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Due to the pandemic, the model for delivering healthcare has changed. But is the change permanent — and is that a good thing?
In the Before Times, if you were feeling achy and feverish, you arranged for time off from work or a babysitter for your kids, dragged yourself to your doctor’s office building, searched for parking, checked in, filled out a long form, and sat in a waiting room for a (hopefully) short or (more likely) long time with other potentially contagious patients. Then, you were ushered into an exam room with only some dog-eared People magazines to keep you company, where you waited some more before finally seeing your doctor.
That model of healthcare all but disappeared during the pandemic. It was replaced by some form of telemedicine or virtual doctor visits, augmented by masked, in-office visits for those with issues requiring hands-on examination, testing, or imaging. And while patients weren’t teleporting Star Trek-style through space, they did receive the medical care they needed from their own homes as outpatient healthcare made a huge pivot to telemedicine.
“We had to go from zero to 60; the pandemic underlined a clinical need not being met,” says Dr. Patricia Calayag, chief medical officer of Westmed Medical Group, which has several locations in Westchester. “Now, telemedicine is the future of healthcare,” she adds, “and our early data indicate that it is making a significant impact on improving patient outcomes while decreasing total healthcare expenditures.”
The words telemedicine and telehealth have come to be used interchangeably, but the American Academy of Family Physicians (AAFP) distinguishes between the two: Telemedicine, it says, “is using technology to deliver care from a distance,” while telehealth is “the technology and services to provide that distance care.” Here, we are focusing on telemedicine — the providing of medical, mental health and wellness, and healthcare education remotely to outpatients by physicians and other medical professionals.
Telemedicine by the numbers.
While some forms of telemedicine were being used or in the pipeline prior to the pandemic, COVID quickly propelled them from a “good idea someday” to “the future is now” status. According to research by Rand Health Care Corporation, the use of telemedicine increased by more than 4,000% in March 2020 over the previous year. Results published in the Journal of General Internal Medicine show that during the peak of the pandemic onset — mid-March 2020 through early May 2020 — it was used by more than 40% of patients with a chronic medical condition and by more than 50% of those with a behavioral health condition.
Local use reflects those findings. Dr. Tobe Banc, senior vice president and medical director of Phelps Hospital Northwell Health in Sleepy Hollow, says that from February 2020 to February 2021, the Northwell system — comprising 23 hospitals and 830 outpatient facilities — saw a 5,000% increase in use of telemedicine offerings. And Michael Fosina, FACHE, president of NewYork-Presbyterian Lawrence Hospital in Bronxville, estimates that 4–5% of Lawrence Hospital patients used televisits before the pandemic but that at its height, March 2020 to June 2020, that figure soared to about 80–85%. As of this writing, that number, he says, has receded to about 15%.
“This technology is a very powerful tool. Ramping up remote patient monitoring — with constant health consulting and feedback — really helps empower our patients and enables them to take ownership of their health.”
—Dr. Farrukh Jafri, Medical Director of WPH Cares
Who is using telemedicine and for what?
Specific use of telemedicine depends on the patient, the specialty, and the nature of the issue. In general, it is good for preventive care, health maintenance and monitoring, and patient education, says Dr. Farrukh Jafri, medical director of WPH Cares at White Plains Hospital, and less so if you need to put hands on the patient during exams. “But most of what you’re going to find out can often be done through history-taking, and that can be done virtually,” he adds.
Not surprisingly, notes Fosina, telemedicine is often used for behavioral health (“Psychiatrists don’t need to do an EKG,” he points out) and works for both individual visits and online support groups. An example of the latter would be the groups led by NewYork-Presbyterian psychologists for parents of anxious children or those with substance abuse issues. Another specialty that lends itself to virtual visits, Fosina adds, includes primary care, for review of symptoms or prescription refills, but each specialty uses it slightly differently.
Initial orthopedic visits, for example, which rely on imaging for diagnosis, require an in-person visit, yet post-op visits and other treatments might be done remotely, a plus for patients with temporary limited mobility. That was the case for CareMount patient Jessica Apicella of Tarrytown, who consulted orthopedist Dr. Stacy Spivack-Gross in Mount Kisco when she tore a ligament in her ankle while hiking last fall. While her first visit required an MRI and was thus in person, the follow-up, in which the doctor adjusted her PT regimen, was done remotely. “It was a really easy, smooth, and efficient experience,” says Apicella, “and we covered all my questions without my driving to an office or sitting in a waiting room.”
Remote monitoring devices are a game changer.
An important adjunct to virtual visits, incorporated by all those we spoke with, is the use of home health monitoring devices, like electronic blood pressure cuffs, scales, oximeters, spirometers, etc. These are described as especially useful for those with chronic medical conditions, like diabetes or obesity, or patients who are leaving the hospital with high-risk medical conditions, like pulmonary disease or COVID. In these instances, the patient or caregiver is taught to use the device from their home, and data is transmitted to the doctor by iPhone or other means.
“We realized that you could really improve care if you can understand what is happening between visits and see if patients are getting sicker.”
—Dr. Patricia Calayag, Chief Medical Officer of Westmed Medical Group
“We realized that you could really improve care if you can understand what is happening between visits and see if patients are getting sicker,” says Calayag. “For this, mobile devices are a game changer.” Jafri concurs: “This technology is a very powerful tool. Ramping up remote patient monitoring — with constant health consulting and feedback — really helps empower our patients and enables them to take ownership of their health.” Another exciting use of telemedicine, Jafri says, is White Plains Hospital’s Paracares program. The hospital partners with local paramedic organizations to perform virtual visits with patients in their own homes, thus enhancing the care they receive and connecting them back to the hospital as they recover.
Telemedicine is a plus for both patient and physician.
“One of the biggest benefits of telemedicine is increased access to care, particularly for a large, sophisticated medical center like ours, which covers an enormous geographic area, with patients who often live several hours away,” notes Dr. Neil Schluger, director of medicine at Westchester Medical Center (part of WMCHealth), in Valhalla. “It allows more patients to access more specialized levels of care than they might where they live.”
“Telemedicine’s convenience,” adds Dr. Lisa Bardack, chief medical officer of CareMount Medical, “improves the quality of the patient’s healthcare experience and takes away so much of the stress level involved with making a visit to a doctor.” Not only do patients not have to take off a half day of work,” she says, “we can see people in bad weather and those who are housebound or without reliable transportation.” Telemedicine definitely improved the quality of the healthcare experience for Rachel Rosenblum-Monahan of Long Island’s Williston Park. After months of working remotely, hunched over a laptop in her kitchen, an MRI confirmed that she had developed a painful herniated disc in her back. When she was told by her local physician that she might benefit from an epidural, her research led her to Dr. Yili Huang, an anesthesiologist and founder of the Pain Management service at Northwell Phelps Hospital. She had her MRI sent to him electronically, and the two reviewed it together on a video screen during their first televisit. “In that 20-minute visit,” says Rosenblum-Monahan, “Dr. Huang gave me a great education about my issues and the available options.” Her next visit, when the doctor administered the epidural, was, of course, in person, but her follow-up visit was once again via telemed. “My experience surpassed my best expectations,” notes Rosenblum-Monahan. “Not only did my doctor give me all the information I needed during our one-on-one televisits, using telemed saved me a long drive back and forth from my home, especially when my back was so painful.”
“One of the biggest benefits of telemedicine is increased access to care, particularly for a large, sophisticated medical center like ours, which covers an enormous geographic area, with patients who often live several hours away.”
—Dr. Neil Schluger, Director of Medicine at Westchester Medical Center
Indeed, “telemedicine puts the patient-physician encounter squarely in focus, which is something that both crave in this day and age but can be hard to find,” says Schluger. “Both patients and physicians find it frustrating that there seems to be less and less time to just talk.” But why is a virtual visit better than, say, just a phone call? “If the doctor can’t do a physical exam, it is very important to be able to look at and see the patient,” Schluger explains. “Most physicians develop a sixth sense about how sick a patient is by looking at them, so a virtual visit gives them more information than just a phone call.”
Finally, telemedicine also offers benefits to the healthcare delivery system and to the physician, adds Bardack. “When we offer telemed visits, we have way more exam-room access — and exam rooms are a precious commodity. With the doctor at home,” she continues, “the flow is faster, and the use of staff and space is much more efficient.” Plus, she says, when physicians can schedule telemed visits from their homes into their work weeks, their quality of life improves. “It’s an alternative method of healthcare delivery that can also be used to decrease doctor burnout.”
Of course, telemedicine, like everything, has its limitations and is not a panacea for all that ails the health-care system. One has to have the right technology and equipment and WiFi, which some populations may not have access to, says Banc of Phelps, creating potential inequities in the portfolio of healthcare options available to those populations. “And sometimes, technology just doesn’t work,” she adds. “Also, because care is happening remotely, there needs to be a way to ensure that patient data is being fully protected.”
While it was difficult for any of those we consulted to estimate the costs involved to ramp up their telemed offerings, certainly additional expenses were incurred. These included acquiring more sophisticated equipment, such as high-definition cameras, more tablets and specific telemed carts for provider use, training, and, of course, improving WiFi and broadband systems.
What’s the prognosis for telemedicine?
All the experts we spoke with predicted that use of telemedicine will only continue to grow and improve. “The pandemic accelerated the growth of something that was already on the rise,” says Jafri, “and it will continue to expand, allowing greater access to the right physician, at the right time, for the right visit.” Hopefully, with better technology and increased access to it for all populations, Banc sees telemedicine “becoming more standardized, mainstream, and more of a daily occurrence, and not just used in special incidences.” She does caution that the policies for health insurance reimbursements that were put into place during the pandemic — in which telemed visits were reimbursed at parity with in-office visits by most insurance companies — need to continue post-pandemic for that to happen.
Telemedicine will find its steady state, predicts Bardack, “and the ratio of telemed to in-office visits will continue to change as we understand what technology is available and physicians and patients become more comfortable with it.” And while the geriatric population will continue to grow as people live longer, she says, “We can’t forget the younger, tech-savvy individuals who might not have the patience to make an appointment to see a doctor in person. Telemedicine is a way to engage this important segment of the population in their own healthcare.”