House calls will never be the same
Telemedicine moves from niche service into health care mainstream
Joan Starr can take a telemedicine appointment anywhere. The 70-year-old could sit on the couch in her southwest Houston home, or perhaps on the front porch, where her niece recently tapped a link on her iPad to turn on the camera for a virtual visit with Dr. Donnie Aga at Kelsey-Seybold Clinic.
Starr, who has a respiratory condition and depends on inhalers and nebulizers to breathe, is the perfect candidate for telemedicine in the age of COVID-19. She’s at high risk of complications if she catches the coronavirus, but she can’t avoid seeing her three specialists, who regularly monitor her lungs and esophagus.
Telemedicine, once regarded as a niche in medical care, has moved into the mainstream. Since the pandemic forced its widespread adoption during spring shutdowns, telemedicine has established itself as an vital tool for patients, particularly older ones and people with chronic illnesses that put them at high-risk of complications from COVID-19.
The use of telemedicine is down from its peaks in the spring, when up to 90 percent of non-emergency visits were conducted virtually, but still far above prepandemic levels. At Kelsey-Seybold, 15 percent of visits as of early October were conducted over telemedicine, compared to less than 1 percent in October 2019.
At UT Physicians, which did not offer a virtual visit platform before the pandemic, telemedicine made up about 13 percent of visits, said chief operating officer Andrew Casas.
Like UT, MD Anderson Cancer Center didn’t offer a telemedicine platform before the pandemic. Now, about 20 percent of patient visits are done through telemedicine to avoid bringing immunocompromised patients into the hospital, said Dr. Welela Tereffe, MD Anderson’s chief medical officer.
“Patients with chronic illnesses have had much more vigorous uptake of telehealth because they’ve got personal reasons to not travel,” Tereffe said. “That patient population is uniquely vulnerable because of their immune status.”
Convenient clinic
For Starr, the Kelsey-Seybold patient, going to the doctor’s office can be an ordeal. When she gets dressed, she often has to stop and sit on her bed to catch her breath and summon the strength to get up again.
If she is seeing a specialist, she must also collect medical records and medicines if she needs to go over them with the doctor. She’ll drive the 20-to-30 minutes to the KelseySeybold main campus on the edge of West University, or the clinic in Meyerland, and wait for her appointment.
Starr may spend up to three hours to see one of her doctors, which happens as often as once a week. Since March, however, she’s cut that time to 30 minutes by logging into Vydeo and Epic, the telemedicine platforms used by Kelsey-Seybold.
“If I was in one of their offices, I would be answering the same questions,” she said. “They would be saying the same things, so I probably will keep using video visits.”
In the clinic’s main office, Aga, clad in a white doctor’s coat and cognac colored cowboy boots, pulled up a medical profile of Starr on his computer monitor. Through a Macbook set up just next to the screen, Starr waved at the internal medicine doctor, who oversees telehealth, and nurse Rachel Robinson, who manages Starr’s care.
“Virtual health is something people prefer to do for convenience,” said Aga. “They don’t want to be exposed to a clinic, from primary care to specialty. It definitely changes the way patients can receive care.”
Entrepreneurs who have built businesses around telemedicine have long predicted virtual doctor’s visits would someday be the norm, not a special occasion.
‘A significant shift’
Clinton Phillips, who runs the Austin telehealth company Medici, said his firm provides a virtual visit platform for more than 30,000 providers (including physicians, hospital systems and veterinarians), twice the number it had in January before the pandemic.
“How they responded to the pandemic has caused a significant shift in retaining and attracting patients,” Phillips said.
The trends have benefited providers like Kelsey-Seybold Clinic, which has offered virtual health visits since 2016. While few patients initially signed on, the number of patients doing online visits has steadily, Aga said.
Telemedicine was particularly useful during natural disasters such as Hurricane Harvey, when many patients were unable to come in to get minor injuries checked out due to floodwaters. When stay-at-home orders were issued in March, Aga said, his staff was able to get 95 percent of their patients set up on telemedicine within 10 days.
How to improve rates
Older adults and people with chronic illnesses represent most telemedicine users, but health care leaders see the opportunity to expand its use to other populations. For example, they say that telemedicine has the potential to expand access to health care for low-income families and individuals.
But to achieve that, said Dr. Latisha Rowe, who has run telemedicine practice Rowedocs since 2014, health care providers and policy makers must close the technology gap that leaves poor families without access to stable internet services and devices. That has become an even bigger problem during the pandemic-driven recession that has put millions of people out of work.
“In an ideal world, everyone’s able to do a telemedicine visit on the phone,” she said. “But it’s COVID — what if I have to cut myWiFi or can’t pay for the phone?”
The Centers for Medicare and Medicaid Services lifted restrictions on the federal insurance plans for the elderly and the poor to allow patients on Medicare and Medicaid to do telehealth visits. But Rowe said digital literacy programs and financial support for low-income communities also are needed to make telemedicine accessible.
Profitability
Telemedicine isn’t a lucrative medical service, said Phillips, the telemedicine executive. Hospitals make the bulk of their cash from elective procedures, where insurance companies pay higher fees for using pricey equipment, overnight hospital stays and prescribed diagnostic tests.
“Telemedicine doesn’t really allow them to capture revenues the way they used to,” he said.
It’s possible that some health care providers will treat telemedicine like a loss leader, a service that loses money, but gets more patients through the door and ultimately into more profitable services and procedures.
Doctors like MD Anderson’s Tereffe said it’s not about the moneymaking as much as it is providing patients an opportunity to get care. It’s difficult to distinguish the impact of any one service on hospitals’ bottom lines, she added, since the pandemic has upset traditional business models as it halted elective surgeriess, filled ICUs and hospital beds with COVID-19 patients, provided federal relief funds and introduced telemedicine platforms.
Overall, doctors agree that offering telemedicine has been a way for vulnerable patients like Starr to continue receiving medical care during the pandemic while reducing the chances of infection.
“There are some patients who are now newly introduced to virtual health,” Aga said, “and they love it.”