Telehealth takes center stage during coronavirus pandemic

The novel coronavirus has changed life as we know it in countless ways, including how medical practices are managing patient care.

Telehealth has quickly come to the forefront as a viable first line of care for treating patients without risking anyone’s health or safety. While not new, telehealth — defined health care provided remotely through phones, video or other communication technologies — offers the potential for better-coordinated care. The downside risk is fragmented care when multiple physicians are managing a patient’s treatment.

According to the California Medical Association, telehealth allows for the continuation of care in a way that reduces the likelihood of infection and transmission of disease and eases the strain on the delivery system.

“For these reasons, the CDC has recommended care be delivered virtually during the COVID-19 crisis as the best way to protect patients, physicians and medical staff,” the CMA states on its website. “Beyond COVID-19, telehealth grows practices and improves access to care by providing alternative points-of-care and appealing to the technology-enabled populations.”

Ramping up

Kaiser Permanente’s primary care physicians were already using telehealth before the novel coronavirus reached the U.S., said Tricia Hiserote, a family medicine physician and program director of the Kaiser Permanente Santa Rosa Family Medicine Residency, which launched in 2018 and will graduate its first class next year.

“Telehealth was just part of our daily business as primary care physicians,” Hiserote said. “So when the time came with COVID for us to reorganize our services, it just got ramped up.”

Before the pandemic, telehealth had proven to be an effective and viable way for patients who need quick access to care but can’t get to the doctor’s office, she noted. Some examples include people who live in rural areas, single moms without a car, or those who can’t get away from their jobs during normal business hours.

“There are so many patients who have obstacles to care,” Hiserote said. “I think for a myriad of diagnoses, (telehealth) is perfect. But (physicians) need to be able to read between the lines and put all the information together, because telehealth relies on having experience and having that clinical reasoning to ensure you know when to bring the patient in.”

“Prior to COVID-19, if I had a patient who had a cough and I could do a video visit with them, there's some physical exams I can do just by visualizing them,” Hiserote said. “Are they speaking in complete sentences? Are they taking gasps? Do they have bags under their eyes? Are they using muscles in their chest to help them breathe? There's all these different things that I can pick up.”

If it’s determined the patient needs an in-person visit, then much of the work is already done and the office visit is more concise, she said.

Meanwhile, technological advances continue to push telehealth forward as a formidable first line of primary care even when the pandemic is over.

There is technology where patients can physically move a stethoscope over their chest, allowing the doctor to pick up respiratory and heart sounds, Hiserote said. And Bluetooth technology can be enabled to reach cell phones or computers so doctors can access data, such as blood pressure readings.

“For example, if the patient's weight is going up, and the blood pressure is changing, you don't need to bring them to the office,” Hiserote said. “You need to talk to them and you need to see them; that’s where a video visit can help. There’s ways technology can do that and support the work.”

Outside of Kaiser Permanente, Hiserote had praise for the California Medical Association’s work toward ensuring remuneration follows the practice of telehealth.

“Remuneration drives a lot of the care, so having it recognized as a valuable asset and having funding supported is really a game changer,” she said.

Another proponent of telehealth is the Napa County Medical Society, which describes the practice as a critical way to provide patient care.

“Not only does it help stop the spread of the virus by reducing in-person appointments, it allows physicians to treat patients with chronic conditions who typically have a hard time traveling for an office visit,” said Griffin Rogers, director of both the Napa County Medical Society and Solano County Medical Society. “It’s a win-win in the fight to reduce costs and provide better access to quality care.”

An overnight surprise

“Before the coronavirus and the shelter-in-place orders, I had never used telehealth and had never really anticipated the need for it,” said Ralph Myers, a 30-year pediatrician who practices at Harvest Pediatrics, which has offices in Napa and St. Helena.

Then COVID-19 changed everything.

“Basically, we came to a screeching halt, and telehealth offered us an opportunity to kind of bridge the gap between not seeing patients and then later on figuring out who we could see and how we could do that safely,” Myers said. “It’s a balancing act.”

Some families prefer telehealth visits to avoid bringing their children into a medical setting unless it’s absolutely necessary, he said.

Myers doesn’t mind telehealth visits — when it’s appropriate.

“But there are other things (where) I just wouldn't be able to even make a reasonable diagnosis that way, such as a child with a swollen lump in their neck,” Myers said. “I might be able to see the lump through the camera but doing the rest of the exam, looking for other masses, for example, would be next to impossible. That’s where there’s no substitute for a hands-on (exam).”

Well-child visits also are not conducive to telehealth, he said. Those exams must be done in the office so the doctor can administer vaccines and evaluate if babies and children are meeting their developmental milestones.

There can be other obstacles with telehealth in pediatrics, such as a video visit when a parent is trying to capture a toddler who is running around, or not being able to fully view a baby being held in Mom’s arms.

But in some cases, like treating teenagers, telehealth visits work well.

“I may not even interact much with the parents once I get permission to do the visit, and then it would just be one-on-one with the adolescent,” he said. “So it really depends on the circumstances.”

And then there’s the billing and payment side of telehealth, which Harvest Pediatrics office manager Linda Simas has been navigating with the insurers the practice contracts with.

“At first they were paying what we’re contracted with, and as time continued to go on they stopped doing that,” said Simas, declining to single out any of the dozens of insurers contracted with the practice. “One of our better payors decreased the amount by 40%, and others continue to stay the same even now.” Simas is expecting more insurers to start decreasing their rates, she said.

At this time, it hasn’t been decided if Harvest Pediatrics will continue telehealth visits when the pandemic is over, but it’s possible, according to both Myers and Simas.

Cheryl Sarfaty covers tourism, hospitality, health care and education. She previously worked for a Gannett daily newspaper in New Jersey and NJBIZ, the state’s business journal. Cheryl has freelanced for business journals in Sacramento, Silicon Valley, San Francisco and Lehigh Valley, Pennsylvania. She has a bachelor’s degree in journalism from California State University, Northridge. Reach her at cheryl.sarfaty@busjrnl.com or 707-521-4259.