For the past month or more, doctors in the US have had their hands full with the rapid onset and spread of the coronavirus. Affecting thousands of citizens each day, it’s all hands on deck to try to treat patients in need.
With an increased attention on patients suffering from this deadly virus, however, many doctors worry about their non-coronavirus patients. From those fighting off the flu or some other virus to those with preexisting conditions like diabetes, heart disease, and cancer, lots of people aren’t getting the care they should be.
Some patients are afraid to come forward out of fear they’ll contract COVID-19, others hold off on contacting their doctor to avoid taking up precious time or available hospital beds for those they feel are in greater need right now. In any event, the concern is that there could be a lot of people out there suffering in silence. If you run a healthcare practice and have some of these same concerns, know that there are some effective solutions to help you treat and support your non-COVID-19 patients.
Many healthcare facilities across the country have implemented telehealth options. It is a digital platform that allows medical professionals to provide care and treatment to their patients remotely. Not only can this type of platform be instrumental in helping you to pre-screen potential COVID-19 patients, but it can be used to help non-coronavirus patients as well.
Advising your patients to utilize this application when in need of medical attention allows you to meet with the patient virtually and assess their health status. You can prescribe medication, provide self-care tips to treat their problem at home, or, if necessary, advise them to get to a healthcare facility or hospital for immediate attention. This prevents them from coming in the office unnecessarily (saving thousands of lives), but still provides them with an option to get medical care if they need to.
Virtual visits help providers increase productivity by adding revenue and reducing travel to different clinical settings. However, despite these obvious advantages, 2019 saw an abysmally low utilization rate of less than 10%. Things have monumentally changed. As a local physician characterized telehealth today, convenience is the new quality. Love it or hate it, telehealth is here to stay.
The primary care collaborative conducts a weekly survey of physicians, nurse practitioners, and physician assistants working in primary care on how their practices are responding to the COVID-19 outbreak. Over 80% of respondents indicate their patients accept telehealth visits and nearly half of the respondents plan to continue using telehealth after the COVID-19 crisis is controlled.
Prior to the pandemic, telehealth was seen as convenient and time efficient for patients. It also showed promise for providing access to care for various underserved populations. Today we’ve gone beyond convenience as telehealth has become a necessity for both patients and providers. Increased utilization has been made possible by the relaxation of rules and requirements by both government and commercial health plans. Notably, the use of telehealth had been restricted by design.
Health plans wanted to control how and where telehealth was offered along with who could provide the service. For the duration of the COVID-19 health emergency, most health plans are allowing telehealth to be used in place of in-person encounters. Many are waiving patient cost share and paying providers the same rate as an in-person visit.
Medicare has made the following changes effective during the COVID-19 health emergency: telehealth can be used with both new and established patients, telehealth via telephone will be reimbursed, and providers are allowed to treat patients across state lines. In addition, the Centers for Medicare and Medicaid Services (CMS) is waiving HIPAA violation penalties for utilizing technologies such as FaceTime or Skype.
By A.J. Hanna, vice president client advocacy, SYKES.
People’s knowledge of telehealth isn’t necessarily leading to usage — at least, that is what we found at SYKES as a part of our survey on attitudes toward telehealth. Telehealth, in its purest form, has existed for decades. Physicians, whether by phone, radio, or other forms of transmission, have been calling on clinicians from outside of their communities to assist them with second opinions or provide specialty expertise for many years.
And while the internet has opened up new and more expansive opportunities for telehealth — including making it easier for the remote caregiver and the patient to interact via both video and audio — regulatory restrictions, reimbursement inconsistency, attitudes toward effectiveness and other factors have prevented it from finding its full promise.
COVID-19 and its ability to spread easily and rapidly has pushed the healthcare system in the United States and around the world to take a more expansive view of how telehealth can be used. Given the growing importance of this tool for triage of those potentially infected by the novel coronavirus, we wanted to first assess how many people even knew what telehealth was.
When presented with the question, “Telehealth is the use of communication technologies to support long-distance health care, instead of an in-person appointment. Are you familiar with telehealth?,” over 42 percent of those contacted for this survey were not even aware of the service (in excess of 1400 people). While usage of telehealth services has increased over the last several years, there are still many people who do not equate services available to them as being telehealth.
Of those few in our survey who knew what telehealth was and had actually used the service, satisfaction rates were very high. This follows trends from other studies that find that telehealth satisfaction levels exceed other parts of the healthcare industry. And not surprisingly, the primary benefit that they cite is the ability to avoid being with others in a clinical waiting room. But for those who had not been engaged in a telehealth visit, or had not considered the service, some expressed concern that telehealth would only be effective for minor illnesses and diagnoses. Others felt that a diagnosis would be difficult without the “touch and feel” aspect of a care visit.
Perhaps not surprisingly, respondents in the 55+ age group were less likely to have used telehealth or expressed concerns about its effectiveness. Because many in the upper level of this age group are likely Medicare beneficiaries, and because coverage by Medicare has been restricted to specific conditions, geographic regions and care settings, this is not surprising. Recent decisions by the federal government to relax restrictions for Medicare coverage of telehealth as a result of the novel coronavirus pandemic may help to close the gap in utilization represented in our survey.
If there is any outcome of the current pandemic as it relates to telehealth, it may be that it will encourage more people to consider using it. Nearly 60 percent of respondents indicated that COVID-19 has made them more likely to consider using a telehealth service in the future. Almost 25 percent of our respondents had not linked COVID-19 to their opinion of using telehealth. However, those numbers will surely change as the health system in the United States continues to utilize all means necessary to care for the health of people in ways that prevent further spread of the disease.
Coronavirus has forced practices nationwide to undertake dramatic changes in how they practice medicine. But whatever the means we use to deliver care, there is still nothing as dramatic as saving a life.
Although I had been thinking about and planning to use telehealth for about a year, the sudden arrival of the COVID-19 pandemic left me with no choice. I recognized that there was no way to safeguard my patients or staff if I kept my office open.
I still had some reservations. Would patients use telehealth technology? Would they accept it? Most importantly, would telehealth allow me to deliver the same quality as an in-person office visit?
The answers came quickly and clearly. With healow TeleVisits from eClinicalWorks, getting started was simple and easy for my staff. Patients were thrilled to have a way to receive care without having to risk exposure to the coronavirus by traveling to my office. We transformed our more than 20 daily in-office visits to more than 20 televisits in just 10 days.
Saving a patient’s life via telehealth
And my remaining doubts about the efficacy and quality of remote care were erased in a single encounter.
I was meeting with a new patient who was complaining about vomiting, diarrhea, and abdominal pain. When I asked him to show me what the vomit looked like, he placed a jar containing black vomit in front of the camera.
I immediately knew that he was suffering internal bleeding and instructed him to get to a hospital. His wife ended the call and took him to the ER, where he was admitted. The bleeding was stopped and he received a transfusion.
Five days later, we had a follow-up televisit. He was in good spirits and told me that his life had been saved because of that first televisit.
Updox, a telehealth platform, experienced a significant spike in demand throughout March, onboarding more than 10,000 new customer users to its HIPAA-compliant telehealth solution in just two weeks. Today, the company facilitates more than 45,000 telehealth visits per day between patients and their doctors, with that number increasing rapidly.
More than 300 million Americans are currently under orders to shelter-in-place as public health officials and providers work to contain and mitigate the coronavirus. Updox experienced a sharp increase in the demand for telehealth from mid-March, when more states began issuing stay-at-home orders and physicians needed a safe and secure way to connect with their patients.
Unlike some first-generation telehealth solutions, Updox allows patients to connect with their own physicians instead of someone unfamiliar to them. Likewise, rather than competing with physicians, the Updox platform supports practices to maintain revenue, protect staff and deliver care safely to their patients. Studies show that patients prefer receiving treatment from their own physicians, with whom they’ve developed strong, trusted relationships. In fact, according to a recent survey by Sharecare, 60% of Americans noted they would want to “access care with their primary physician if they experienced COVID-19 symptoms.”
The Trump administration temporarily changed the policy for Centers for Medicare & Medicaid Services (CMS) allowing healthcare providers to have phone-only visits with patients, which is a major breakthrough in the industry and one that was not allowed before.
With the coronavirus being spread throughout the United States, the administration understands the importance of social distancing and the pivotal role that telehealth will play in keeping patients healthy. What is necessary to support the amount of patients today is an economically sustainable, scalable and immediate telecare solution that is available to anyone, regardless of income, age, or location.
The way to keep the general population healthy, is in a fight to flatten the curve and protect most specifically older adults and those at-risk from COVID-19. Telehealth is likely the most effective way to provide care to those who need it and minimize exposure to the virus for the both the patient and the doctor. Right now the hospital systems are overwhelmed with the sudden influx of patients from this virus and telecare’s primary role is to treat patients remotely, reducing the pressure being put on the hospital systems.
Another important factor is the effects that social isolation has placed on older adults and how that will impact their overall physical and mental well-being. We created Uniper to provide a familiar service for older adults, right on their TV screens, mobile phone or desktop to have access to life: their communities, friends, family and physicians so that they can obtain much needed care, from a distance.
Uniper is designed to be economically sustainable, scalable, and accessible to anyone that needs it to help them thrive during these unusual times.
Maven, the largest telemedicine provider for women’s and family health, announced a new partnership with MassHealth, the Massachusetts, Medicaid and the Children’s Health Insurance Program. MassHealth will provide free telemedicine appointments for members with COVID-19 symptoms with Maven’s network obstetric/gynecologists, maternal fetal medicine specialist, pediatricians, family physicians, and general practitioners for women and families in Massachusetts.
MassHealth members will be connected through an online navigation tool to Maven providers through on-demand chat and video appointments 24 hours a day through the use of any web-enabled device.
“During the COVID-19 emergency, MassHealth has made unprecedented efforts to eliminate barriers to health care access, including expansive coverage of telehealth services,” said Acting Medicaid Director Amanda Cassel Kraft. “We are excited to announce this partnership with Maven ?to provide medical support to our members seeking guidance on COVID-19 symptoms or risk factors.”
In the wake of COVID-19, women and families are dealing with a myriad of health concerns, from managing conditions related to a high risk pregnancy to being discharged from hospitals soon after giving birth to caring for a newborn. Telehealth now plays an essential role in giving these women and families the support and care they need from the safety of their own homes.
“This pandemic has raised serious concerns for millions of women who are pregnant or have just given birth,” said Kate Ryder, founder and CEO of Maven. “We have doctors available around the clock to support MassHealth members and alleviate the burden on the healthcare system during this public health crisis. Massachusetts has long been a leader in healthcare and other states should look to their innovative response to this crisis as a model.”
With the incredible demand for care, trusted clinical data and information, and resources around COVID-19, Maven has developed dedicated COVID-19 resources. This includes:
Ongoing webinar series led by healthcare professionals to provide clinical updates on the rapidly evolving COVID-19 pandemic, answer member questions and address topics including pregnancy, fertility, anxiety and pediatrics. The next webinar will be held on Thursday, April 2 at 1:30 p.m. EST. Please register here.
Covid-19 support section in our member app for those looking to connect with specific providers.
Specific Maven provider in-app resources with the most up-to-date information regarding COVID-19.
The HIPAA waiver issued for telemedicine during COVID-19 is a game-changer for physicians now that CMS says virtual visits are reimbursable.
And now, telehealth is emerging as an effective and sustainable solution for precaution, prevention, and treatment to stem the spread of COVIS-19. But what do the new HIPAA waiver and CMS rule about telemedicine during COVID-19 mean?
According to Dr. Neil Baum, chief medical advisor at Vanguard Communications, professor of Clinical Urology at Tulane Medical School, and in clinical practice for 40+ years, the glass is half full.
“Telemedicine is a great opportunity for us to fill our glass and engage our patients in a way we never have before. We’re still able to practice good medicine without having to be face to face or touching a patient,” says Dr. Baum.
Telehealth is bridging the gap between people, physicians, and health systems, enabling everyone, primarily symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines.
For healthcare professionals, this news means that CMS now allows providers to be reimbursed for the vast majority of virtual visits using telemedicine during the COVID-19 pandemic. (Only a small number qualified for reimbursements as recently as March 14.)
Plus, no special software or extra expense for healthcare-specific hardware and software is needed. The tools are free and easy to use.
Below is a chart of the popular apps approved for telemedicine during COVID-19.
Dr. Baum says telemedicine will go a long way to enhancing a physician’s connection with patients and providing access to care but stresses the importance of documenting virtual visits and video conversations just as you would an in-office appointment.
“If you didn’t document, then you didn’t do it, and then you don’t get paid for it,” says Dr. Baum.
Visiting nurses are valued for their caring and compassionate nature. Their valuable skillset makes a difference in the well-being of their patients and the lives of patients’ families. However, they face unique challenges amid the coronavirus as patients and staff are concerned about receiving in-home care during this time. Bringing healthcare to the home is no easy task.
As NAHC President William A. Dombi stated, “Home care and hospice nurses, therapists, aides, and other providers who choose to use their lives to serve our country’s aged, disabled, and dying. This noble work deserves our recognition and praise.”
Home health agencies are on the front line amid the coronavirus pandemic. A recent Home Care Association of New York State (HCA-NYS) survey found that nearly half of agencies in the survey said they have experienced patients or family members refusing entry of home care personnel. “Different states and regions are at different stages in surveillance and monitoring,” Roger Noyes, director of communications at HCA-NYS, told Home Health Care News.
“This speaks to some very important educational and outreach needs to reassure patients and to ensure that vital care can be delivered,” Noyes said. In addition to patients’ hesitation to let nurses into their homes for in-person visits, many patients are already quarantined, sheltering in place, or social distancing. And, some patients are denying service because they appreciate their nurses so much that they do not want to risk getting their nurse sick in-person. Concurrently, the nurses themselves might also be wary of conducting in-person visits as they might not have sufficient protective gear and/or fear the risk of infection.
Agencies are implementing telehealth/virtual care to preserve their patients, their staff and their limited supplies. Technology can help agencies’ staff continue what they do – provide compassionate and critical care – and “be present” with their patients as much as possible. With technology, agencies can safely continue the delivery of care during this time and quickly communicate critical updates as needed. The technology helps home healthcare agencies:
Conduct virtual visits with patients to safely ensure continuity of care
Send out critical COVID-19 updates and self-care tips
Send condition-specific messages to improve ongoing adherence
Provide virtual access to their staff which helps nurses address patients’ emerging concerns and also alleviate patients’ loneliness while being socially isolated
With virtual visits, agencies are kept abreast of the realities of the patient’s home environment and their available resources (financial, food, social, etc.). Staff can continue to monitor their patients’ day-to-day situation and individualize the care (and conversation) to the “new normal” for the at-home patient.
Use of telemedicine in the U.S. has been low to date. However, asexpected, it is expected that demand for these services will increase dramatically over the next few months because of the coronavirus (COVID-19) crisis, says GlobalData, a leading data and analytics company.
Telemedicine has been touted as a critical strategy during the COVID-19 emergency to limit the risk of person-to-person transmission of the virus, prevent emergency rooms from being inundated, reduce barriers to screening, and allowing those with moderate symptoms to be treated from home. Teladoc Health, a telehealth provider, announced that patient visit volume had increased by 50% since the previous week and was continuing to rise.
Kathryn Whitney, MSc, director of thematic analysis at GlobalData, said: “Prior to the COVID-19 crisis, telemedicine had never reached its full potential in the US, with several barriers preventing its widespread uptake. These include lack of reimbursement and restrictions affecting access for rural populations, general lack of awareness of these services, and the desire of the sick to see their physician in person.”
Since early March, regulations in the US governing the use of telemedicine have changed regularly, which will expand access to services during the COVID-19 emergency, particularly for Medicare beneficiaries who are deemed at high risk for the virus. In certain states, including California and New York, officials have also announced that payers must offer telehealth services as part of their emergency plans. In Massachusetts, payers must cover the COVID-19 testing and treatment via telehealth, and cannot impose cost sharing via co-pays, deductibles, or coinsurance, and prior authorization is not required to receive treatment via telehealth.
Whitney continues: “Recent changes to regulations by the U.S. government will remove many of the financial barriers to telehealth and drive the use of these services, particularly among older and vulnerable populations. People will also become more aware of these types of services, given amount of information being disseminated by the government, hospitals, healthcare systems and payers.
“As more U.S. cities and states begin to lock down and social distancing becomes the new normal for the foreseeable future, Americans are likely to change their views on telemedicine. With the ongoing risk of virus transmission, people will be eager to avoid hospitals and get screened and receive care from the safety of their own homes.”