Videoconferencing can't be used for everything, of course. Annual physicals and diagnoses requiring the doctor to lay hands on the patient must be done in person. — Health care photo created by freepik - www.freepik.com
The coronavirus compelled doctors to see patients in new ways, and one of those is through a computer monitor, miles away from the patient.
The pandemic placed greater emphasis on telehealth, which has been around for years but was put to use urgently when the coronavirus spread in early 2020. Officials with Medicare, the government-sponsored insurance for senior citizens, also increased the number of the occasions in which telehealth could be covered during the pandemic.
Whether vast telehealth use and broad insurance coverage for it will continue isn't certain, those who know the benefits of telehealth say it has proved itself and is here to stay.
"It's become part of life," said Sharon V. Nir, administrative director of strategic operations with Albuquerque-based Lovelace Medical Group. "I do think it's the new world."
Lovelace created an extensive program in March 2020, with the arrival of the coronavirus, to make remote visits available to patients and doctors through laptop computers, iPads, cellphones and desktops with cameras and microphones.
Presbyterian Healthcare Services, Christus St. Vincent Regional Medical Centre, University of New Mexico Health, La Familia Medical Centre and most other medical systems also increased their use of telehealth.
Santa Fe Preparatory School teacher Brad Fairbanks went head over handlebars on his bicycle last month, breaking a collarbone and three ribs. He spent time in an emergency room, but his follow-up visits with his family physician, Dr Carl Friedrichs of Presbyterian Medical Group, were done remotely.
Fairbanks, 61, said the follow-up appointments and pain medication assessments were as effective by videoconference as they would have been in person.
"This was the first time I'd done telehealth," said Fairbanks, the performing arts chairman at his school. "Yes, it worked great."
He said the accident happened at a bad time, with his students preparing to put on the show 9 to 5 The Musical. He missed four days of work and two rehearsals and had to participate in two other rehearsals by Zoom technology.
Friedrichs said there is plenty that can be accomplished in a telehealth appointment.
"The patient has the choice," he said. "It's an extra tool for patients."
In a big state like New Mexico with vast rural expanses, it makes sense to lean on telehealth, he said. "This is a state that has limited medical resources."
Videoconferencing can't be used for everything, of course. Annual physicals and diagnoses requiring the doctor to lay hands on the patient must be done in person. Blood draws for lab work require a visit, although the result of that lab work can be covered in a virtual appointment. And some patients aren't at ease with the technology.
But telehealth gives patients in rural areas and those who struggle to find transportation the chance to get some of their services done by videoconference. And when the highly contagious coronavirus roared through the world, patients who were reluctant to visit the doctor's office had an alternative.
Christine and Ed Shestak of Albuquerque have had about four videoconference appointments apiece through Lovelace since the start of the pandemic.
"For routine things, it just kind of minimises the risk of picking up anything anybody else might have" in the doctor's office, said Christine Shestak, 69. She recalled when she took her children to the paediatrician many years ago, kids would cough, noses would run and children would share toys in the waiting room.
Telehealth is a solution, she said, and if she has the flu, she doesn't have to carry it into the clinic and possibly infect others.
Ed Shestak, who will soon be 70, said he has hearing aids and sometimes struggles to absorb everything if there is background noise in the doctor's office. At home, he puts on headphones for his virtual visits. "I can hear and understand better," he said.
Naturally, insurance coverage of telehealth is complicated. Before the pandemic, Medicare coverage for telehealth generally favoured rural patients and also included some specific conditions such as end-stage renal disease and strokes.
But when the coronavirus forced patients to work from home and limit travel, the Centres or Medicare & Medicaid Services expanded coverage on an emergency basis to patients in cities, to a wider variety of medical practitioners and for a broader set of reasons.
Telehealth used by primary care doctors boomed. Specialists in psychology, the digestive tract, lungs and heart also saw increased use of telehealth. The federal government reported in December that Medicare-covered telehealth visits leaped from 840,000 in 2019 to 52.7 million in 2020.
Presbyterian spokeswoman Amanda Schoenberg said scheduled telehealth visits with Presbyterian Medical Group went up by 100 times from 2019 through 2021.
Medicare will continue to cover many of those services at least through 2023 while officials evaluate the system.
Tennessee-based Baker Donelson law firm says on its website new Medicare provisions also permanently removed geographic restrictions on telehealth for diagnosis, evaluation and treatment of mental health disorders.
Stetson Berg, chairman of the New Mexico Telehealth Alliance, said Congress will have to pass laws to cement much of the coverage that was added on an emergency basis during the pandemic.
Berg said state law in New Mexico has provided some of the most progressive private insurance coverage of telehealth and has served as a "shining star" in the field for close to 10 years. New Mexico was ahead of the game in part because it is so rural, he said. Other states are catching up.
In the journal Annals of Internal Medicine, researchers reported last month that analysis of 38 studies showed videoconferencing "generally results in similar clinical effectiveness, health care use, patient satisfaction, and quality of life as usual care for areas studied."
Those studies were limited to "patients seeking care for a limited set of purposes," the report added.
Christus spokesman Arturo Delgado wrote in a text message that virtual visits "are appropriate for most evaluations. Conditions that can be evaluated include anything from a cough or a cold to more complicated conditions like diabetes or heart disease."
Jasmin Milz Holmstrup, a spokeswoman for La Familia Medical Centre in Santa Fe, said the use of telehealth increased considerably at her institution from 2020 to 2021.
"It's an effective way to see patients who have non-urgent needs," she said.
University of New Mexico Health said the institution "utilised all available options to continue to provide patient care, including telehealth. This was a successful way to ensure patients continued to receive care and access to a provider."
Prep teacher Fairbanks said his students prepared for the play while he was "in my recliner, all banged up."
The shows took place March 3 to March 6 and the medical appointments by telehealth and attendance of rehearsals by Zoom didn't pose a problem. His students came through.
"It worked out," he said. "And the kids stepped up." – The Santa Fe New Mexican/Tribune News Service
