Turns out telehealth is good medicine
In the world we lived in before the pandemic boom lowered, if we had decent access to health care, the annual doctor’s visit, a half-hour with the physician after a little prep from a nurse, is something many Americans took for granted. Not all, but many, maybe even most.
Medicare-MediCal and access through the Affordable Care Act provide incentives for health care teams to get it done and more incentives to get it done in a way that patients deem satisfactory or better. Everything in the world now is the equivalent of a “Yelp” rating.
In 2019, my colleagues at High Desert Medical Group conducted 301 “Telehealth,” or “Audio” health check-ups amid our tens of thousands of patients. I can only imagine it was similar with many other health care providers.
In 2020, the pandemic boom dropped and wham! In-person exams became a rare thing. Contagion was high, with illness numbers getting bigger daily.
Consulting rooms tend to be small, with the air close, in windowless rooms. Then another boom happened.
The number of telehealth (video or computer screen) and audio (telephone) check-ups and checkins exploded. During the year that
COVID-19 changed life for all of us, our medical services provider group check-ups by phone and some federally compliant versions of FaceTime calls went from 301 to nearly 20,000. It was a keystone mode for staying connected to our tens of thousands of patients and it has been working.
“At the beginning of the pandemic, a crucial change to the Medi-Cal reimbursement policy made telehealth more accessible than ever for California’s most vulnerable populations. Visits conducted via telephone, online video or in-person were to be covered equally,” Drs. Sirena Keesara and Anastasia Coutinho wrote last week in the Los Angeles Times.
The rules modification expanded health care and information access for some of our most vulnerable populations, particularly the elder population, and minority communities.
“Our experience as clinicians during this time has shown us that putting telephone visits on equal benefit footing has dramatically expanded access to care without compromising quality,” the doctors wrote.
The two Northern California physicians note that Centers for Medicare and Medicaid Services, along with California’s Department
of Health Care Services, recently signaled they would cut, or eliminate entirely, physician reimbursement for audio-only visits. Such a cut would almost certainly be self-defeating. The reasons are simple.
Many patients, particularly senior patients, as well as minority and financially disadvantaged people, lack high-bandwidth Internet access or ease of use with technology. We all use the telephone and the telephone in the hands of an experienced physician can be an essential diagnostic tool.
Dr. Anthony Dulgeroff, associate medical director at HDMG, concurs that the telephone has kept the patient-physician connection vital throughout the pandemic and that eliminating reimbursement equates to reducing access for some of our most vulnerable charges.
“Telephone visits allow access to care for those who don’t have or can’t use technology and reducing reimbursement would reduce access for seniors and disadvantaged patients alike,” Dulgeroff said. “Many of my scheduled virtual visits (telehealth visual access) get converted to telephone visits due to technical issues.”
Another consideration, he said, patients rarely no-show to telephone visits and frequently state they prefer phone calls to driving sometimes up to one-and-a-half hours just to drive to town.
In the Antelope Valley, our communities served, range from the Tehachapi Mountains to the San Bernardino County line.
“Despite the major investments that have been made in video technology, most telehealth visits at safety net healthcare providers ... are conducted by telephone, without any video component,” Drs. Keesara and Coutinho write.
Telehealth use during the COVID-19 pandemic has lowered barriers that families face in receiving care, including transportation, child-care and work schedules, according to the physicians who work at federally qualified health clinics.
“These barriers are not unique to care during the pandemic,” they said.
State health care officials should plan a shift to payment systems that reimburse for quality rather than quantity of care, allowing payment of a set amount per patient, per year, for good health outcomes.
Most desirable is flexibility to use any care model via phone, digital outreach, community health workers, group visits or individual visits that results in best outcomes for patients, Dr. Keesara, an affiliate scholar at Stanford Medicine’s Clinical Excellence Research Center said. Dr. Coutinho is a family physician at La Clinica de la Raza in Contra Costa County.
In a year that has seen an excess of death and loss, more access options for care, not less, make sense.
Amid the most recent losses of Vietnam War-era veterans in our Antelope Valley was Jim Sholund from a battle with cancer. Jim served as a sergeant and served unselfishly with Vets4Veterans, overseeing the nonprofit’s scholarship program and with his wife, Pat, volunteered annually for Wreaths Across America. If anyone earned a wreath for work on behalf of veterans, it was Staff Sgt. Jim Sholund.
Dennis Anderson is a licensed clinical social worker at High Desert Medical Group. An Army veteran, he deployed to Iraq with local National Guard troops to cover the war for the Antelope Valley Press. He specializes in veterans and community health initiatives.