Telehealth provides more ways to benefit people
Regulations posed obstacles before the pandemic. For some, the question is will it continue even after the pandemic passes. Options for virtual visits, video check-ins, are now more numerous than ever before. For medical providers it has been a way for all types of care and particularly a way to connect with those who deal with anxiety, depression and substance use.
BRAINERD, Minn. — In April of 2020, with the pandemic in its early weeks, uncertainty hung over many things.
The idea of so much changing and some of it for the long term — in all aspects of life, work, home, school — wasn’t yet on the horizon. But what did change quickly for medical providers was the use of telecommunications to change how patients and providers interact.
Staff at Essentia Health’s clinic in Baxter, Minnesota, said they were initially working with their technology services to add telehealth for patients who had substance use disorders, depression and anxiety. The goal was to disrupt their lives as little as possible while working with them to improve their health and their lives.
Then the pandemic hit and those telehealth visits expanded exponentially as a way to reduce exposure to the virus. The Baxter facility went from two rooms for virtual visits to six in the family practice clinic. Patients across the board are able to schedule virtual visits, or video appointments, and speak directly to their doctor using computers, tablets or smartphones.
“If you have a substance use disorder, if you have anxiety, you have depression, coming to the clinic can make those things worse, it can be an anxiety provoking event,” registered nurse Jessica Schwartz said in 2020 when the virtual visits were beginning. “Whereas when we meet you, in your home, people are a lot more comfortable. And our visits have been really, really good.”
It also allowed medical providers to see patients in their homes, learn more about the people they previously mainly saw in a clinic treatment space, and even see their pets. Schwartz said patients were comfortable with the virtual visits from their homes and using their iPads to chase after their dogs.
“And you know, it's those relationships that we already have, because this is primary care, we establish relationships with our patients, and we continue to maintain them,” Schwartz said. “And so instead of them being like, ‘oh, I have three dogs at home,’ we met them.”
Nutritionists could see what people had to work with at home. Those who were working from home, with children at home or other family to care for, could still connect for a needed appointment. Older residents didn’t have to make the trip or feel they had to find someone to take them to an appointment. Those who may have had trouble getting time off from work could still do a check-in and consult with their primary care provider.
With the onset of the pandemic, family practice physician Dr. Shiela Klemmetsen noted there was a lot of stress and they wanted to be there to help people who may be using substances to cope or those who may be extra challenged to control their blood sugar. She wanted the virtual visits to be a way to stay connected to people and for those in recovery to still know they were not alone. Klemmetsen said the technology also allowed them to be creative. When a husband wasn’t able to be there for a visit with his wife because of his work schedule, they were able to set one up from their home when they could both be there. For parents with multiple children or for those who struggle with reliable transportation, it was also a benefit in being able to do a virtual visit. With the virtual visits, they were also able to connect with people where they lived and engage with them in a different way to make healthier choices and help them with anxiety, depression and substance use.
“And we have patients who normally have to drive two and a half hours one way to come and see us,” Klemmetsen said. “Well, now we can see them virtually, if we think they need to come in, we ask them to come in.”
Prior to March 2020, Essentia reported it had never conducted a virtual visit. But in a robust response to the pandemic, the health care provider was performing more than 3,500 per day within weeks. Two years later, they had about 645,000 telehealth visits.
Regulations that previously made telehealth visits challenging to accomplish were relaxed for the pandemic. With medical providers across the nation now providing telehealth visits, the question may be what happens after the pandemic ends. Already there are signs from the private sector and from consumers that this is a change that should be in place permanently.
Teladoc Health announced Monday, Feb. 28, it was partnering with Amazon, meaning customers with voice-activated Echo devices will be able to connect with Teladoc for general medical assistance. Customers can say, “Alexa, I want to talk to a doctor,” to their supported Echo device and they will be connected to the Teladoc call center.
“Customers will then get a call back on their Echo devices from a Teladoc doctor for virtual visits related to non-emergency health needs, such as experiencing symptoms of a cold, flu, or allergies,” Teladoc reported. “The cost per visit can be as low as $0 per visit with insurance or $75 without insurance.”
As with hybrid and flexible work, which changed the experience of labor for people who can work from home, it will be hard to roll back the clock on the hybrid experience. And for businesses doing everything possible to attract workers, the flexible model is the future.
Telemedicine is on that same track.
“Before the pandemic, telemedicine was hamstrung by a mess of bureaucratic red tape,” Forbes reported Monday. “A patchwork of state regulations prohibited patients from scheduling a virtual visit with a doctor across state lines. Medicare only reimbursed telehealth services for patients from scheduling a virtual visit with a doctor across state lines. Medicare only reimbursed telehealth services for patients living in rural areas. Medicare beneficiaries who wanted to use telehealth had to travel to a designated medical facility to do so.”
In a letter from the Federal Trade Commission dated May 29, 2020, the FTC noted public and private reimbursement laws and policies were frequently listed as impeding the development and widespread use of telehealth services.
“By limiting entry of telehealth practitioners, overly restrictive reimbursement requirements may unnecessarily limit consumers’ access to care and choice of practitioner, especially in areas where there is a shortage of healthcare professionals and at times outside normal business hours,” the FTC stated. “… Reducing or eliminating restrictions on reimbursement of telehealth services could potentially enhance competition, improve access and quality, and decrease health care costs in both the public and private sectors.”
For many who can do wellness check-ins without making a trip to a clinic, it means not having to make what can be an arduous trip. For others, it’s a way to reduce the anxiety that comes from going to a medical facility. The FTC stated it also saw the expansion and continued use of telehealth as a way to reach the underserved populations and help with continuing challenges in terms of hiring.