The State of Telemedicine During the Pandemic
Although we live in an age and place in the Merrimack Valley where cellphones, tablets, computers and smart devices are commonplace and virtual medicine has seemed like a tangible idea to many, the leap from in-center to telephonic and virtual medicine had never materialized.
Then an unfathomable crisis, the COVID-19 pandemic, came along.
“Prior to COVID-19, telehealth was a promise of the future. It just had never been operationalized,” says John Silva, president and CEO of Greater Lawrence Family Health Center. “It was a kind of dream or a vision people had that this might be a way to get more people into a system to improve health and reduce health disparities, but [the pandemic] became the laboratory where it worked, and it worked all across the country.”
Silva was faced with an enormous dilemma when COVID-19 was declared a pandemic. At facilities such as Greater Lawrence Family Health Center, providers such as nurse practitioners, doctors and nurses couldn’t have face-to-face visits because either they or their patients could be at risk of exposure to the coronavirus. But Silva and many other leaders of health care organizations did what seems almost impossible in retrospect. “In two days,” he says, “[we were able to] convert a face-to-face health care delivery system into a telephone/telehealth delivery system so that we could continue to serve all of our patients.”
Dr. Randi Berkowitz, chief medical officer at Lowell Community Health Center, reflected on those very early days and the support from Massachusetts Gov. Charlie Baker, who issued an executive order requiring insurance companies to reimburse health care providers for telemedicine visits at the same rate as in-person visits shortly after the World Health Organization declared COVID-19 a pandemic. “I’m very impressed with Baker and MassHealth, who have made sure that … providers were not needing to bring people into the office inappropriately,” Berkowitz says. Because health care providers didn’t have to worry about reimbursement issues, they were able to focus on making appropriate clinical assessments, and to protect staff and patients. “It’s been a huge success story. Patients almost uniformly love it,” Berkowitz says.
As spring turned into summer, reports came in and the benefits of telemedicine seemed remarkable. “Because we serve an underserved community, the no-show rate is high,” Silva says. “As many as 1 in 4 patients regularly do not show up for their appointments. Implementation of telehealth has shown a drop in the no-show rate, bringing it to only 3 to 4%.”
Berkowitz echoes the drop in no-show rates for her clinic, and explains that telemedicine has been dramatically helpful for patients who have no transportation or child care, or for patients with disabilities. Berkowitz says that the increase in accessibility to providers has also led to a decrease in patient hospitalizations, although she says it is difficult to draw a clear cause-and-effect relationship with the pandemic presenting so many variables.
Dr. Mary Lynn Joe, medical director at Circle Health Urgent Care, explains what is not considered a suitable reason for a telehealth visit: “Any injury. Something that would require imaging like an X-ray we would want the patient to come in.” She also notes that telemedicine cannot provide “that reassuring personal touch” that providers miss giving and patients miss getting.
Berkowitz says it’s a little too early to know what to expect of telemedicine after COVID-19. “The data is not clear yet which visits should be face to face and what should be telemedicine,” she says. Her clinic, Lowell Community Health Center, has been taking an approach in which the individual provider uses clinical judgement based on the reason for the visit and knowing the individual patient. The clinic is also tailoring treatment by asking the patient for their preferences.
A bill entitled “An Act Putting Patients First” (MALegislature.gov) was passed by the Massachusetts State Senate on June 25. It would require insurers, including MassHealth, to cover telehealth services and for reimbursement to providers at the same rate as in-person visits. The fate of the bill, which is expected to be taken up by the state House of Representatives remains uncertain, but local health care leaders feel certain that telemedicine isn’t going anywhere.