The past few months have been a crash course in telemedicine for those seeking care as well as their providers. Now that both groups are deep into the learning curve, many are seeing the longer-term benefits of telephonic, video and other kinds of “virtual visits” for all patients, especially older adults, beyond the efforts to “flatten the curve” of COVID-19 by staying home and avoiding public spaces.
“About 75 percent of the older adults I’ve seen over the past few months have been via telemedicine,” said Dr. Tom McCarrick, chief medical officer of Vanguard Medical Group, a family medicine practice in Verona with a large base of patients who are 60 and older. “It’s amazing how easily they have adapted to the technology.”
Of course, patients aren’t the only ones who have had to adjust. “We’ve taken courses on how to provide telehealth. We’ve learned new tricks to help us evaluate patients for everything from shortness of breath and musculoskeletal problems to depression,” said McCarrick.
Telehealth has provided a way for a higher-risk population to receive the non-emergent medical care they need without creating potential exposure to COVID-19. Since it has been pressed into wider use than ever before, patients and clinicians have noticed that the technology offers benefits that are particularly relevant to older adults. Below are some of the advantages.
Removes barriers to access. Older patients may have difficulty arranging transportation to and from appointments and may suffer from mobility issues. Telehealth makes seeing a doctor as easy as picking up a smartphone.
The treatment option relevant now
Consider this: Since the outbreak of the COVID-19 began here in March, Horizon Blue Cross Blue Shield has seen a 2300 percent increase in telemedicine claims filed by the State’s doctors and mental health professionals.
If telemedicine is an idea you’ve considered but have left to simmer on the back burner these last few years, now is the time to move it to the front burner.
The COVID-19 outbreak added new urgency to adopting telemedicine as a vital new care model. In the face of unprecedented challenges to the U.S. health care system, telemedicine offered two critical benefits:
- It was an effective way to maintain social distancing while still delivering necessary care for patients. In many ways, telemedicine was made for a moment like the pandemic – when demand for care exists and delivering that care in a face-to-face visit poses risk to both the patient and office staff.
- It became at least a partial solution to meeting the surge in demand due to the quickly spreading virus. Not only does telemedicine offer an opportunity for individual clinicians to operate more efficiently, but it’s also a way to better match supply with demand as cases multiply. Idle capacity in one area can potentially be used to relieve pressure in hot spots, and providers who themselves may be under quarantine but are still healthy can continue to be productive.
It quickly became apparent to doctors, other clinicians and their patients that telemedicine was an effective and efficient way to handle many routine health needs – particularly acute episodic care, follow-up visits, and, selectively, management of chronic conditions. Mental health professionals quickly understood that for most patients, therapy by phone or video had little or no negative effect on the efficacy of treatment. Telemedicine has earned a place in the care continuum and that is a good thing for doctors and their patients.
In response, professional organizations have stepped up and are offering a variety of resources to help providers incorporate telemedicine into their practices. These resources offer useful information on virtually every aspect of telemedicine, including:
- Understanding policy, coding and payment protocols
- Evaluating and selecting a vendor
- Developing new office workflows
- Complying with HIPAA requirements
- Scheduling and documenting patient visits
Here are several resources you might find useful:
- American Medical Association – Quick Guide to Telemedicine in Practice
- American Academy of Family Physicians – Telemedicine and Telehealth Guide
- Centers for Medicare & Medicaid Services – Telemedicine Health Care Provider Factsheet
- American Telemedicine Association – COVID-19 News, Information & Resources
- American College of Physicians – COVID-19 Telehealth Coding and Billing Practice Management Tips
- Practice Management Resources
- Practical Guide for Implementing Telehealth into Your Practice
- American Psychiatric Association – Telepsychiatry Toolkit
- Telepsychiatry and COVID-19 Guide
While telemedicine is not new, patients, doctors, and health insurers all see a role for it in the healthcare system going forward; the recent pandemic has only served to accelerate adoption. Given this new urgency, it’s time for practices that have not built telemedicine into their care delivery models to answer the call.
— By Dr. Steven Peskin, executive medical director, Population Health Transformation Horizon Blue Cross Blue Shield of New Jersey
Earlier treatment. Older adults experience better outcomes when they don’t delay care. Telehealth means they do not put off issues – like urinary tract infections or medication side effects – that may not seem like a “big deal,” but can cause bigger problems if left untreated.
More frequent check-ins. Telehealth allows older adults to check in with their provider on a weekly or even daily basis, making it easier to catch even small fluctuations in vital signs early on.
Technology brings the office to them. Technology like a blood pressure cuff, pulse oximeter, and thermometer can allow the provider to monitor the patient’s vital signs remotely and decide if they require an in-office visit. In some cases, the doctor can ask a friend or family member to assist the patient in taking readings if necessary.
See a specialist on the spot. In cases where a patient in their primary care physician’s office requires urgent care from a specialist, telehealth means an instant visit instead of waiting days or weeks. New technologies like digital stethoscopes can allow the provider to transmit the patient’s heart and lung sounds to a cardiologist or pulmonologist in real time.
The right tool at the right time. Telemedicine is not a substitute for in-person visits. However, it can be an essential part of a treatment plan that gets seniors the care they need, when and where they need it.
For people over 60 who are considering giving telemedicine a try, experts offer this practical advice:
Get to know the different types of telehealth. Start with your own doctors. Find out what they offer, how it works, and when it’s right. Some offer virtual visits only through their own, secure platform that requires you to sign in with a personal password and account. Others might use common video platforms like Skype, FaceTime or Zoom or conduct appointments over the phone. More advanced practices may offer their own app or remote monitoring of vital signs or other health indicators. You might have a more traditional “virtual appointment” via video chat, remote monitoring of vital signs and other health indicators, or chat via a mobile app. Mental health professionals have moved quickly to embrace telemedicine and provide therapy remotely.
Ask a friend or family member for assistance. New technology can sometimes feel overwhelming at first but asking someone who is already comfortable with it can help you familiarize yourself with all the ins and outs. Again, your doctor’s office staff may be a good place to start.
Lean into your health insurance carrier. It’s important to not only know how your health insurer covers telemedicine visits, but also what other telemedicine resources they provide. For example, members who have coverage through Horizon Blue Cross Blue Shield of New Jersey can chat with a nurse by phone 24/7. Its mobile app, Horizon Blue, and online portal allows members, including those with Medicare Advantage plans, to use their smartphone or tablet to have a virtual visit and consult with primary care doctors who can diagnose and prescribe medicine when appropriate. Members whose plans include Horizon CareOnline have yet another level of telemedicine access. That service, included with many of Horizon’s MA plans, provides members free video visits with a group of Board-certified specialists in addition to doctors training in primary care. Horizon encourages members to always turn first to their own doctors, but says that its telemedicine programs are a high quality, convenient, and free option when a member can’t connect with his or her own doctor. And for the time being cost-sharing for telehealth has been waived to help reduce the spread of COVID-19, making it an even more attractive option.
When asked what role he saw telehealth playing in the future, McCarrick said, “I hope it’s here to stay. There are many use cases. For instance, we could have a trained medical assistant with specialized devices visit a patient’s home and transmit his or her vitals, history, and current medications to a geriatrician or cardiologist.” His key takeaway for seniors? “Have a smartphone, and ask for help learning how to use it if you need it. Staying connected is important in so many ways.”
Keith Peifer is vice president and chief Medicare officer at Horizon Blue Cross Blue Shield of New Jersey.