Coronavirus pandemic drives exponential growth of telehealth in the Upstate
'The healthcare industry will never be the same.'
Even though she’s just 2½ years old, Haley Chadwick has spent a lot of time in the hospital.
Suffering from progressive infantile scoliosis, or curvature of the spine, her treatment has meant many visits to Shriners Hospital for Children in Greenville, some lasting two to three hours.
But as the coronavirus pandemic emerged, her mother, Samantha Chadwick, worried that the frequent medical interactions might result in infection.
So when Shriners shifted to telemedicine for some of these visits, it helped allay her fears.
Via laptop or tablet, Chadwick said she can see the doctor and the doctor can see Haley, eliminating the need to make the one-hour drive from Abbeville County to the hospital and possible exposure to the virus.
“My biggest fear is that I’ve known a couple friends who had the virus and they got very sick,” Chadwick told The Greenville News. “And to not take her in was actually helpful.”
Shriners currently averages 30 to 40 telehealth visits a week, but that’s expected to grow to as many as 200 visits by May 11, said Hope Cummings, interim director of patient care services.
“Shriners has been doing some limited telehealth visits for a while,” she said. “But when COVID-19 came on the horizon, and we couldn’t do business as usual, we had to look for alternate ways to see patients.”
Hospitals everywhere ramped up telemedicine almost overnight as they faced the threat of the virus, initially for virtual visits to help screen potential COVID-19 patients, said Schipp Ames, spokesman for the South Carolina Hospital Association. Then came the stay-at-home orders.
“Hospitals saw a significant uptick in telemedicine usage as individuals followed social distancing measures,” he said, “and hospitals sought to keep beds available for a potential surge in patients.”
Meeting the demand
Nearly six in 10 people, 59%, of health care consumers say they are more likely to use telehealth services since the emergence of the coronavirus though only 25% had done so up to now, according to a recent survey by Sage Growth Partners, a health care consulting firm, and Black Book Market Research, a technology and services market research company.
More than a third, 35%, would switch physicians to have that option, and 45% would like more access to virtual mental health services, the survey showed.
As virus fears grew, the usual cancelation rate for doctor visits and other services at Prisma Health ballooned from about 5% to as high as 50%, said Dr. Nick Patel, chief digital executive.
But the system was able to ramp up for telehealth quickly and this week, which is week seven, more than 120,000 virtual visits had been done, he said. They made up less than 1% before, he said. For routine office visits didn’t do many telehealth visits at all.
“The fear was if we don’t see these patients, they could get worse or run out of medications, or have a gap in care with no flu or pneumonia shots, especially for older folks over 65 or who have comorbid conditions,” he said. “So we formulated a plan over a weekend and were up and running in three days. And every routine talk office visit was converted to a video or telephone visit.”
The hospital developed a digital health continuum that included getting patient data from wearables and remote monitoring, that combined with telehealth ensured that patients don’t come into an area of possible exposure with someone who is asymptomatic or in a high-traffic area with patients who are sick, he said.
Patients who don’t have broadband or video capability are “seen” via telephone, he said.
Dr. Steve Newman, regional medical director at Bon Secours Mercy Health, said the pandemic “catapulted our use and utilization of virtual platforms almost literally overnight.”
“When we recognized, as a system and society, that the pandemic was becoming much more of a threat to the community,” he said, “(we) began to take immediate action in order to protect patients to rethink how we provide care in the short term and intermediate and long term.”
So in early to mid-March, although a handful of providers had been using telemedicine up to then, the hospital launched a plan to convert its traditional business patients to a virtual platform, he said. That included he infrastructure and the education.
“In a week to 10 days, we flipped the switch from being 95% in-person to the opposite, to maybe 5% in-person and 95% virtual,” he said. “We needed to model the social distancing value as much as the community did.”
And Kim Burden, director of physician network services at AnMed Health, said the coronavirus has completely changed the way they provide care.
Before mid-March, the system wasn’t able to offer much in the way of telemedicine, she said. Since then, telemedicine has made up almost half, 46%, of the services provided.
“The reason for that is that we weren’t able to bill for any of those services,” she said. “When the COVID pandemic got started, (Medicare) started relaxing requirements for how they will reimburse for telemedicine.”
To help providers make the switch during the pandemic, Congress appropriated $200 million as part of the CARES Act for the purchase telecommunications, broadband connectivity, and devices necessary for providing telehealth services, according to the Federal Communications Commission, which set up a separate pilot program to support telehealth.
While the payment rules around telehealth have been loosened so that providers are reimbursed at the same rate as an office visit, Patel said, telephone visits are reimbursed at a much lower rate. And they shouldn’t be, he said.
Hospitals also have to make massive investments in technology to facilitate telehealth, he said.
Safety and convenience
Cummings said Shriners developed a telehealth team of providers and set up a line to contact patients ahead of time to make sure they have audio and video capability.
“We started initially with existing patients, and then added in new patients,” she said, “and beginning next week, we will add rehab and physical therapy telehealth visits so we can look at a person’s gait and be able to establish what physical therapy needs to happen going forward,” she said.
All the providers say patients and staff are happy with the technology for its safety and convenience.
“Patients love it,” said Newman. “And … we’re clearly protecting both provider and patient from exchange of infectious process.”
It’s been of special help to families who live outside Greenville and in the six surrounding states that Shriners serves, Cummings said.
“It’s been a phenomenal experience to be able to offer something for somebody who lives in Tennessee, saving hours of drive time,” she said.
Patients are glad they don’t have to drive to the office when they’re sick and sit in a waiting room full of other sick people, Patel said.
“I don’t blame people for not coming to see doctors,” he said. “They don’t feel safe.”
They also say that telehealth is likely here to stay.
“The post-COVID world is never going to be the same as pre-COVID world,” said Patel. “People have gotten used to telehealth.”
“Virtual medicine has been thrust upon us because of the COVID crisis, but it will remain once the crisis is gone,” said Newman. “And I think that’s a good thing personally.”
Still some in-person visits
But not all visits can be virtual.
As a primary care physician, Patel estimates he can see 60-70% of his patients via telehealth. But some patients still must be seen, to remove stitches, for example.
The staff has devised some creative ways to limit exposure.
Patients pull into the parking lot and wait there until they’re called, then go directly into the examination room bypassing the waiting room, then go straight back to their cars. This way, there’s only one patient inside at a time, he said.
Other patients are seen in the parking lot, for blood draws, vaccines and other functions that don’t require being inside, he said.
AnMed and St. Francis have taken similar precautions. Newman added that all patients are screened for temperature and symptoms when they arrive.
Because some patients will still require imaging and other services, Shriners will continue to provide in-person visits as well, using social distancing and other techniques to keep them and the staff safe, Cummings said.
“With stay-at-home orders in place, and it being dangerous for people to come out, (telehealth) has been a huge advantage,” said Burden. “I’m not sure how we would have been able to provide care and see the patients we’ve seen.”
Liv Osby is the health writer at The Greenville News. She can be reached at firstname.lastname@example.org, 864-298-4422 or @livgnews.