By Christine Graf
According to national data, doctors in the United States logged more than 1 billion virtual telemedicine appointments during 2020. Its usage peaked in April at which time 69 percent of all patient visits were virtual.
Saratoga Hospital Medical Group, a group of more than 250 providers practicing out of 20-plus locations, implemented a telemedicine platform in the spring of 2019.
“We had the capability, but found we weren’t using it,” said Julie Demaree, Saratoga Hospital director of informatics and data integrity. “We didn’t have much interest from our providers and patients.”
The COVID-19 pandemic in 2020 put the issue in a different light.
In mid-March, all providers in the group were trained on how to use the platform. In the two weeks that followed, 3,500 virtual visits were conducted.
“It was a learning curve for both patients and providers,” said Demaree. “I really give so much credit to our providers because they had to pivot very quickly. Delivering medicine through a camera is very different than doing it in person. They also had to take on a new role of being tech support for patients.”
At Glens Falls Hospital, no telemedicine system was in place when the pandemic began. As a result, administrators had to scramble to get a system in place.
“This was all new to all of us,” said Patti Hammond, vice president for physician practice management. “One of the reasons was that the insurance companies including Medicare were not paying for virtual visits as though it was an in-person visit. Because of COVID, there were some emergency approvals, and the insurance companies said they would pay for that visit just as though the patient was in your office setting.”
In a matter of 48 hours, Glens Falls Hospital had a telemedicine system up and running. The hospital uses the Doxy.me platform and pays a monthly fee for each provider who uses the tool.
“Because we are a health care organization, we had to have a system that was HIPPA compliant. You can’t just do a Zoom call,” said Hammond.
Each virtual visit begins with a phone call, during which time patients are registered and screened by a nurse. Patients are then sent a link via text or email that takes them into a virtual waiting room. After meeting with doctors, follow up appointments are scheduled as necessary.
“You want to mirror the in-office workflow as best you can because that is what the providers and patients have become accustomed to,” said Ann Marie Hatch, senior director of physician practice at Glens Falls Hospital.
At Saratoga Hospital Medical Group, each provider has customized their telehealth procedures. Some incorporate the use of phone calls while others rely on video only. Like Glens Falls Hospital, phone appointments are conducted for patients without access to video.
“One of the challenges we have up here in the North Country is connectivity,” said Hammond, referring to access to broadband service which is difficult in some rural areas.
At Glens Falls Hospital, 50 percent of patient visits were conducted virtually during the peak of COVID. When cases began to rise in December, the hospital’s primary care practices returned to conducting the majority of patient visits virtually.
“The primary goal of our practices is protect our most vulnerable patients and to keep our staff from becoming exposed” said Hatch. “We hold that value, and that’s how we make our decisions.”
Saratoga Hospital Medical Group’s telemedicine visits peaked in April at which time 65 percent of patient visits were virtual. That number has dropped to 15 percent but is climbing due to the second wave of COVID, officials said. In June, the medical group began using telemedicine in their urgent cares. It has been especially useful for patients who need COVID testing.
“We had hundreds of people coming every day and waiting in line at our urgent care centers just to ask for a COVID test. They are able to do a telemedicine visit and we can send an order for them to go be tested. We’re able to see a lot of patients through telehealth. It’s really good for our patients and it helps us see the people who are sicker and really need to be in the office,” said Demaree.
She said the utilization of telemedicine also minimizes risk to health care providers and allows a provider who is in quarantine to see patients. Additionally, it leads to a decrease in the use of personal protective equipment (PPE) which remains in short supply.
“Telehealth creates some barrier,” said Demaree. “It requires understanding of technology, access to a device, a need for connectivity at home. But we found that it also removed some barriers that exist when you are accessing traditional health care. Things like transportation, child care, getting out of work, having the motivation to drive somewhere. We found that we actually had decreased no shows rates and increased compliance in some of our departments which was really fascinating.”
Telemedicine is expected to remain popular even after the pandemic is over. In order for this to happen, insurance company reimbursement must continue.
“Effective the first of the year, Medicare is going to make that a permanent change. And I think the other insurance companies will follow,” said Hammond. “I think there’s going to be a niche for telehealth in the future.”
Despite the success of telemedicine, it is not appropriate for all patients. In both Glens Falls and Saratoga, providers stress that it is safe to come into the hospital or doctor’s office. Medical staff members are screened for symptoms each day, and strict disinfecting and social distancing procedures are in place.
“The most important thing to me is that people continue to get the health care that they need,” said Demaree. “I worry mostly about people delaying care when they need it. I don’t want to see delays in diagnoses or people dying at home from things we could have treated because they are afraid to go to the doctor.”
By Christine Graf