Everyone benefits if telemedicine continues

New funding model needed in Sask.,

“I hope this continues after the pandemic is over.”

It seemed a strange thing to say, but I understood what he meant. He and I had just finished a consultation about his kidney stones. We talked about his pain attacks, reviewed his past health, discussed his X-ray results and arranged urgent surgery. He wasn’t happy about the kidney stones, but he was happy with this: We did it entirely over the phone.

He was spared a two-hour trip to my Saskatoon office for a conventional, face-toface meeting. I share his sentiment: I hope we continue to take advantage of this approach, even after we settle into the next normal.

Virtual medical care, or telemedicine, is not new or uncommon. As do many health-care practitioners, I routinely phone my patients with test results, to followup on new treatments or to answer questions. But most visits are in person, at my office. That changed abruptly in late March when we temporarily closed our urology office, in light of concerns about COVID -19. In the first 30 days of this new practice, our eight urologists provided more than 1,000 consultations. That adds up to a lot of kilometres that patients didn’t have to travel.

Eliminating travel is the main benefit of telemedicine. Patients are also spared the expense of accommodation, parking, childcare and time away from work.

However, virtual care has limitations. Communication challenges can be amplified. Phone consultation removes the ability to read body language, non-verbal communication or a person’s general physical or mental health. Video platforms are available, but have inconsistent quality and require an additional level of access to technology and high-speed internet connection. Consultations requiring physical examination or diagnostic procedures cannot currently be completed through telemedicine. Telemedicine may also get in the way of an intangible, yet critical part of the consultation: developing a trusting patient-physician relationship. Physicians conducting telemedicine assessments must remain vigilant so as not to neglect the value of in-person visits.

Given the potential benefits of telemedicine, why did it take a global crisis to spur its wider use? The main reason is economic. Saskatchewan’s provincial health insurance plan doesn’t pay for most virtual care. If the government pays your physician on fee-for-service basis, then every time she calls you about a lab result or X-ray report, she is doing it for free. What other professional, say a lawyer or accountant, makes a distinction between expertise provided over the phone and that provided in person? They expect to be paid in either case.

To the credit of health-care administrators and policy-makers, Saskatchewan rapidly adopted new methods of physician compensation during the pandemic. Provincial health insurance was expanded to include virtual care by phone or video ( beyond the SHA’S Telehealth system). Physicians are also eligible for a salary-like stipend to allow them to keep partly shuttered practices open. These measures have allowed necessary care to continue without requiring people to cluster in physicians’ waiting rooms.

But these are temporary measures. If there isn’t ongoing financial support for physicians to provide virtual care, the old normal will prevail. Physicians are advocating for funding changes to support virtual care.

If that involves extending Saskatchewan’s health insurance coverage to include virtual care, then payments to physicians may increase, given that many of these services are currently being provided for free. Those costs will be scrutinized by administrators and politicians.

They must also give consideration to the other side of the balance sheet — that is, the benefits to Saskatchewan residents. These benefits are more difficult to measure: reduced travel expenses, less time off work, and better access to health care for those in remote communities or with restricted mobility.

Perhaps the most compelling measurement is in the hands of all residents: Taking into account your time, travel costs and other expenses, how much is it worth to you to have the choice of a virtual appointment? Write down that amount and send it to your MLA. Let’s not put this genie back in the bottle.

Dr. Kishore Visvanathan is a Saskatoon physician.