Coronavirus way-of-life: Doctors, patients turn to telemedicine like never before

Telehealth

In this Tuesday, Oct. 15, 2013 photo, Orlando Vallone of Specialty Telehealth Services, demonstrates how a consultation is done from his office at the Miami Innovation Center. Telemedicine was on the rise prior to the coronavirus pandemic, but is being utilized more and more to connect patients with doctors and hospitals. (AP Photo/Wilfredo Lee)AP

Add telemedicine to the lists of ways your life might change during the coronavirus pandemic.

Hospitals are strained. The doctor’s office is a Petri dish of germs. And everyone is being told to stay home and at least six feet away from other people.

But rashes still break out, stomach pains and sniffles come and go, and kids still fall and sprain their ankles.

Patients like never before are turning to telemedicine, or virtual healthcare, to connect with doctors and nurses without leaving their homes.

The coronavirus is prompting people, in droves, to take advantage of a service that has been available for years. Telehealth companies are estimating that at least half their visits in the last two weeks have been first-time virtual patients. Companies say their call volume has doubled, or more, in recent weeks. Some experts estimate virtual visits across the U.S. will rise from 50,000 to 100,000 daily.

Doctors have been experimenting with the technology for years; some providers including in rural areas rely on telemedicine. The Syracuse VA Hospital lists dozens of services on its website -- from diabetes counseling to cardiologist check-ups -- offered to veterans in far-flung places across Central and Northern New York.

More recently, insurers and even municipalities have offered virtual health care. Before the coronavirus pandemic, Onondaga County Executive Ryan McMahon said in his annual speech he wanted to partner with a “virtual ER” to cut down on Medicaid costs. Some insurers, like UnitedHealthcare have created their own portals for telehealth visits. Others have partnered with companies such as Teledoc, which works with major insurers including Aetna and Molina Healthcare.

Central New York’s largest insurer has been urging patients with minor illnesses to use telemedicine as an alternative to the emergency room for a few years now. Excellus Blue Cross Blue Shield partners with the telehealth provider MDLIVE, which for the last several days has run a banner across the top of its website indicating longer wait times and increased call volume.

Teledoc alone reported it saw a 50% spike in call volume in the last two weeks, reaching as many as 15,000 visits requested per day.

Statistics like those indicate the coronavirus pandemic might make online doctor’s appointments ubiquitous for the first time in the U.S.

Experts say telemedicine is getting a chance to prove how useful it can be. That’s not just for consultations or appointments that seem to translate seamlessly online -- but for all types of medicine -- even, or perhaps especially, in emergencies.

Triage

In 2014, a physician’s assistant and a doctor who both work in hospital emergency departments in Upstate New York started what they believe is the country’s first "virtual ER.”

Keith Algozzine, CEO and co-founder of United Concierge Medicine based in Troy, said he and his partner Dr. Michael Bibighaus always recognized that about 10% of their work would need to be performed in person. Yet 90% of Algozzine’s job as a PA, he said, was not mending gunshot wounds or responding to heart attacks.

The real specialty of emergency medical providers, he said, is triage.

Algozzine says UCM’s model shows how the process of evaluating a patient and determining to whom or where they need to go for treatment, can — and even should — happen online.

UCM about two years ago expanded its presence in Central New York, adding the Syracuse Fire Department and CenterstateCEO as clients. Employees of SFD and Centerstate can log into UCM for virtual evaluations, diagnosis and even treatment. Through online visits, the team can order labs, X-rays, referrals to specialists or prescriptions.

United Concierge Medicine and 'ER Anywhere'

United Concierge Medicine co-founder and CEO Keith Algozzine speaks at the announcement of his company's partnership with Rensselaer County and insurer CDPHP. Algozzine helped launch an "ER Anywhere" with the county that allows Medicaid members to access online emergency physicians 24/7. (Provided Photo)

UCM has seen massive growth, starting with its first “ER Anywhere” in Rensselaer County where the company is based, and expanding across the country and in the Capital Region, where all Medicaid members have access to the service.

This week, UCM announced partnerships with two leading New York insurers, MVP Health Care and CDPHP. Members insured by those companies now have access to physicians at no additional cost, 24/7 from the comfort of their homes. Officials from the insurers said they contracted with UCM to help patients and reduce the strain on local hospitals and doctors.

“The technology will triage patients to the most appropriate point of service, keeping local medical centers safe and ensure that all patients get the appropriate and timely service they need,” MVP officials said in a statement.

Algozzine said UCM has seen an explosion in patients’ use of their services in the last two weeks as the coronavirus spread to the U.S. and became a global pandemic. Virtual visits are up 1,000% in two weeks’ time, Algozzine said.

“In a normal healthcare state, not a national healthcare crisis, this is immensely needed,” Algozzine said, noting how high the stakes typically are when someone is considering whether to go to the emergency room. “In this situation, in a public health crisis, it is just beyond critical. You really do not want to make the wrong decision. You need someone with emergency medicine expertise.”

Tipping Point

UCM sees itself as a critical tool to help an already stretched-thin health-care system.

Algozzine said as UCM expands, it plugs into local health-care networks, hospitals, ambulance services, 911 centers, the local Department of Social Services.

He said UCM is not an alternative to the existing medical system, but a tool to enhance it, hopefully relieving the burdens on hospitals and 911 responders. Many people turn to these entities if they don’t have general practitioners or aren’t sure what to do, Algozzine notes.

We’ve all been there: A child wakes up at 2 a.m. with a high fever, or someone isn’t sure a bone is broken.

Sometimes it’s less urgent.

Mei Kwong, the executive director of the telehealth-focused nonprofit Center for Connected Health Policy, spent 2 1/2 hours in a doctor’s office waiting room with a relative who had a major surgery. Once inside the examination room, the doctor just had to review the patient’s MRI results with him. The appointment took all of two minutes.

Kwong said that’s an example of when a virtual appointment could be really convenient, for both patient and doctor.

“There are certain things that are just going to need to happen in person, right? You can’t draw blood online,” Kwong said. “Telehealth is not replacing the provider. It is another tool in the provider’s toolkit."

During the coronavirus, it’s an essential tool.

Kwong said she thought telehealth is at a “tipping point," as providers report a “huge influx” of patients seeking virtual options during the coronavirus pandemic.

While health experts emphasize how the virus and the subsequent need for social distancing underscore what a helpful tool virtual healthcare can be, legal experts say the coronavirus also importantly cleared the way of any legal barriers to telemedicine.

State and federal agencies have temporarily lifted many regulations on telemedicine, Barclay Damon health-care lawyer Bridget Steele said.

For example, New York has expanded which telephone communications are reimbursable by Medicaid, Steele said. She emphasized that federal and state agencies are rapidly releasing new guidance on telemedicine.

New York state officials, who broadly instructed insurers to cover telemedicine visits and waive copays, have said they want to ensure there are no regulatory barriers to telehealth during the coronavirus crisis.

Helping people at the right place, right time

Algozzine, the “ER Anywhere” CEO, said United Concierge Medicine is ready to take on more patients in response to the coronavirus pandemic.

UCM is hiring emergency medicine providers — rapidly, he said. The company is prepared to scale up its operations as needed.

UCM has reached out to municipalities around the county to offer its services, to supplement hospitals and 911 centers that are preparing for a wave of COVID-19 cases. That includes Onondaga County, which has urged residents to seek out telehealth options during the crisis.

But UCM was on County Executive McMahon’s radar long before coronavirus seemed to be a threat to residents here.

In his February State of the County speech, McMahon vowed to put together a telemedicine partnership “to help the overall system save money.” He gave a nod to UCM’s service in Rensselaer County, with its virtual app that provides care “within minutes rather than hours ... triage of acute issues can be addressed rapidly.”

McMahon said he saw telemedicine as a solution to address the “overuse of emergency rooms for what is otherwise considered routine care.”

That’s exactly what Algozzine sought to tackle when he found UCM.

“Most people don’t realize that our emergency medical system is on the verge of peril. There is only a finite number of resources, but there is already way too much demand on those resources. Even in good times, if you call 911 and an ambulance is taking a bruised knee to the hospital, that might mean that someone having a heart attack or stroke has to wait 20 minutes for an ambulance, and then they die. So why wouldn’t that 911 call be transferred directly to us so we can do something better for that patient with a bruised knee than send an ambulance?

Seeing the bright side of the current crisis, Algozzine hopes the urgency of the present situation leads more people to telehealth.

If it was up to him, it would already be a ubiquitous tool, he said.

“We want people to get the right care at the right place at the right time."

Advice for patients: How to see a doctor without leaving your house

Public Affairs Reporter Julie McMahon covers courts, government, education and sometimes fun stuff like treasure hunters. She can be reached anytime: Email | Twitter | 315-412-1992

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