Publisher's note: This post appears here courtesy of the Carolina Journal, and written by Julie Havlak.
Telehealth has the potential to increase and further care and slow the spread of COVID-19. | Photo: Department of Veterans Affairs
Telemedicine is finally realizing its potential in patients' homes and hospital rooms across North Carolina.
COVID-19 overhauled how hospitals deliver medicine in a matter of days, forcing providers to radically expand telemedicine, sometimes with the help of private companies. But now providers are wondering whether those reforms will last any longer than the virus.
Congress expanded telehealth with its coronavirus relief bill, but the CARES Act didn't make most reforms permanent.
Before the coronavirus, Medicare regulations choked telemedicine. Only seniors who lived in rural areas could get telemedicine services, and even they had to travel to a designated medical facility to qualify for Medicare telehealth coverage. Private insurers mostly imitated Medicare - until the outbreak.
"Then we entered the world of COVID-19,"
said Dr. Robert Gianforcaro, executive medical director of UNC Health's Virtual Care Center. "That was the watershed moment where everyone now is interested and capable of providing telemedicine visits."
Federal waivers let seniors access virtual care where they wanted to, including in their homes, and the CARES Act allowed providers to see new patients virtually. The bill also poured billions of dollars into telehealth programs and investments, including broadband expansion for veterans. Some private insurers are temporarily covering telemedicine for COVID-19 related illnesses.
Hospitals are already responding.
Novant Health ramped up its telemedicine program in a week. In just days, Novant expanded its program from a small but long-standing group of providers. It plans to make telemedicine viable systemwide, until it can shift any visit to a virtual platform if clinically appropriate. A year ago, they had done 199 scheduled visits. On Thursday, March 26, they did 2,300 visits.
"In 48 hours, we advanced five years into the future,"
said Dr. Hank Capps, Novant Health senior vice president and chief digital health and engagement officer. "This is a monumental shift in how providers are thinking about delivering care. Providers are learning to do care delivery in a whole new way."
Private-sector companies are stepping in to help "virtualize the hospital room." Nebraska "telenursing" provider Banyan Medical Systems is partnering with TeleHealth - a major provider of telemedicine based in the Triangle - to donate telenursing services to some hospitals during the outbreak, said Michel Koopman, executive vice president of Banyan Medical Systems.
Their telenursing services will equip patients with a speaker and a button to call the telenurse. They are looking to introduce the system into facilities in the Triangle area.
"It'll call a virtual provider sitting halfway across the country,"
Koopman said. "They don't have to wait for someone. It's immediate. And when you're an isolated patient, you are isolated."
The threat of contagion has transformed telemedicine's role within hospitals. With shortages of personal protective equipment, hospitals have cancelled elective surgeries to conserve masks and other essential equipment. Dentists have donated their masks, and private companies have switched to producing medical equipment in N.C.
But Koopman argues telemedicine can relieve shortages by cutting demand instead of increasing supply.
"Everybody's talking about the supply of PPE being a problem,"
Koopman said. "How about if you just need to use less of it? If you don't have to go in and out of a room 10 times a day, you don't need to change your gloves or mask [as often]."
Hospitals are also using telemedicine to protect vulnerable workers and patients. UNC Health opened a virtual care clinic for coronavirus patients, where providers have treated more than 3,500 patients virtually since mid-March. Vulnerable providers are staying away from the hospital, but telemedicine can allow them to continue to treat patients, Gianforcaro said.
"This allowed us to achieve and realize the ultimate potential of the future,"
said Gianforcaro. "Everybody looks at telemedicine as a niche. But telemedicine needed to become medicine. The future is coming on today. The virus forced us into this environment, and forced us to accept a viable and reasonable alternative to face-to-face visits."
But most of the reforms expire with the virus. Now providers are wondering if reforms will be made permanent, especially the reimbursements from private insurance.
"That's a major unknown,"
Capps said. "The way we deliver care will never exactly be the same after the pandemic. ... The expectation will have been set by consumers, clinicians are ready to deliver, and insurance coverage will reflect that demand and capability."