Amid the urgent need for social distancing to prevent the spread of the coronavirus, an elderly male patient of the East Boston Neighborhood Health Center who suffers from major depression and alcohol use disorder was able to “see” the doctor last week — without having to leave his home.
“Our behavioral care practice had a telemedicine visit with this 84-year-old on the phone,” said Steven Snyder, vice president of the health center. The clinic wants to keep patients like him away from the facility to reduce the risk of COVID-19 contagion while also preventing any disruption in his care.
Long before the coronavirus outbreak, health care providers and policy makers saw promise in telemedicine. Providing care by phone or video call can be a way to reach patients in underserved areas — and, potentially, to save money in the health care system. Now, by necessity, telemedicine is getting a huge unexpected test run. If this experiment works, it should accelerate the acceptance of remote health care after the pandemic subsides.
So far, Snyder likes what he sees. “We’re now able to do full telephonic follow-up visits with him, including checking responses to medication, offering interventions to help manage cravings, and of course, the uptick in anxiety associated with social isolation. And we’re going to keep doing it because we want that 84-year-old to stay healthy.”
Before the outbreak, such remote medical services were barely available at the East Boston clinic — only a handful of patients were being seen via telemedicine. But on March 15, Governor Charlie Baker, in response to the emergency, signed an executive order dramatically expanding access to telehealth calls by requiring insurers to reimburse them and by relaxing rules to allow patients to consult a doctor by phone or video chat.
Baker’s order will remain in effect during the state of emergency. It mandates coverage of telehealth calls through MassHealth and commercial medical insurance at the same rate as in-person visits. It also prevents insurers from restricting which technology to use in their delivery of virtual medical services. The state’s medical board also eased its rules for physician credentialing to perform telemedicine. This means now there will be more doctors available to conduct virtual visits. Additionally, physicians are allowed to “see” a patient remotely even if they have never met in person.
In the short term, that decision will help sustain care for patients statewide and reduce some of the expected burden on health care workers and doctors’ offices. It also represents a valuable opportunity to test the potential benefits that supporters of telehealth have touted over the years.
Despite improvements in technology and its clear potential, telemedicine has been underutilized, operating with restrictive guardrails like lower reimbursement rates and other barriers put up by many insurers. In 2018, it generated less than 1 percent of medical claims nationwide.
Now, telemedicine is experiencing an unprecedented expansion — and not just in Massachusetts. On March 17, federal officials announced that Medicare would similarly cover telehealth services nationwide to keep older adults safe at home. Even veterinarians are being allowed to use telehealth to examine pets.
For the last few years, the Massachusetts Health Policy Commission, which monitors health care costs in the state, has been urging reform. In its 2015 cost trends report, the commission wrote that “expanding patients’ ability to communicate with health professionals on nights and weekends or when transportation barriers exist may avoid unnecessary visits” to emergency rooms. Two years later, the commission “recommended to scale the use of telehealth in the Commonwealth, particularly to enhance access to care for certain high need services and patient populations.” Similarly, last year’s report listed telemedicine expansion as a key policy to improve primary and behavioral health access.
But the coronavirus has forced everybody’s hand. In the East Boston clinic, which serves about 300,000 patients annually, many of them immigrants and low-income residents, medical providers have performed over 1,200 telehealth audio visits in just the short time since Baker’s executive order went into effect. “We had over 600 on Monday," Snyder said, adding that the center will be offering video calls in a couple of weeks via the now-ubiquitous Zoom platform.
The COVID-19 outbreak is catapulting organizations like EBNHC into the future. It would be a shame to squander the capacity they’re building now to offer clinically appropriate medical services online or on the phone by reverting to restrictive policies after the crisis.
Of course, if this emergency exposes flaws in telemedicine, the state needs to learn that, too. It may not prove appropriate or ideal for some patients or some illnesses. But when the crisis abates, policies and regulations should stay flexible enough to keep using technology to increase access to health care for the most vulnerable populations.
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