“Wow, I won’t have to wear one of those stupid paper gowns.”
That was my first reaction upon learning that my initial post-surgical follow-up visit was rescheduled as a virtual telehealth session due to the coronavirus pandemic.
But my thoughts quickly turned to practical matters: how was my orthopedic surgeon going to critically examine my totally repaired hip remotely? Orthopedics by its nature is a visceral, hands-on kind of medicine, sort of like advanced carpentry. How could he tell how well the scar was healing (very well)? Or whether my range of motion was where it needed to be (it wasn’t)? Or if there were other issues we hadn’t even considered (there were)?
Which got me to thinking about things like blood tests. Or urine samples. How does that work in a telehealth situation? Will you have to mail that in prior to the appointment? And how exactly does one ensure the viability of that sample by the time it reaches the physician or the lab? Are there laws governing the shipping of bodily fluids? One thing’s for sure: I’m not going to be sticking myself any time soon.
Pandemic phenomenon or wave of the future?
The pandemic of 2020 has changed the face of medicine and how we accept it in ways big and small. One of these is the emergence of telehealth, at least for now, as a “thing.” Whether it remains a viable and well-utilized option post pandemic is anyone’s guess. But for now, it’s gaining a lot of acceptance.
According to a recent survey, 82% of Americans still don’t think telehealth is available to them. Nonetheless, interest in using telehealth has jumped by 40% in Americans aged 18 to 44 and more than 30% in those aged 45 and older. Of note, two out of five said the COVID-19 pandemic made them more likely to use telehealth.
For example, the executive director of one healthcare system noted that, prior to the surge in COVID-19 cases in March, the system struggled to get healthcare providers engaged in video visits. That same healthcare system in March and April conducted about 50,000 virtual visits a week, a huge jump compared to about 100 a month before COVID-19.
The chief marketing officer at a large healthcare insurer concurred, observing that, over the past month, the company has seen a 60% year-over-year increase in weekly telemedicine consults per 1,000 members.
The 3 key issues surrounding telehealth
Timely and remarkably prescient government intervention helped address key pain points of telehealth: privacy, insurance coverage, and remote monitoring. In a matter of weeks, many of the barriers to telehealth reimbursement were put on hold, allowing for changes that provider groups have wanted for years: payment parity for virtual visits, the ability to provide telehealth to patients at home, and allowing more providers to offer telehealth visits.
Once policy hurdles regarding costs and privacy were addressed, the Food and Drug Administration (FDA) made it easier to monitor patients remotely by issuing guidance that allowed providers to use consumer health devices. The new policy included devices that measure body temperature, respiratory rate, heart rate, and blood pressure.
In March, the HHS Office for Civil Rights also announced that providers could temporarily use common virtual platforms like Skype and FaceTime to do telehealth visits, which are not HIPAA compliant. OCR said it would waive potential penalties for HIPAA violations against healthcare providers that serve patients using these apps during the COVID-19 pandemic.
A new kind of waiting room
Which all sounds great for insurers and physicians, but how does this affect the patients in the trenches, people like me?
First of all, telehealth does nothing to quell “white coat syndrome.” I was still as nervous as ever. Worried that I would miss my appointment, I signed into the practice portal 15 minutes ahead of time. I had seen a notification on the portal when I signed in that the doctor was ready for me, but just like in real life, I found myself waiting in front of my laptop monitor for my doctor to appear. Thank goodness I could stare at my cell phone in the meantime.
Once my surgeon showed up, though, I felt more at ease. When he asked to see my incision, I simply lifted up my shorts to display that 8-inch beauty in all its splendor (confident it was only me and him sharing this moment of vulnerability). He then put me through a number of Zumba-like maneuvers in front of the screen to demonstrate my range of motion. When he saw that I wasn’t as flexible as I should have been, that’s where telehealth met person-to-person health—he immediately ordered an in-office X-ray for the following day, with all the appropriate precautions.
Still a lot of questions needing answers
As usual, I had written down all the questions I could think of to ask him during the visit. And as I usually do, I remembered a few really important ones after we hung up. And there was no way to get the immediate feedback I wanted for those questions, because he had moved on to another patient and an office assistant never has the right answers. Some things never change.
One very important question for all of us: who’s going to pay for televisits? During the pandemic, insurance companies are generally picking up the cost, but the jury is still out about afterwards. Physicians believe their time is money, regardless of how it’s dispensed, and that they deserve to be compensated. Interestingly, even though my deductible had been met, I was charged $25—which in comparison to the six-figure cost of my surgery and rehab seemed pretty paltry.
While physician groups are generally happy with these pandemic-induced changes, they also worry that many of these currently relaxed regulations might tighten up again, which will reduce payer coverage for telehealth.
Most experts feel that OCR is unlikely to extend HIPAA exceptions. When the pandemic is over, Facetime and Skype will no longer be viable vehicles for telehealth, mandating use of a HIPAA compliant platform.
What about getting prescriptions?
Another example is the DEA temporarily allowing providers to prescribe controlled substances via telehealth for behavioral health patients. Many providers would like to see that change stay in place, but the DEA will be the ultimate arbiter.
My personal prescription experience was hassle-free. The surgeon’s office contacted my pharmacy and my anti-inflammatory was waiting for me when I arrived at CVS. And the office suggested I call back to receive an antibiotic Rx prior to my next dental visit. Seemed pretty easy to me, although to be sure I wasn’t asking about painkillers (without going into details, believe me when I tell you the side effects are NOT worth it).
Don’t lose the personal touch
And I agree. Even though I oddly like in-person office visits, there’s a certain appeal to the convenience of receiving professional expertise in the comfort of your home—and not having to wear paper gowns.