Brave New World: Telehealth in the Age of COVID-19
By Taylor Smith
The coronavirus pandemic hit the globe like a tidal wave and promptly overwhelmed hospitals, physicians, and the medical community. While remote treatment isn’t a new concept in medical care, it hasn’t always been embraced due to limitations surrounding insurance coverage, privacy laws, and traditional medical business models. However, when social distancing became imperative in order to combat the spread of the virus, telehealth and more specifically, telemedicine (which provides remote clinical services to patients) gained new ground.
Removing Telehealth Barriers
From the first COVID-19 case confirmed in the U.S. by the CDC on January 21, 2020, regulatory changes have sought to reduce barriers that previously existed to allow for patients to opt-out of in-person visits when appropriate. The first coronavirus relief legislation was signed by Congress on March 6 and the passage of the CARES Act followed on March 27. This over $2 trillion economic relief package was delivered by the Trump administration to protect the American people from the public health and economic impacts of COVID-19. The CARES Act provides assistance for American workers and families, assistance for small businesses, an attempt to preserve jobs for American industry, and assistance for states, local, and tribal governments. Among these many provisions, the CARES Act also seeks to encourage the use and availability of telehealth.
Medicare regulations historically restricted the availability of telemedicine services to those living in rural areas. Privacy laws also previously limited remote medical treatment, but those laws were recently temporarily waived so doctors could use video conferencing tools like Polycom, Cisco, Vidyo, and Zoom to connect with patients.
Telehealth and Psychiatric Treatment
Dr. Peter Thomas, vice president of outpatient services for Princeton House Behavioral Health, has worked as a clinical psychologist in Princeton for 20 years. Princeton House provides partial hospital services and intensive outpatient services for those in need of mental health, rehabilitation, and psychiatric support. When COVID-19 struck and quarantine orders were issued by the state of New Jersey, all of Princeton House’s services became remote. As Thomas explains, shutting down group programs on March 17 meant that the staff of psychiatrists, nurses, therapists, and medical professionals had to create a new model for mental health treatment.
“Since we’ve gone to this remote model, we’ve admitted more than 1,300 patients in the telehealth model,” he notes. “We’re actually providing the services on the same scale as before the shutdown.”
When asked about overall patient satisfaction with the remote model, Thomas is extremely positive. “From a patient experience, it’s kind of interesting…. When we conducted a patient experience survey and asked them how well they communicate with their therapist, 94 percent said receiving remote treatment was helpful and 63 percent said they would consider choosing telehealth over in-person in the future.”
With all of Princeton House’s staff operating 100 percent remotely, Thomas adds that “everyone’s adapting to how to use the platform effectively for their own business and treatment purposes. It took us a good six weeks to two months to figure out how to best utilize this technology for the needs of our patients.”
For patients who previously had issues with transportation or for whom distance or work scheduling conflicted with regular doctor’s appointments, the flexibility of connecting with a psychiatrist via a laptop or smartphone has been paramount. Thomas says that “the laptop experience is sometimes even more intensive than an in-person encounter. The patient’s face encompasses almost the entire laptop screen and the patient is there, in your field of vision. It is, in many ways, a very effective form of communication.”
Regarding how the insurance companies have adjusted their business model to allow for telehealth treatment, Thomas explains, “most of the insurance companies made rapid adjustments to accommodate remote treatment. The big question from the provider and patient communities is whether or not remote treatment will be a permanent option for patients to receive their care.”
Much has been noted nationally on how telemedicine actually highlights issues of income inequality. On one side, medical specialists are now available to anyone almost anywhere in the country. Conversely, reliance on advanced technology platforms, access to quality health insurance, and language barriers continue to hinder doctor-patient relationships for those operating completely remotely.
Other potential drawbacks to virtual diagnosis from a patient perspective are the quality and uniformity of health care and treatment, reliance on sometimes faulty electronic devices and wireless internet, miscommunication, and the inability for a physician to observe one’s symptoms in-person.
Monitoring Pre-Existing Health Conditions Remotely
Dr. Tobe M. Fisch, M.D. is a primary care physician and chief medical information officer with the Princeton Health division of Penn Medicine. Fisch also currently serves as the medical director for outpatient population health, which tracks and monitors the overall health of current Penn Medicine Princeton Health patients (this includes tracking vaccination and health screenings among the current patient population).
In terms of how COVID-19 has impacted her practice, Fisch says, “There have been a number of impacts. First, a lot of the patients were affected by social distancing practices, social isolation, and a change in the way their everyday lives are conducted. Also, some of our patients have become ill from COVID and others have died.”
Immediately, Princeton Healthcare realized that they needed to deal with many patients remotely in order to reduce the rates of exposure and infection. This was a means of protecting not only vulnerable patients, but the many frontline workers as well.
Fisch explains that many non-life-threatening health conditions can be monitored remotely. This includes tracking a patient’s weight, blood pressure, blood sugar, medication management, and coordination of care (connecting patients with referrals to specialists). The remote model also allows for a patient’s family to join in on the conversation via their laptop or smartphone. Translator services further aids non-English speakers in receiving adequate care. All of these efforts work towards reducing the repercussions of crowded waiting rooms.
While some patients may elect for a virtual model for routine monitoring, Fisch points out that many health issues require in-person diagnosis, treatment, and monitoring. For example, since March 2020, many individuals have forgone blood work, pap smears, mammograms, colonoscopies, vaccinations, and other forms of preventative medicine (the long-term impact of which is still uncertain).
Fisch expects that the new medical model will have to continually weigh concerns and current news on infection rates, patient-provider safety, and federal laws in order to determine how best to proceed.
“In many ways we’ve had to become the IT guys,” says Fisch. “A silver lining in all of this is the movement to adopt new technology.”
Finally, Fisch believes that the improvements made to telehealth coverage by insurance companies will continue in the long term. “Many, if not all of them, plan to continue reimbursement for telehealth in the future.”
From a patient perspective, improvements in telemedicine services and coverage offer a certain level of convenient care. Conversely, many patients and doctors are eager to return to in-person visits where the risk of phone tag, misdiagnosis, and abbreviated video conversations are much less likely.