COVID-19 forced people out of waiting rooms. People still needed care. Chronic health conditions didn’t just go away.
McColley, then lead clinician at Riverside Health Center in Belle, and her team began driving to patients’ homes for appointments. Telehealth, or virtual care, couldn’t reach most of Riverside’s patients.
The Cabin Creek Health System, with care centers across Kanawha County, including Riverside, conducted 829 virtual care visits during the first week of April. Just 22 were done via video chat. The rest were by telephone.
Telemedicine has proved effective during the pandemic, keeping people with chronic health conditions away from crowds and allowing more one-on-one time between patients and caregivers, according to health professionals.
“Once [the pandemic] is all said and done, telemedicine is here to stay. There’s no two questions about it,” said Dr. Kishore Challa, president of the West Virginia Board of Medicine.
But West Virginia has a connectivity problem.
Without sufficient internet access, drastic health disparities will widen between the state’s most impoverished and vulnerable communities and wealthier places, said Dr. Rahul Gupta, West Virginia’s chief health officer from 2015 to 2018.
Telephone visits only go so far, McColley said, who was recently promoted to chief medical officer of Cabin Creek Health Systems.
“Even if it is over video or Zoom, them being able to see my face ... and me being able to look them in the eyes and know that they’re OK, or know that they’re not OK,” she said. “I think it’s easier being able to hide stuff on the phone definitely than it is on the video.”
It’s not just telehealth that requires sufficient broadband. The success of West Virginia’s children is directly dependent on internet access, Gupta said.
“If there’s one investment that needs to happen immediately, it is in broadband, to ensure that this does not become a basic fundamental rights issue … it’s as important as the air we breathe,” Gupta said. “In a time where we cannot remain connected any other way, being online is very important.”
“If we don’t, then we’re already creating the divide to begin with.”
The digital divide
West Virginia was the reason telehealth requirements needed to be loosened nationwide early in the pandemic.In March, the federal Centers for Medicare and Medicaid Services expanded telehealth access to keep elderly patients in their homes. But Challa and state health officials and professionals immediately raised concerns because the expanded service required both audio and video communication between caregivers and patients.
Challa urged Centers for Medicare and Medicaid Services Administrator Seema Verma to waive the requirements because of the digital divide in West Virginia, and then worked with Sens. Joe Manchin, D-W.Va., and Shelley Moore Capito, R-W.Va., to make it happen.
The next problem: Medicare did not reimburse audio telehealth visits at the same rate as video visits.
Had that also not been changed, doctors’ offices in West Virginia, especially in rural areas without broadband, would have closed, Challa said.
These fixes expire once the national state of emergency ends. Telehealth is here to stay, Challa said, but those who need it most are more likely to live in a community without sufficient broadband.
“[Internet access] is essential,” he said. “It is the backbone of telemedicine.”
The Kanawha Valley’s digital divide is quantifiable, McColley said. About 70% of patients at Cabin Creek’s Kanawha City facility have utilized telemedicine during the pandemic compared to 11% at the Clendenin Health Center.
The Clendenin facility serves communities in Clay and Roane counties as well as eastern and northern Kanawha County.
Vaccinations, cancer screenings and well-child visits still must be done in-person, McColley said, but almost all of Cabin Creek’s behavioral health screenings, or mental health treatments, are conducted virtually.
Communities without sufficient broadband show the highest rates of people with chronic health conditions.
McColley said those places are often home to the worst mental health conditions.
“That’s our most vulnerable population, I would say, and it is because they have little to no access [to mental health treatment] or it’s because they have little to no resources,” she said. “Ensuring that we have these broadband abilities to have telehealth services — internet, video — in those remote places, it should be the most important [goal], because we also see in those remote places some of the highest incidences of mental health disorders.”
Challa is advocating for permanent changes to Medicare and Medicaid access and billing. Low-income Medicaid patients lack the same access to telehealth as Medicare patients 65 or older.
“Essentially, Medicaid patients are going to the emergency room. They’re going to [doctor’s] offices rather than on the phone and it’s been a big problem for everybody,” he said. “These are the most vulnerable patients … their socioeconomic status is not good.”
In the meantime, Challa, a cardiologist practicing in South Charleston, has implemented telemedicine procedures to ensure patients and doctors don’t fall into bad habits.
“In our office, we made a policy that once a patient gets virtual care once, the next time it has to be a physical appointment … unless it’s just a follow-up or minor ‘Hey how you doing?’ kind of thing,” he said. “Otherwise the doctor will never see the patient or the patient will never see the doctor.
McColley predicts a similar hybrid model for telehealth and in-person visits with screenings and tests at facilities and subsequent check-ins and prescription refills done virtually.
‘We could have been years ahead’
In 2007, eight state senators co-sponsored a broadband expansion bill. Its premise, lead sponsor Sen. John Unger II, D-Berkeley, said, was to get internet access to every municipality and rural area in West Virginia by 2010.Under the bill, if the state couldn’t get private corporations to invest in expanding broadband, then West Virginia could enter into a public-private partnership to get it done. If private companies weren’t interested, then municipalities and counties could do it themselves.
The bill passed both chambers before Manchin, then governor, vetoed it.
“We could have been years ahead with all this and we weren’t,” said Unger, chairman of the state Senate Public Health Caucus.
There’s a strong and long-standing correlation between high poverty rates, low educational attainment and lack of higher-wage jobs and communities without sufficient internet access, Unger said.
“They can’t attract businesses because of the lack of it … They’re not able to maximize opportunities with their educational system because of the lack of it,” he said.
Unger took issue with Gov. Jim Justice’s plan to use $100 million in federal CARES Act money to pave roads. Justice eventually moved $50 million to broadband expansion. Unger said West Virginia should stop laying asphalt and start laying broadband fiber.
“I mean even the most creative thinking is a real stretch of how building a road helps with COVID-19,” he said. “What we really need to be doing is looking at a whole new normal, and that new normal is going to be that we’re going to have to enhance our connectivity, our broadband, and make sure there’s no digital divide.”
©2020 The Charleston Gazette, Distributed by Tribune Content Agency, LLC.
