Cardiologists Make Good Use of Virtual Visits for their Patients
Lots of new phrases have sprung from the coronavirus pandemic: social distancing, essential workers, flatten the curve, and virtual visits. Just as these have become part of our vernacular, so have they become part of our routines.
But virtual visits - also called telemedicine - had been around for some time before the global pandemic sent us all into isolation. Since the 1920s, the radio has been used to give medical advice to clinics on ships, according to the National Institutes for Health (NIH). Alaska has been a model for the development and use of telemedicine for decades, as community health aides in far-flung villages share information with specialists in Anchorage or Fairbanks to make the determination of whether a patient needs to travel to the specialist for more definitive treatment. In fact, the NIH notes, “More than a decade ago, the Veterans Administration developed a care management program that offered personalized education, monitoring, and feedback at home from a remote disease management support team. Use of technologies for chronic disease care management has been associated with reductions in hospitalizations, readmissions, lengths of stay, and costs; improvement in some physiologic measures; high rates of satisfaction; and better adherence to medication. Studies of home monitoring programs have shown specific improvements in the management of hypertension, congestive heart failure, and diabetes.”
IN MARCH 2020, A PIVOT TO VIRTUAL
Last March, when Gov. Ned Lamont declared a state of emergency in Connecticut due to the coronavirus pandemic, most of the state went into lockdown. As part of his emergency orders, Lamont required Medicare, Medicaid and private insurers to cover virtual visits.
“After we launched virtual visits last spring, within three weeks we had pivoted to almost 90 percent virtual health,'' said Dr. Howard L. Haronian, chief medical director and vice president, Hartford HealthCare Heart & Vascular Institute. “Within a month, Hartford HealthCare was doing 150,000 virtual visits.” Haronian likes the virtual visit to meet patients from out of town who are referred to him for cardiac interventions, “so we know each other before we meet for the actual procedure. It gives spouses and families a chance to easily join visits, because they are still not allowed at in-person visits.”
WHEN A VISIT IS MORE OF A CONVERSATION
Dr. Sumeet Pawar, a cardiology specialist with Hartford Healthcare’s Heart & Vascular Institute, has been a strong proponent of virtual visits since long before the pandemic arrived. He has been gratified to see his colleagues embrace the technology in the last year.
“During an office visit, there are certain components of the visit that don’t require us to be in the same room,” Pawar explained. “A big part of what we do during these visits is provide test results and discuss treatment options. That discussion can be conducted virtually. We don’t need to be in the same room.”
For example, Pawar talks about a patient who was having heart issues, and so he ordered a stress test, which obviously has to be done in the office. “But the subsequent visits, those would be to talk about next steps, and in those situations we can easily accomplish it in a video conference.
“The beauty of using virtual visits is that sometimes these conversations are difficult conversations to have, and the patient can have them with me from the comfort of their own home, with family members with them.”
REACHING PATIENTS FAR AND WIDE
Dr. Michael Fucci, chief of cardiology at Backus and Windham hospitals, joined Hartford HealthCare in May 2020. “I was seeing the majority of my patients using virtual visits,” he noted. “As things progressed through the summer, I started seeing more patients in-person in the office. “More recently, as a result of Hartford HealthCare’s COVID Recovery Center program, I am able to see patients with previous COVID-19 infections using virtual visits, which greatly increases access to multi-specialty care for these patients. Even though my office is located in Mystic, I have been able to care for patients as far away as Windsor and Ansonia using virtual visits.”
Hartford HealthCare’s COVID Recovery Center was created last year to help patients who have recovered from COVID but are continuing to experience side effects, such as lung, heart and behavioral health complications. Many patients continue to have symptoms such as fatigue, cough, shortness of breath, confusion, depression and memory issues, among others. These symptoms can be debilitating, often preventing people from returning back to their pre-COVID work and physical activity routines.
Fucci sees patients at the Recovery Center if they are having cardiac symptoms, such as chest pain or shortness of breath. Myocarditis – an inflammation of the heart muscle – is one of the worrisome cardiac issues doctors watch for.
TAKING ADVANTAGE OF TECHNOLOGY
Pawar said that as Hartford HealthCare was launching its virtual visits program last March, there was concern that older patients would not embrace the technology or feel comfortable having a “virtual” visit. “The question was, would this work for our older patients?” he said. “Surprisingly, the majority of our older patients are totally fine with it. Those that do have trouble, they usually have a child, grandchild, or even great-grandchild who can help them get set up, and once they are in, they are fine.”
Office staff can help patients set up their online MyChart account, which provides direct video access to appointments within the app. During the pandemic, federal law expanded the platforms doctors can use to meet with patients, to include Zoom, FaceTime and Skype. The state of Connecticut also expanded insurance laws to make sure that all types of virtual visits were covered by Medicare, Medicaid and private insurance.
Among other things, the law addresses coverage by the state’s Medicaid program and private insurers, and:
• Expands the list of care providers able to use virtual visits to include art and music therapists, athletic trainers, behavior analysts, dentists, genetic counselors, nurse midwives and occupational and physical therapist assistants;
• Allows coverage for services delivered over an audio-only phone and other audio-visual telemedicine platforms, including FaceTime, Skype and Facebook Messenger;
• Allows care providers to use virtual visits from any location; and
• Requires reimbursement parity for virtual visits services, and prevents insurers from seeking copays or deductibles or reducing the amount of reimbursement to providers.
“This pandemic has provided the validation that virtual visits can really work,” Pawar said. “It has really tested this idea, and it forced everyone to use it. Many clinicians have realized that we can deliver high-quality care in a virtual setting.”
New practice models such as virtual visits are transforming how Hartford HealthCare delivers care. The easy adoption of virtual visits by patients has untethered them from the brick and mortar visit, while allowing their cardiologists to securely meet online, share information in realtime, and collaborate on treatment, without sacrificing the medical care they require.
Hartford HealthCare and the Heart & Vascular Institute are committed to leveraging the use of virtual visits to keep patients and providers connected in a safe and virtual way.
To learn more about how Hartford HealthCare Heart & Vascular Institute can keep your heart healthy, visit hartfordhealthcare. org/moreheart.