Study: Pandemic has forced medical professionals to add more virtual visits

WILKES-BARRE — Teri Ooms, executive director at The Institute for Public Policy & Economic Development at Wilkes University, this week said although there are technological downfalls and some aspects of medicine that are currently impossible to accomplish over a video chat, local telehealth practices have allowed patients to stay socially distanced from one another while simultaneously acquiring much needed care from their trusted healthcare professionals.

“Sadly, we are in the midst of a resurgence of COVID-19, this surge is just as if not more challenging than the original in the spring and taxes all essential workers, but most of all our health care systems and workers. we are going to discuss how our innovative health care systems and providers pivoted during COVID, used technology, and took care of so many of us through telehealth services,” Ooms said.

Telehealth, the practice of utilizing technology such as video and phone calls to allow for long-distance care, has been around for a while. While virtual medical visits are not new, the effects of the COVID-19 pandemic have forced medical professionals to add more and more virtual visits to their schedules and patients to rethink how they seek access to medical care. In an effort for members of the community to stay safe and socially distanced, many have turned to telemedicine to discuss problems with their primary healthcare providers as well as specialists.

Local Health Systems’ Telehealth Practices

Geisinger is just one of the health systems in the region using telehealth, or telemedicine, to provide care during the era of COVID-19. To schedule an appointment, patients can call a toll-free number to speak with a representative and see if their regular Geisinger doctor is offering virtual visits. During that call, a patient can schedule an appointment with a primary care doctor or a wide variety of specialists.

According to a published report, Geisinger averaged more than 1,000 video visits per day in April and May, resulting in more than 60,000 video visits during this time-frame, compared to 27 video visits per day prior to the pandemic.

To access the telehealth system, a patient needs access to a smartphone, tablet, or computer with a web cam and speakers, as well as high-speed internet capabilities.

Commonwealth Health Network is another regional health network that is currently utilizing telehealth services more frequently. Commonwealth Health is currently accepting both new and existing patients for telehealth visits and has a list available on their website of each of their providers that is currently providing telehealth care. Most insurance plans will cover a Commonwealth Health telehealth visit, especially if the visit is done over a video format.

In addition to these local health systems, many local, community-based health care providers are offering telehealth services and have modified their operations to use telehealth to continue providing patient services during the pandemic. According to survey data collected from federally funded health centers and reported by the National Association of Community Health Centers, 45 percent of total visits at health centers in Pennsylvania were conducted virtually, based on June survey results.

In our region, The Wright Center for Community Health is currently providing their patients access to both telehealth and e-visits. The telehealth visits are in the form of video visits and the e-visits allow patients to communicate with their care team through a secure email or the patient portal.

Volunteers in Medicine, a free primary and preventative clinic for the working poor in Wilkes-Barre conducted over 1,700 virtual appointments ranging from physical to pharmaceutical concerns while the stay at home orders were in place, and has since transitioned back to in-person visits. However, phone and telehealth visits are still available primarily for mental health counseling.

Key changes

The key changes made to telehealth services following the COVID-19 outbreak include the following:

• Removes restrictions on telehealth to allow Medicare providers to offer telehealth services to beneficiaries regardless of geographic location, and for patients to access telehealth from their home. Previously, telehealth services were only available on a limited basis to Medicare beneficiaries in designated rural areas and from certain health care facilities.

• Allows Rural Health Centers and Federally Qualified Health Centers to provide services via telehealth instead of in-person.

• Expands the services that can be provided via telehealth, including emergency department visits, initial nursing facility and discharge visits, critical care services, home visits for new and established patients, and physical and operational therapy services, among others.

• Allows clinicians to provide virtual services to new patients instead of only those with which they had an established relationship.

• Allows physicians to practice across state lines during the pandemic to treat Medicare patients virtually, even if not licensed in the patient’s state.

• Allowed all heath care professionals who are eligible to bill Medicare for services to use telehealth, including physical and occupational therapists, and speech language pathologists.

• Removes restrictions for using smartphones and other everyday communication technologies, such as FaceTime and Skype, to conduct telehealth visits.

• Allows reimbursement for audio-only visits.

• Allows providers to reduce or waive cost-sharing for patients.

In addition to the regulatory waivers issued regarding telehealth services for Medicare patients, many private insurers have also adjustment their reimbursement policies to increase the payments to providers for telehealth visits so they are on par with in-person visits. Prior to the pandemic, reimbursements for telehealth visits were often less than half the amount of an in-person visit, which discouraged many providers from offering telehealth services.

Challenges with services

Telehealth services provide many benefits for both healthcare providers and patients, but there are some drawbacks as well. There are technological challenges that can include anything from a patient not having a phone or tablet with a camera to a lack of internet connectivity.

Additionally, the patient must take the phone call inside state lines of the state in which they are a resident. Telehealth is currently treated as an office visit, however, there are regulations regarding cross-state licensing of physicians.

Finally, health insurers have made many changes over the past few months to accommodate the boom of telehealth appointments. It was unrealistic to ask high risk patients and potentially exposed patients to come into an office, so both healthcare and insurance providers needed to change the way they approached telehealth. Although telehealth is on an upward trend and seems to be here to stay, technology, cross state licensing, and insurance provide challenges that must be faced going forward.

According to data from the U.S. Census Bureau, about 83 percent of households in Lackawanna and Luzerne Counties have broadband access and nearly 73 percent have smartphones.

While that may seem like a large number, 17 percent of households still have no broadband access whatsoever, and most of the region does not have access to the faster fiber-optic internet.

Another concern for telehealth is cross-state licensing of physicians. Stay at home orders and quarantine have greatly reduced traveling, but there are many who chose to go to a different state to quarantine with family and friends.

Before the pandemic, government-provided insurance including Medicare and Medicaid did not generally cover telehealth visits, specifically those with specialists, social workers, or therapists. Since March, the government has issued a waiver to allow Medicare patients to receive care virtually for the same cost as an in-person office visit.

There are still many challenges with providing telehealth services that are apparent even with the current waivers and special considerations. Policy changes and advancement in internet capabilities across rural areas will be extremely important to the longevity of telemedicine once it is safe for patients to go back to the doctor’s office in person.

Summary/recommendations

According to Megan Stachowiak, Institute Research Analyst and Principal Investigator on this study, “There are still many challenges with providing telehealth services that are apparent even with the current waivers and special considerations. Policy changes and advancement in internet capabilities across rural areas will be extremely important to the longevity of telemedicine once it is safe for patients to go back to the doctor’s office in person. Changes to these challenges can be tedious and potentially expensive, but telehealth is providing much needed help in a difficult time and, despite its drawbacks, will have the chance to grow and evolve as the field of medicine continues to make strides in the coming months and years. Telehealth is just one facet of the future of medicine, but the COVID-19 pandemic has forced both patients and health networks to fine-tune the system for potential growth and expansion going forward.”

Stachowiak explained that the expansion of telehealth services offers the potential to increase access to healthcare services in rural areas and medically under-served regions. The following recommendations outline suggested approaches to ensure this temporary shift in virtual health care delivery is sustained:

• Support the long-term adoption of regulatory changes and reimbursement policies that enable broad access to telehealth.

• Support policies to make telehealth services more accessible to lower-income individuals to help address health inequities and improve access to care, including permanently expand telehealth services to Medicaid and CHIP programs, and making telehealth services available from community health centers.

• Support investments in developing and expanding the telecommunications infrastructure to accommodate telehealth services, especially in currently under-served rural areas.

• Reexamine licensing and credentialing requirements for providers that have been given temporary authorization to provide telehealth services, including physical, occupational, behavioral and speech therapists to allow long-term access to these services virtually and address gaps in care.

• Promote payment parity between in-person and telehealth visits for public and private payors to encourage providers to offer telehealth care options.

• Enact measures to minimize the risk of fraud or inappropriate usage of telehealth services.”