When it came time for the Calvert County, Md., resident’s follow-up visit with surgeon Dr. Jason Stein of MedStar Health, she learned her appointment would take place via video — and wound up generally pleased with the experience.
“It felt like it was a house call, like the old days,” said Parker, 65. “Post-surgery, I’d prefer to go in. But I didn’t really want to drive in to an office right now.”
As cases of COVID-19 threaten to overwhelm Maryland’s medical system, doctors and hospitals are rushing to embrace the long-promised but little-used innovations of telemedicine, remotely delivering health care in an effort to keep patients out of the office and away from one another and the providers. They are limiting in-person contact to those in need of urgent care.
It’s a sea change in how doctors treat patients and has the potential to alter how medical providers deliver services long after the virus abates.
The upper respiratory illness has presented challenges for hospitals and health care systems to overcome as more than 2 million known cases saturate the globe. Elective procedures and routine visits have been canceled. But such services bring in revenue and keep patients healthy, and out of the emergency room where beds are needed to handle a surge of COVID-19 patients.
While some medical networks and hospitals have gradually embraced remote care methods over the years — using patient “portals” designed to help people engage with their physicians via a website or cellphone app, for example — they now must pivot to conducting most regular business off-site.
The slow rollout has given way to rapid adoption of technology, new procedures and training.
“If you think about how prevalent technology is in our lives, doctors have been amazingly slow to adopt telemedicine,” said Gene Ransom, CEO of MedChi, the state’s medical society.
But due to the coronavirus, he said, the move has been given a large push by most insurers, public and private, who are now paying for telemedicine.
That includes Medicare and Medicaid, the government health programs for seniors and low-income residents. It also includes the major private insurers in Maryland, such as Kaiser Permanente and CareFirst Blue Cross Blue Shield, which is working with MedChi to offer independent physician practices with five or fewer members a year of free access to a telehealth platform. This will ensure doctors remain available to patients during the pandemic and beyond, MedChi and CareFirst officials said.
Doctors and hospitals will continue to use such platforms if insurers continue to cover them at the regular rates, Ransom said.
“If you think about how prevalent technology is in our lives, doctors have been amazingly slow to adopt telemedicine.”
Gene Ransom, CEO of MedChi, the state’s medical society
“The biggest change is the doctors are now getting paid for it,” he said. “Before, the vast majority of doctors were not doing any of this for that reason. Now they can get their full rates for a telemedicine visit.”
State lawmakers also passed two bills during the final days of their shortened General Assembly session expanding medical professionals’ use of telehealth to treat patients. Gov. Larry Hogan, a Republican, issued an executive order designed to make it easier for providers to use telemedicine, suspending some of the normal hurdles hospitals face in implementing it during the state of emergency.
Bob Atlas, CEO of the Maryland Hospital Association, said the transition in the state has been swift. Such access has been helpful for many patients, and the need will continue after the pandemic.
“It’s very valuable for doctors to be able to communicate with patients without the patients having to come to their office ... whether it’s COVID-related or otherwise," Atlas said.
He said it remains unclear how much telemedicine will continue after the pandemic ends.
There are many barriers to work out, such as patients without smartphones or broadband Internet service at home. Also, with a huge drop in in-person visits now, doctors will have to see what works to keep practices and services in business.
“After this is over, we will have to sort out what makes sense for more normal times,” Atlas said. “Now we’re trying to deal with what’s on our plates today.”
MedStar’s Stein also said some visits will need to return to the office.
“Phone visits are just not as good as video visits,” said the orthopedic surgeon who specializes in the shoulder and elbow.
Stein hopes telemedicine does not become the gold standard of health care when the virus abates, but he agreed it can save some patients like Parker valuable time, money and energy in commuting to their doctors. Perhaps, he said, medicine can evolve into a hybrid of virtual and in-person visits.
Parker, who used to live in Baltimore County before moving to Calvert, added that the expansion of telemedicine would allow people like her to stay with their physicians even after they move, which can prove especially vital for those with restrictive health insurance or rare conditions that only some can treat.
Baltimore-based Mercy Hospital planned to roll out its videoconferencing system for patients in the next fiscal year but accelerated its development, said Dr. Fernando Ferro, medical director for Mercy at Overlea.
Ferro said in the weeks since he started doing video sessions, he’s found it easy to establish a rapport with patients.
“I think we’re going to use it a lot more than we were before — from the physician end, it’s opened our eyes to the fact it’s not really anything burdensome,” he said.
But Ferro said other hospital staffers have endured the brunt of the work.
Pivots to telehealth require hospital staffs to ensure the apps, platforms and software they use comply with privacy laws, Ferro said, and during public health emergencies, administrators do not have time to iron out many technological kinks.
Some doctors, he added, won’t be able to embrace telemedicine as others do. For example, doctors who specialize in the ear will have greater limitations in assessing patient discomfort via phone or video.
Still, telehealth has allowed for continuity of care in a climate of uncertainty.
The University of Maryland Medical System established emergency "tele-triage” units throughout the 13-hospital system, said Dr. Laura Pimentel, an emergency medicine physician at the University of Maryland Medical Center. Patients use iPads to consult with remote physicians as on-site nurses review medical records and check vital signs.
“An important goal of telemedicine is to keep the patient and the provider physically separate,” she said. “If we can complete a visit without having a patient see provider, that’s one less point of contact.”
Patients also appear to approve of telemedicine: A new study by Sage Growth Partners showed 64% of those surveyed believing they are more likely to use telehealth services since the COVID-19 crisis started, and 69% wanting their provider to offer more virtual visits as an alternative option to office visits after the crisis ends.
Johns Hopkins transitioned to virtual appointments, not just for its primary care patients but also for those in need of complex, specialty care, said Brian Hasselfeld, a pediatrician and Hopkins’ assistant medical director for digital health innovations.
“Those problems don’t stop because of the pandemic,” he said. “We’re deploying whatever resources we have ... to keep things going.”
Rebecca Canino, Hopkins’ administrative director of telemedicine, said patients and physicians have simultaneously experienced a learning curve. She said that’s partly because about four months’ of administrative and IT work was compressed into about four days.
Telemedicine visits have ballooned from eight patients a day to more than 1,200 a day at Hopkins, Kevin Sowers, president of Johns Hopkins Health System, recently told the Greater Baltimore Committee.
"Out of something really horrific that is happening in our world, this will also force us to look at ways that we can change and become better at delivering health care services to our communities,” Sowers said.
MedChi’s Ransom said he’s heard of pain doctors, orthopedists, cardiologists and even ophthalmologists using telemedicine, which is likely keeping some practices in business.
Hundreds of practices of all sizes have signed up for telemedicine, he said. In the short term, these virtual visits are helping keep people healthy and out of the hospitals.
“But telemedicine is something we should have implemented a long time ago,” Ransom said. “It’s convenient for a lot of people. Maybe this is one good thing to come out of this pandemic.”
©2020 The Baltimore Sun, Distributed by Tribune Content Agency, LLC.
