The educational psychology professor at the University of Texas at San Antonio said government-mandated social distancing requirements, necessary to prevent the spread of the coronavirus, had also temporarily prevented some clients at the Autism Treatment Center in San Antonio from getting needed care.
“We had to consider the ethics of not continuing these services,” said Neely, who started a new program that trains the nonprofit center’s behavioral therapists to conduct sessions with clients virtually.
These therapists help children with autism or other disabilities learn how to do the basics — take their daily medication and brush their teeth, for example — through a method of therapy called Applied Behavior Analysis, or ABA.
Neely received a $50,000 grant for the project from the COVID-19 Response Fund, a $5.4 million fund managed by the San Antonio Area Foundation and the United Way of San Antonio & Bexar County.
Over an eight-week period, 70 children will receive behavior therapy using videoconferencing technology, and 23 therapists will remain employed while receiving hands-on training in telehealth.
The long-term goal of this project, she said, is to establish telehealth as an effective alternative to in-person services, even after the threat of COVID-19 has passed.
In the midst of the crisis, many health care providers are seeing patients online to minimize person-to-person. The looming question for the industry is to what extent telemedicine has taken root since mid-March.
Apart from the convenience of conferring through laptops and smartphones, the answer will depend on: how well patients’ health outcomes from online sessions match up with the results of face-to-face appointments; how secure the digital platforms are in handling patients’ sensitive health information; and how willing insurers will be to pay for telemedicine at the same rates they do for in-person visits.
For the first time, telemedicine is widespread in San Antonio.
Laurel Ridge Treatment Center, a psychiatric hospital near Stone Oak, announced a new service allowing patients to participate remotely in their intensive outpatient programs. University Health System recently updated its new mobile app to give patients free access to a virtual triage and to schedule telehealth visits.
Texas Medical Association recently conducted a poll of physician members asking whether they had started to use telemedicine during the pandemic: 74 percent answered yes.
“It’s time,” said Neely, who has researched telemedicine in her field since 2015. “It’s been emerging for years.”
Within weeks, patients with chronic or acute health conditions were given easier access to their doctors via Zoom or FaceTime, without the risk of exposure to coronavirus at a doctor’s office or hospital.
What took so long? For clinic owners, it’s an investment of time and money. It requires buying computer hardware and software, training employees, Internet bandwidth and contracting with a company that offers a platform that can protect patient privacy and reduce liability from data breaches.
Health care businesses’ transition to telemedicine is coming during a public health emergency when these providers are already hurt financially by lower patient volumes.
But moving more of the business online could also mean reduced rent payments as providers seek to lease a clinic space with less square footage. Some doctors report being able to see more patients a day via telemedicine — and many patients could get used to getting medical care without loading up the kids in the car or missing work.
“This telemedicine expansion is very much an urgent pilot study,” said Dr. Zeke Silva, a diagnostic and interventional radiologist for South Texas Radiology Group in San Antonio. “I think we’re going to look back at this point in time as objectively and responsibly as we can to see what worked and what didn’t work.”
Silva runs the radiology departments at two Methodist Healthcare System hospitals and was a lead author of a white paper in 2012 on teleradiology.
On Wednesday, the doctor spoke to American Medical Association members via webinar about coding for telemedicine during COVID-19, which is how providers get payment for services from multiple insurance companies.
He said the increased use of telehealth was triggered by the current public health emergency because of a waiver of section 1135 of the Social Security Act relaxed rules about paying for online medical visits.
The waiver allowed doctors to bill federally-funded health insurance —Medicaid, Medicare and the Children’s Health Insurance Program— for virtual services starting on March 18 at the same rate as face-to-face visits.
Chad Mulvany, a policy director for Washington D.C.-based Healthcare Financial Management Association, said it’s likely that there will be an aggressive push for Congress to make these legislative changes permanent.
When the national health emergency ends and the government rolls back the telehealth expansion, he said he fully expects to see a coalition of providers, health plans, patient advocates, consumer groups and public health workers band together to make telehealth just health care.
Congress has already appropriated $200 million through the CARES Act to fund efforts to expand telehealth.
Major health insurance companies tend to follow what the Centers for Medicare and Medicaid Services does. UnitedHealthcare has since announced plans to reimburse its member’s claims for telehealth services, at least through June 18.
Blue Cross Blue Shield of Texas temporarily lifted cost-sharing, which includes copays, deductibles and coinsurance for remote care from in-network providers during the emergency.
As the COVID-19 pandemic continues there has been a considerable increase in the utilization of telemedicine technology, said Laura Tolley, spokeswoman for BCBSTX.
The average weekly telemedicine claims volume has increased from about 23,860 claims per week in early February to more than 160,000 claims per week in April.
©2020 the San Antonio Express-News, Distributed by Tribune Content Agency, LLC.
