make a lot of sense, for example, in areas where there is less access to specialists and critical care.”
Serving Rural Needs
The Veterans Health Administration (VHA) runs one of the largest telehospitalist programs in the U.S., providing a range of virtual services. Like NewYork-Presbyterian, the program began with a pilot at one site in response to the COVID pandemic and now services 12 facilities across the U.S.
“We provide a couple different models that include cross-coverage, after-hours calls from inpatient units, nursing home-type facilities (CLCs), and residential rehab treatment programs,” said Jaydeith Gutierrez, MD, MPH, director of the National Tele-Hospital Medicine Program at the VHA and clinical associate professor of internal medicine at the University of Iowa in Iowa City.
“The benefits are that the veterans can get access to a physician immediately without having to go to an emergency room. We are also able to direct them to the next level of care if they need additional services,” said Gutierrez, adding that in most cases, virtual hospitalists are able to treat at every facility, prevent transfers, provide drug coverage, and provide support to local nurse practitioners and physician assistants.
The VHA has the receipts demonstrating the program’s success. Findings from a 2025 internal survey of 125 veterans underscored overall satisfaction with the care they were receiving (96% indicated satisfied or very satisfied) and technical issues were not problematic. On the provider side, among a staff survey of 32 respondents across six sites, 75% of respondents were satisfied or highly satisfied with the program and believed it improved the quality of care.
Rural hospital coverage is also found at UCHealth University of Colorado Hospital’s Virtual Health Center in Aurora. The goal, said Hemali Patel, MD, associate chief medical officer of the program, was to devise a strategy that would allow patients to remain in their community while still providing the same level of services.
Patel’s program has 12 hospitalists who live in the Denver metro area who either work from home or from a virtual care center, she said.
“They can admit a patient directly, physically examine them (even though they’re virtual), and even listen to their heart and lungs and coordinate with bedside nurses. If the nurses have questions, we can beam into their room to address them. And if patients get sicker and need more urgent care, we can run rapid responses virtually or transfer them,” she said.
Patel said they’ve made a concerted effort to develop workflows with each hospital. When emergencies occur and level of care requires a hands-on physician, they are able to call on local hospitals to arrange someone to see the patient.
Taking It Home
UW Health’s home-based hospital care program in Wisconsin relies on a different approach than many of the other programs.“We take patients who’ve been admitted straight from ER or transfer those who require ongoing acute, hospital-level care (e.g., heart failure exacerbations, chronic obstructive pulmonary disease exacerbations, infections, cellulitis, substance abuse, etc.) from one of our brick-and-mortar hospital floors to their home,” said Joshua Shapiro, MD, medical director of the program.
“We have nurses or paramedics who visit them at least twice daily, set up whatever IV medications they might need, and continue to treat them as if they were still in the hospital,” he said, noting that the model is a hybrid one.
Rounds are conducted virtually using tablets, but onsite providers facilitate the visits unless the doctors determine the necessity to physically evaluate patients.
There are multiple benefits, said Shapiro.
“We free up hospital capacity by taking care of people who would otherwise need to be in the hospital. And the quality metrics are pretty incredible (e.g., reduced risk of hospital-acquired infections or delirium). There are no serious safety events. Because patients remain in their homes, they are more mobile, are significantly happier, and eat their own food. The patient experience is really positive,” he said.
All of these programs started with a single question: What problem are we trying to solve? Though the answers might vary, the solutions appear to have garnered patient and hospitalist satisfaction.
Ellison, Bloom-Feshbach, Gutierrez, Patel, and Shapiro reported no relevant financial relationships.
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