“THE TELEHEALTH EXPERIENCE:
DR. IT IS HERE TO SERVE YOU NOW”
AUTHOR Thomas S. Higgins, MD, MSPH
TECHNOLOGY IN MEDICINE
And then we were teledocs.
As the coronavirus disease
(COVID-19) pandemic emerged,
we discovered an insufficiency in
supplies of Personal Protective
Equipment (PPE), and we prepared
to ensure the health care system
had the capacity to care for a surge in critically
ill patients. But there was another, more subtle area in the outpatient
setting, lacking in supplies for both clinicians and patients:
telehealth.
Several years ago, I decided to explore telehealth options. I
wanted to know more about the technology, and how it could potentially
benefit my patients. I tried several different formats and
asked some of my closest patients to participate, free of charge, in
some virtual visits to see what it was like. I thought that telehealth
would be good for screening some of my patients having acute
issues for which they were unable to come into the office or maybe
to check on my postoperative patients.
The biggest issue for me with the routine implementation of
telehealth at the time was that neither the commercial insurance
carriers nor Medicare/Medicaid, despite the availability of telehealth-related
CPT codes, would provide reimbursement for the
visits. They would, however, pay third-party vendors with remote
clinicians who did not have established relationships with the patients
to perform telehealth visits. The second problem was that
people didn’t really understand it. Many of the patients would ask
me why I didn’t just call them on the phone. I recall one patient
saying that she couldn’t do the video because she hadn’t “made up
her hair.” The third issue was that many of the patients reported not
having the technology available to them to do the virtual visit. So,
telehealth in my practice was a nonstarter at the time.
And then the COVID-19 pandemic hit Kentucky in March 2020.
All of a sudden, doctors were asked to do telehealth visits preferentially.
Yet, most doctors had no experience with telehealth,
and they started complaining of the same issues I had experienced
a few years previously.
Here are some of the complaints I heard:
• The telehealth software, particularly for systems that provided
proper HIPAA securities, added expense at a time when physician
collections were at a historic low.
Figure 1. Telehealth has led to many unique situations, from treating a patient
on a turkey hunt (top) to teaching a lady the location of her phone camera
(bottom left) to looking at a bunch of ceilings (bottom right).
• Insurance reimbursement, especially at the beginning of the
pandemic, was either unavailable, unreliable or too low for
the time spent. This issue has not been completely resolved.
• Clinicians were unfamiliar with how to use telehealth applications.
• Patients were unfamiliar or uncomfortable using telehealth
applications, and many of them declined visits.
• Some patients, particularly the elderly, did not have the technology—a
smartphone or computer with video and audio
capabilities and internet access—available to them to proceed
with a telehealth visit.
• Telehealth visits required exuberant preparatory work, from
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