House calls: ‘Telehealth’ doctor visits a helpful tool even beyond pandemic
Remote health care appointments a practice experts say will live on beyond coronavirus crisis
Bringing her 14-year-old son, Alessandro, into Chicago for doctor’s visits has been a heavy burden on Ramona Gonzalez.
As a baby, Alessandro’s brain was deprived of oxygen and, as a result, he needs a ventilator to breathe, a feeding tube to eat, he’s deaf and blind. In recent years, Gonzalez has had to bring her son from Matteson to La Rabida Children’s Hospital on the South Side, which specializes in caring for medically complex chronically ill children. Sometimes, she has to load him in an ambulance along with his medical supplies and equipment.
“It’s a lot,” she said.
But over the past few months, Alessandro was able to see six doctors from La Rabida in three exams conducted over video. It was a godsend for Gonzalez during a pandemic she feared would endanger her son’s life.
“It was really good,” she said. “I don’t want to risk him getting any disease.”
One of the many things the pandemic has changed is the way people see their doctors. Almost overnight, patients began switching to so-called telehealth visits, a trend that’s expected to last.
“We went from doing zero telehealth … to within a week, we were doing 80% telehealth,” said La Rabida Chief Medical Officer David Soglin. “Over time, we’ll find the right balance. For some of these complex kids, maybe we do two personal and two telehealth visits a year. We’re still learning.”
Insurers largely didn’t cover telehealth visits until March as the pandemic forced new practices. In Illinois, Gov. J.B. Pritzker called for an expansion. Around the same time, the federal agency that runs Medicare and Medicaid and private insurers agreed to reimburse doctors for such visits as they would for office appointments, something they weren’t willing to do in the past. Doctors interviewed say telemedicine will expand as long as insurers pay. Multiple bills in Congress encourage it.
In a statement, Blue Cross and Blue Shield of Illinois, the dominant private insurer in Chicago, said it views “telehealth as a mode of delivering health care that will remain a part of our health care landscape.”
More frequent contact
Proponents say telehealth creates opportunities for doctors and patients to stay in contact more frequently. Federal health officials cite telehealth as a tool to help prevent heart attacks, strokes and other conditions.
Still, doctors stress that video and phone exams have their limitations, and patients are often asked to come in for personal visits to avoid mistakes. Medical errors already lead to tens of thousands of U.S. deaths a year, research shows.
Many visits to specialists, such as gynecologists or ophthalmologists, can only be done in person.
Advocates for children with a broad array of special health needs point to limitations as some intense therapies cannot be done virtually. And immunizations and early care require in-office exams.
“It works for some. It doesn’t work for others,” said Faye Manaster, a project director in Mokena with The Arc of Illinois Family to Family Health Information Center.
In addition to phone calls, as doctors and hospitals across Chicago worked to reduce the number of people coming in for appointments in recent months, they began offering video, or even drive-up options.
On Wednesdays, every patient seen by Dr. Sachin Shah is over video or by phone.
With the help of a medical assistant, patients are prepped much like they would be for a visit to the office, though they are reporting their own weight, blood pressure, pulse or additional information. Patients get a checklist in advance.
Prior to March, Shah, a primary care doctor and associate professor at University of
Chicago, saw his patients in the office. But the pandemic and the resulting stay-home orders changed all that.
Now he’s telling a patient on a video screen to “push on your belly” and “show me where you have discomfort.”
For patients who do go to the doctor, they’re asked to come alone so not to crowd the waiting room. If a person is more than 10 minutes early, that patient has to wait in the car. Visitors are encouraged to use a mobile app to make appointments and check in, a sort of OpenTable for health care, Shah said.
University of Chicago and other hospitals are experimenting with curbside services, including blood draws for lab work and potentially vaccinations. Drive-up shots may be key to handling flu season while doctors and hospitals brace for another wave of coronavirus cases.
“Medical providers have been ready to do this for some time,” Shah said, referring to virtual visits.
Doctors at John H. Stroger Jr. Hospital of Cook County had to make the switch to telehealth, with the majority of visits from April through early June done over the phone or video, said Dr. Claudia Fegan, chief medical officer of Cook County Health.
“Medicine was trying for years to get to telehealth, and this dramatically accelerated it,” Fegan said of the pandemic.
The vast majority of those using telehealth were largely on government insurance plans or uninsured, mirroring the Cook County Health system’s overall patient profile, Fegan said.
In addition to Stroger, the system includes 17 health clinics, Provident Hospital and Cermak Health Services, which treats county jail detainees.
The initial response from patients seen at Cook County was encouraging, Fegan said. While many patients don’t have personal computers or laptops, many have phones with video, she said.
“More people have smartphones than computers,” Fegan said. “That’s their way to access.”
In all, more than 85,000 telehealth visits took place at Cook County Health, according to health system figures.
At University of Chicago, the number of video and phone visits this year is around 90,000, conducted by about 1,000 doctors, nurse practitioners, social workers and other providers.
Advocate Health Care, the state’s largest health system with 10 Illinois hospitals and 350 health centers, has logged 325,000 telehealth visits this year, spokesman Mike Riopell said.
At Rush University Medical Center, video exams have been expanded to include thousands of urgent care consultations, almost 11,000 since March.
One big hope is telehealth can encourage more people to seek treatment early, theoretically keeping them out of the emergency rooms, said Dr. Meeta Shah, an emergency medicine doctor and associate chief medical informatics officer at Rush University Medical Center.
“This is a good opportunity for preventative care,” she said. “Preventative care is also important for keeping emergency rooms from becoming overwhelmed.”
Dr. Meeta Shah speaks with a patient via a video chat at Rush Hospital in early August. ANTHONY VAZQUEZ/SUN-TIMES
Dr. Sachin Shah is doing video and phone visits with his patients at University of Chicago Hospital.