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For all the chaos that COVID-19 has inflicted on the U.S. health care system, the ongoing pandemic has brought at least one silver lining: More patients have been able to see their doctors using video conferencing technology, with the possibility that the practice could make medical care more affordable in the long term.
Those video conference programs have long been seen as a way to deliver low-cost medical services to rural communities or others without many health care providers, but a number of factors have held back their growth over the years, including low reimbursement from health insurers.
Now, the pandemic has lowered some of the barriers for so-called telehealth programs.
As hospitals and clinics have canceled many in-person appointments to preserve their resources for a surge of coronavirus cases and prevent the virus’ spread, insurance programs have temporarily made it easier for them to get paid by instead offering those services over the phone or on video platforms such as Zoom.
With that new source of funding, some Maine health care systems have seen astronomic growth in their use of telehealth since the start of March.
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Northern Light Health, a network of 10 hospitals stretching from Portland to Presque Isle, offered an estimated 1,600 medical appointments via video or telephone in February, according to Matt Weed, senior vice president and chief strategy officer. After the pandemic struck, that number shot up to 7,500 in March and 36,400 in April, with much of the growth in video appointments.
Penobscot Community Health Care, a group of primary care practices in Greater Bangor, offered “essentially no telehealth and no reimbursable telephonic care” before April, according to Dr. Noah Nesin, chief medical officer and vice president of clinical affairs. But in April, those two methods accounted for three-quarters of its primary care visits and nearly all of its psychotherapy or psychiatry.
Telehealth is not a panacea. Providers do not think its recent gains will make up for all the financial losses they’ve incurred from delaying non-emergency care during the first few months of the pandemic. Although remote visits were up for Penobscot Community Health Care in April, its total patient appointments were down more than 50 percent.
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Providers also expect there will continue to be a need for in-person visits to offer physical exams, blood draws and other services that can’t be replicated from a distance, and some patients may still face barriers to remote care such as limited broadband or smartphone access.
But now that the convenience of telehealth has been on display to patients, doctors and insurers, providers do expect it to play a greater role in medicine even after the current pandemic abates. Even if it has not traditionally been reimbursed as well as in-person care, it can be a cost-effective way to deliver mental health care, primary care, preventive services and follow-up visits to patients with chronic conditions such as diabetes, according to Nesin.
“We need to take advantage of what we’ve learned through all of this, and break ourselves out of longstanding, calcified approaches,” he said, adding that PCHC will advocate for better reimbursement of those services going forward.
In mid-March, the federal Medicare program announced that it would temporarily pay for many remote services at the in-person rate during the coronavirus crisis, and it waived other restrictions so that patients could more easily access those services. Maine’s Medicaid program and private insurers — under direction from the state Bureau of Insurance — have made similar changes.
Weed thinks some of those changes will remain in place after the current crisis. “I wonder if that horse is out of the barn at this point. I suspect it is,” he said. “I think the government’s decisions and changes they made, even though they may be temporary or emergency, I think they were the ones that moved the needle most.”
Some patients and doctors have already embraced the changes. A recent random survey of about 500 Americans by the research firm Klein & Partners found that the portion of respondents who were “definitely” willing to receive virtual care after the pandemic rose from 21 to 28 percent between early April and early May.
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One of the converts is Charlotte Ala of Presque Isle, whose 5-year-old son Jacob receives regular speech therapy at Northern Light AR Gould Hospital.
After the pandemic arrived and Jacob’s once-a-week sessions were replaced by two Zoom meetings a week, Charlotte hoped that he would, at best, hold onto some of the gains that he has made in the pronunciation of certain words, such as “cat” and “light,” that have given him trouble.
But she has been pleased with the outcome of the exercises and games that Jacob now does on a laptop as his therapist appears on the other end of a video feed, sometimes using a feature that lets him use programs on her computer. It has helped that he is now able to fit in more sessions per week and do them early in the morning, so they don’t interfere with school. So far, their private insurance has seemed willing to cover the bill.
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“Initially I was very hesitant about it,” Charlotte said. “This is a five-year-old. Sitting in front of a screen for a half-hour and expecting attention, I wasn’t even expecting to see growth. We’ve actually seen no regression. He’s improving on skills he had and building new ones.”
It was initially challenging for Northern Light Health providers to reorient themselves to offering many services over Zoom, which offers a plan geared toward health systems that need to keep patient information private. More than half of Northern Light’s telehealth offerings have been for primary and behavioral health care, but providers of rheumatology, cardiology, orthopedics, occupational therapy and other specialities have also been adopting it.
“We had to move very fast,” said Dr. Michael Ross, a pediatrician at Northern Light Eastern Maine Medical Center in Bangor and a regional chief medical information officer at Northern Light Health who has helped lead the transition. “But after that blitz, we’ve kind of been on autopilot.”
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Dr. Susan Cheff, the medical director of Penobscot Community Health Care’s Helen Hunt Health Center in Old Town, sees the value of offering primary care to her patients remotely, particularly as a way to safely continue their care through the current pandemic.
But she pointed to some challenges, including that it can be exhausting and time consuming spending multiple hours seeing patients over the computer. “There is almost like a ‘Zoom fog’ that you get,” she said. “You need to be deliberate about getting up and taking walks.”
She also can’t learn as much about a patient remotely, in part because she can’t take blood samples or hold a stethoscope up to their chest, but she has been adapting and, when necessary, making in-person visits to patients’ homes. She has also learned to appreciate the unique view of a patient’s life that she gets by seeing them at home.
“I think health care providers in general tend to be very creative thinkers, and this has called on us to use those skills,” she said. “I have had patients show me how they’re breathing, palpate their own abdomens and hop up on one foot. It’s been very, very helpful. I’ve had someone hold their foot up to the phone so I can look at something on their toe.”
John Morrow, managing director of Franklin Trust Ratings, a company that analyzes the financial performance of U.S. hospitals, said he expects the current expansion of telehealth offerings to continue, in part because of new research showing that patients themselves appreciate the service and also because of the insurers’ newfound willingness to pay for it.
The pandemic has normalized the expectation that patients with more minor health complaints should first call a provider rather than just show up at an emergency room. Over the phone, providers can triage patients to a lower level of care so they don’t overburden ER doctors, Morrow said.
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Once the pandemic is over, he said, that kind of shift could reduce the overall costs of medical care in the country by forcing hospitals to more efficiently allocate their resources, as they have shown they can do under the pressure of the pandemic. He compared that evolution to the growth in urgent care and outpatient centers that have also forced hospitals to readjust how they do business over the years.
“We can’t take the first pandemic of our lives and say it’s the new normal, but we have learned an awful lot, and we have learned that the health system is adaptable,” he said.
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