‘The genie’s out of the bottle,’ and telehealth is on its way to being the new norm

When Leon resident Eden Shields-Fuson had coronavirus symptoms, she was able to use FaceTime to connect with her primary care physician.

“It was real awkward at first. Do I look at the camera? Do I look at her?” Shields-Fuson said. “After the first minute of awkwardness wore off, it was just like talking to a friend.”

Even better, her three telehealth appointments have been quick.

“That’s what I enjoy,” said Shields-Fuson, who does not have the virus. “I’m the least patient patient a doctor has ever had.”

Through an app, she was directed into an online waiting room, typed in her name to let her doctor know she was there, and then the appointment happened almost immediately. That is, except for the first time, when Shields-Fuson kept her doctor waiting because she couldn’t get the app to work on her Android phone and had to borrow her child’s iPhone.

Telehealth — or telemedicine or virtual office visits as they’re variously known — existed before the COVID-19 outbreak, but the pandemic has dramatically ramped up its use.

“This is really learning how to do telehealth through a fire hose,” said Donna L. O’Shea, a physician who is UnitedHealthcare’s national chief medical officer for population health management.

“Not all practices were ready to offer virtual visits.”

Some felt forced to due to the new coronavirus, said Doug Scott, director of professional relations for Blue Cross and Blue Shield of Kansas.

“It has got everybody’s attention because with the in-person traffic being way down, and the source of revenue following that, they had to react to it,” he said. “Patients are accepting it, too, and it’s a growing convenience. You know, gee, if I don’t have to get out of my rocking chair.”

That’s precisely why Wichitan Mark Madden is a fan.

He played video games on his computer for about 10 minutes while waiting to see his doctor through video on his phone to discuss his asthma.

Madden said that’s preferable than the sometimes two hours he has to wait in his doctor’s office.

“Basically I sat in my comfy chair and waited for the connection.”

New year, new rules

Even before the new coronavirus hit, Scott said Kansas law regarding telehealth had already changed Jan. 1.

All health insurance carriers now have to cover telehealth under certain guidelines, which limit who gets paid for the virtual visits and how much they receive.

“It wasn’t required that we had to pay the same as an in-person visit,” Scott said.

That’s because there aren’t as many overhead costs or items in use such as instruments, bed tissues or cotton swabs.

There are also requirements about secure connections for the visits.

However, all of those stipulations have been loosened due to the coronavirus.

For instance, previously, only physicians, advanced registered nurses, physician assistants and behavioral health professionals such as psychologists, psychiatrists and social workers had to be paid.

Now, the list includes practitioners such as speech pathologists, physical therapists and dietitians in order to reduce instances of human contact during the pandemic.

Also, the visits temporarily will be reimbursed as if they were office visits.

“Telehealth is a good approach that protects both the patients and the health care providers from physical contact,” Scott said.

To encourage patients to still seek treatment during this time, Blue Cross, UnitedHealthcare and other carriers are waiving patient co-pays as well.

Scott said that also makes it easier for medical practices to not have to worry about co-pays and deductibles right now.

There’s also new leniency on what types of telehealth connections are considered secure. That means channels such as Skype, FaceTime and Facebook Messenger are now eligible for patients and physicians to use.

Blue Cross instituted its changes on March 16, and they’re set to revert to previous telehealth practices after 60 days.

UnitedHealthcare is waiving patient fees until May 31.

Even when everything rolls back to pre-COVID guidelines, telehealth is going to be the new norm, said Patrick Keran, UnitedHealthcare’s vice president for product and innovation.

He said as health care providers continue to change how they operate and further adapt to telehealth, “we’re also going to evolve with it.”

Though there have been issues with such a quick immersion into telehealth, there’s no going back.

“It’s going to be a new world,” Scott said. “Telehealth is going to stay strong and grow.”

Or, as O’Shea put it, “The genie’s out of the bottle.”

A new frontier

Not everyone is appreciating the new journey into telehealth, even those who are using it and acknowledge its importance.

Kansas Joint & Spine Specialists orthopedic surgeon James Joseph admits that after 34 years of practice, he’s more old school than some. He said he worries about what is lost with virtual visits.

“We really lost the art of examining the patient. . . . That’s what technology has robbed from us.”

He said it started even before telehealth as younger physicians increasingly have relied solely on tests instead of physical examinations.

“Technology has become our slave now.”

He said it’s to the point that some patients ask, “Now how come you touched me?”

Joseph said he hates “to sound like such an old fart,” and he said he does see telehealth having a role in health care.

“It’s going to be an interesting frontier for the future.”

Pediatrician Philip Newlin has been doing almost as many virtual visits in the past week as in-office visits. With children, he said, those virtual visits are “one notch more entertaining.”

On the first virtual visit he performed, a technical glitch resulted in no audio, so Newlin simultaneously used a phone and a computer.

“We talked on our phone and looked at each other on our computer, laughed about it and had a great visit.”

Newlin also is chief medical officer for Ascension Medical Group Via Christi, a collection of 180 providers.

“We’re committed to alternative forms of giving health care as long as it can give quality care (and) improve access of patients to their providers in a way that’s efficient and effective,” he said.

The coronavirus “has just accelerated that journey.”

And, Newlin said, “Like so many things about how we do life, this will probably not go back to the status quo.”

He said in Kansas, telehealth is especially great for rural communities.

“It just adds some practical efficiencies to health care.”

For others, there may be situations where people can manage chronic conditions such as diabetes with perhaps a couple of office visits a year and a couple of follow-up virtual appointments.

“Every physician office is going to have a different approach,” Newlin said.

Atlas MD, which offers memberships with monthly fees and does not take insurance, has been doing telehealth since it opened in 2010.

“It’s really kind of the core of our business model,” said physician Doug Nunamaker.

“It really opens up a lot of channels that I think otherwise wouldn’t necessarily be there.”

That includes more frequent contact with patients through texting and e-mailing, and Nunamaker said that leads to better care.

“I can stay on top things.”

Also, for conditions such as depression and anxiety, Nunamaker said he’s found patients prefer being able to put their thoughts in detailed e-mails.

“There are things that some people have a lot of difficulty talking about face to face.”

Fluffy and Fifi, too

Even veterinarian offices and the Kansas Humane Society have gone to virtual visits during the coronavirus outbreak.

Mark Eby, Humane Society president and CEO, said that’s the right call for this time, but it won’t be after the current crisis is over.

“It’s always better to see the animal and touch it and see if there are pain points you can recognize.”

Back on the human side, much of the willingness to adopt telehealth for the long term seems to depend on what type of care a practice provides.

Immediate Medical Care has four Wichita clinics and is not doing telehealth right now for several reasons.

“We didn’t want to do a knee-jerk response . . . and activate something we’re not familiar with,” said administrator Danelle Sommerfeld.

Also, she said, “It’s kind of a crapshoot now if you’re going to get paid by insurance.”

Sommerfeld said she’s not sure how telehealth can work for the urgent care of lacerations, twisted ankles and workers compensation cases — much of the issues her clinics see.

“To me, the psychiatric world or the chemical dependency world, that makes perfect sense.”

Indeed, some of those practices seem to be made for telehealth.

GraceMed has been conducting a telehealth pilot with behavioral health specialists since last year.

“It’s on the spot,” said Julie Elder, GraceMed’s chief medical officer. “It’s when it’s needed, so that has been great.”

She said a telemedicine pilot is now being introduced at GraceMed, and she said she’s excited about it given the success on the behavioral side.

“It’s been positive feedback across the board.”

‘A pleasant surprise’

The coronavirus situation in general and telehealth in specific have been something of a revelation for Wichita’s Michael family.

Lexi Michael said her 10-year-old daughter, Hazel, has something called social pragmatic disorder, which means she has trouble with communication skills such as recognizing tone of voice or facial expressions.

“She’s really flourishing being at home,” Michael said of the break from other contact.

Hazel has play therapy every two weeks. Since the coronavirus shutdown happened, she’s been doing the therapy by video.

“The interesting thing to me is how much more comfortable Hazel is with this kind of medicine,” Michael said.

Instead of getting anxious about her appointments as she did in person, Michael said Hazel is now looking forward to them. She said Hazel is more relaxed at home and is opening up more.

Michael said it’s “interesting and a pleasant surprise amid everything else.”

Brook Pickard, a licensed specialist clinical social worker and registered play therapist who works with Hazel, said some children are more comfortable in their own homes. Others are having difficulty adjusting to telehealth.

“Some kids, I think, really just like the connection face to face, and it largely depends on the personality of the kiddo.”

She said it’s the same with adults. Overall, though, Pickard said she’s seeing benefits with telehealth now that rules surrounding it have relaxed. She said she’s not sure what’s going to happen to telehealth when things change after the coronavirus outbreak.

“There are a lot of hurdles,” Pickard said. “I would like to see them be more flexible for sure.”

This story was originally published April 19, 2020 at 4:47 AM with the headline "‘The genie’s out of the bottle,’ and telehealth is on its way to being the new norm."