Virtual doctor visits won’t stop coronavirus, but they’ll help the walking worried survive it
How will we get through the coronavirus outbreak? One important pathway goes through your smartphone and computer.
Telemedicine, which allows doctors to consult with patients remotely, has emerged as a vital way to cope with the growing surge in demand for medical services — and to keep health workers safer.
Providers are using virtual visits to screen for COVID-19 cases and handle routine inquiries and the chronically ill. They’re proving effective in comforting people who are anxious about the outbreak, the so-called walking worried.
Telemedicine also saves masks, gowns and key supplies, which are in high demand for dealing with the pandemic.
Patients are eagerly embracing this approach, in part to avoid going to clinics and waiting rooms where they might be exposed. Limiting face-to-face encounters also helps protect health workers and support staff, who are concerned about their exposure and the possibility of scared patients descending on clinics and emergency rooms.
Telemedicine is enabling companies to recruit badly needed personnel, including retired doctors and nurses. Even physicians who are isolating at home and recovering from the virus are able to help patients remotely.
“Can you imagine how much worse this would be if we didn’t have all these docs doing telemedicine?” said Dr. Paul Hain, chief medical officer of Blue Cross Blue Shield of Texas. “They’re telling the appropriate people to stay home.”HEALTH CARE
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Many physicians in North Texas are having to radically shift their practices. Last month, virtual visits accounted for about 1% of care provided by members of the Catalyst Health Network in Plano, which has about 800 doctors with over 1 million patients.
Soon, over 80% of their visits could be through telehealth, said Dr. Christopher Crow, Catalyst’s president.
“We’re seeing a 180-degree change in how primary care medicine has been practiced in just a week or two,” Crow said on Friday. “We’re doing 10,000, 12,000 virtual visits a day on our network, and that number could double by next week.”
In some major cities, telehealth capacity has been overwhelmed by the demand, leading to long delays. The Cleveland Clinic had a 15-fold increase in telehealth visits in a week, and Jefferson Health, near Philadelphia, had a 20-fold increase, according to STAT, a medicine and life science news website.PUBLIC HEALTH
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One expert told STAT the technology could handle the “astounding volumes,” but providers needed more clinicians.
In Dallas-Fort Worth, leading players said they’ve been able to keep up with the growing number of calls despite some delays. But the pandemic has been spreading here later than in some population centers, and there are concerns about the coming surge.
At Parkland Health & Hospital System, telemedicine volumes have grown exponentially, said Dr. Joseph Chang, chief medical officer. That’s been by design.
“We do not have backlogs in patients waiting to be seen — at least at this point in time,” Chang wrote in an email.HEALTH CARE
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Last week, UT Southwestern Medical Center trained 750 doctors and advanced practitioners so they could do video consults. The local leader in academic medicine was doing about 300 virtual visits a day and expects that number to eventually top 1,000 visits a day.
Texas Health Resources said over 200 primary care doctors were just trained in telemedicine and will be boosting the number of virtual visits this week. The company expects the added capacity to be especially useful in helping patients manage chronic conditions and routine medications.
Last week, Baylor Scott & White Health processed over 74,000 digital screenings for people concerned about COVID-19. That led to 14,000 virtual consults, Baylor said, and within a week it had trained another 120 clinicians to support the telehealth effort.
“My routine office visits have been cut in half, and I’m doing all those by telemedicine,” said Dr. David Winter, who practices internal medicine, leads a large doctors group and serves on the Baylor board. “This is going to change the way we care for patients.”
Baylor has an app, MyBSWHealth, that has over 400,000 unique visitors a month, and many use it to schedule appointments and message doctors. It’s now available to anyone who wants a COVID-19 screening, which can be followed by a virtual visit.
Baylor urges people to call if they’re worried — and to prevent overcrowding at hospitals, especially as the outbreak intensifies. To get a link to the app, text “Better” to 88408.
Last week, Winter sent a patient to the emergency department for an escalating neurological condition, and he said the department was pretty jammed.
“We have to get the word out,” Winter said. “There are other illnesses besides COVID and these folks need attention also.”
Teladoc Health, the country’s largest telemed provider, reported 100,000 virtual visits in a recent one-week period. That was an increase of 50%, and over half of this month’s callers were first-time visitors. The growth trend has continued, Dr. Jason Tibbels, chief quality officer, said on Friday.
In response, Teladoc has brought on hundreds of physicians in the past 10 days and built up its support teams. That includes adding more nurses to follow up with patients and coordinate with local public health officials. In addition to the swell from coronavirus, there’s been a big increase in patients who don’t have respiratory illness or other COVID-19 symptoms.
“The normal things have not gone away, and a lot of people don’t want to go to the doctor in person,” Tibbels said.
Teladoc, whose Lewisville operations hub has over 600 employees, conducted over 4.1 million virtual visits last year. That’s up from just under 1 million in 2016, and management had projected 5.7 million visits this year — before the impact of the new coronavirus.
“Virtual care will never be the same on the other side of this,” Tibbels said. “We’ve talked a lot about the inflection point in virtual medicine. Forget about the inflection point — we’ve shifted the whole curve upward.”
Part of telemedicine’s appeal is its convenience. At Teladoc, patients can access care at any hour, any day of the week. Last year, the median wait time for a general medical visit was less than 10 minutes, according to one of Teladoc’s regulatory filings.
Currently, Teladoc’s website warns about extended waits.
“People are waiting everywhere,” Tibbels said. “But on a virtual visit, they’re waiting in the safest place possible — likely their own homes,” he said.
Telemedicine has been getting a big lift from the government during the pandemic. The White House coronavirus task force has frequently talked up the value of virtual visits, and last week the Trump administration expanded telehealth access for Medicare patients.
For many years, Texas officials and medical leaders resisted telehealth in the state, and Teladoc had to win many court battles to bring its service here. But Gov. Greg Abbott recently took several steps to encourage more virtual visits.
He directed the state’s medical and nursing boards to fast-track temporary licensing for out-of-state doctors, nurses, physician assistants and certain retired physicians. That will increase the supply of providers for telemedicine and in-person visits, Abbott said.
He also called for an emergency rule requiring health plans to pay the same reimbursement rates for virtual visits as for traditional office appointments. That’s long been an issue in the industry.
One problem with the governor’s order: It doesn’t include self-insured plans in Texas, which is how many large employers handle their health coverage.
In Dallas-Fort Worth, self-insured plans account for about two-thirds of revenue for many independent physicians, said Crow of Catalyst Health.
Doctors are urging federal and state leaders to find a way to ensure that virtual visits are paid on par in all health plans. That’s especially important today because local practices have moved more doctors and support staff to telemedicine, which is accounting for most of their business.
“These primary care physician offices are just like any small business,” Crow said. “If they’re not able to get paid for telehealth visits, then they’re not going to be able to make payroll.”
It’s one more gap being exposed by the coronavirus that needs to be plugged.
“It’s a big, big freakin’ deal,” Crow said.