Released: 5/12/2021 7:40:47 AM
By Annemarie Franczyk – Contributing writer
Telehealth, a remote service with explosive growth during Covid-19, will continue to be an in-demand component of health care when social distance becomes a choice, not a requirement.
Health experts attest to the convenience and effectiveness of telehealth in many health-care settings. The support of state and federal governments and other payers and the increasing comfort level among patients will only ensure widespread acceptance, they said.
It seems widespread couldn’t get much higher than Highmark Blue Cross Blue Shield of Western New York’s reported 8,277% increase in telehealth claims from 2019 to 2020.
“While telehealth cannot replace visits that require a detailed physical exam, the value of telehealth over the past year has been broadly recognized by providers and patients, particularly for behavioral health care,” said Dr. Mark Perry, senior medical director at Highmark. “We anticipate that it will remain a standard of care for years to come.”
The use of telehealth, which encompasses phone, video and email interactions between providers and patients, had been scant until February 2020. The following month telehealth visits grew dramatically, by 154%, when compared to the period the previous year, according to a CDC study. Much of that increase was driven by patients’ fear of circulating during the pandemic and the convenience of the virtual option.
Jericho Road Community Health Center did no telehealth visits prior to the pandemic. By mid-March 2020, about half of all patient encounters were done via video or phone calls.
It helped to alleviate the frustrating no-show rate to appointments at the Broadway and Barton Street facilities. Patients in some situations no longer needed to pack up the kids and take public transportation to check in with the doctor, said Takesha Leonard, family nurse practitioner and East Side medical director.
“It’s more accessible. It gives patients an option,” she said.
Telehealth also is offering options for providers whose focus is delivering care exclusively in patients’ homes, such as the Visiting Nursing Association of Western New York.
Lisa Greisler, VNA president, said a video meeting or phone call can be swapped for a personal check-in for a patient uneasy about home visits during the pandemic. Video meetings have been especially useful for speech therapy, which couldn’t be done through a mask, even if the meeting were in person.
However, in-person visits are critical to visiting nurses for hands-on treatment and evaluation of the home environment to ensure it is conducive to healing and recovery, she said.
“People like it now,” Greisler said. “If you are fairly healthy, you can do a video visit. A true telephone visit is something we expanded and will continue. But the vast majority of our business will continue to be in person.”
Erie County Medical Center had been using telehealth for patients through the state Department of Corrections exclusively since 1998 until the pandemic necessitated an expansion to the greater community.
“The level of adoption is night and day,” said Dr. David Ellis, an emergency medicine physician at ECMC. “The number of providers and the number of patients using telehealth has increased a thousandfold. I’ve taken care of more people in the front seat of their cars or in their bedrooms than I could imagine.”
Ellis said physicians who forever had based their patient care on the traditional in-office, physical exam had to be shown that a video call could provide the same visuals to determine neurologic functioning, respiration, color of skin and signs of distress.
Most health complaints could be handled remotely while 15% to 20% of patients were instructed to go the emergency room, Ellis said.
As the pandemic hit last year, Catholic Health expanded its Care OnDemand program, where physicians were available for the asking via video or phone, from an employees-only service to use by the general public.
The health system is in the process of credentialing its own physicians toward a goal of having a force of entirely local providers, said Joyce Markiewicz, Catholic Health executive vice president and chief business development officer. Further, the health system is expanding services to include behavioral health and linking Care OnDemand to its electronic medical records, she said.
Policy changes and regulatory waivers in government drove the shift to remote platforms. Last March, the CDC and provisions in the U.S. Coronavirus Aid, Relief, and Economic Security Act did much to improve provider payments for telehealth, expand its use among medical specialists, and include care given outside of medical offices.
States contributed to the rise in telehealth when they issued stay-at-home orders and included telehealth as a Medicaid covered benefit. Further, the Reimagine New York Commission has among its initiatives enabling wider use of telehealth “to build a more accessible, equitable, effective, and efficient healthcare system” statewide.
Private insurers also loosened their rules prompted by Covid-19. Independent Health, for one, shifted from a hybrid reimbursement model that combined capitation plus fee-for-service to full capitation.
“Now we’ve given the practices the ability to see patients in any way they can, by phone, email, video or in person,” said Dr. Anthony Billittier IV, chief medical officer. “Prior to Covid, the federal and states rules were just stifling. Covid was an awakening for all these regulators. We said we have to loosen our rules too. So, something good came from it.”