Social distancing and stay-at-home orders due to the coronavirus (COVID-19) crisis have led many health care providers to conduct visits with patients through telemedicine — providing medical and mental health care using the internet and telecommunications technology. People who never wanted to try telemedicine before are suddenly getting a crash course in how it works.
Even those who may not have grown up with computers, tablets or smartphones are acclimating and giving this form of health care a try, says Dr. Michelle Lin, associate director of telehealth for the Mt. Sinai Health System in New York City.
“We have seen a dramatic increase in the proportion of patients using our telehealth services here at Mt. Sinai who are older and who have some chronic medical conditions,” Lin says.
More People Embracing the Technology
Before the crisis began, only about 10% of U.S. residents had used telemedicine, according to a July 2019 J.D. Power survey. Now, volume, at least at Mt. Sinai’s site, is 10 times higher than usual, she says.
“We have seen a dramatic increase in the proportion of patients using our telehealth services here at Mt. Sinai who are older and who have some chronic medical conditions.”
While some Mt. Sinai patients using telehealth have COVID-19-type symptoms and are seeking guidance on whether they need go to the hospital, others are using it to avoid coming in contact with anyone who might be contagious. “We know the risk to older folks is higher when they do get infected, so I think it’s beneficial to both patients and providers to keep patients at home who are well enough,” Lin says.
Medicare Allows More People 65+ to Use Telehealth
What’s more, the Centers for Medicare & Medicaid Services (CMS) has recognized the current need and recently changed Medicare telemedicine rules to accommodate patients, says Dr. Sirisha Mohan, clinical assistant professor at the Keck School of Medicine at the University of Southern California (USC). Mohan also is the department lead for telehealth at USC.
“Prior to all of this COVID pandemic, telemedicine was limited in terms of use because Medicare had more stringent guidelines on when telemedicine could be used for patients older than 65,” Mohan says. Medicare limited its use to rural patients, and they had to go to designated clinics or hospitals for their visits.
But, as of March 17, 2020, the rules changed, allowing more Medicare beneficiaries to receive medical advice from their doctors without going to a clinic or hospital. “CMS is expanding this benefit on a temporary and emergency basis,” according to the agency’s announcement.
Medicare announced these specifics about its telemedicine changes:
- Medicare co-pays and deductibles still apply to telemedicine visits, but health care providers will be allowed to waive or reduce these costs.
- Clinicians must use an interactive, real-time audio and video telecommunications system. Medicare will waive penalties for potential violations of federal health care privacy laws if clinicians make good-faith efforts to serve patients.
- Hospitals and a range of health care providers can use telemedicine, including doctors, nurse practitioners, mental health professionals and nutrition professionals.
- Nursing home residents also can consult health care professionals via telemedicine.
Many health care providers also offer “e-visits,” in which patients use a secured part of their health care provider’s website to fill in a questionnaire about their symptoms. Then, a doctor or other provider gets back to them with a treatment plan and, if needed, a prescription. E-visits work for non-serious medical issues in which in-person tests are unnecessary.
Novices Give Telemedicine a Try
As someone who is at increased risk for COVID-19, Barton Colin, 69, is one USC patient who has embraced the technology. With several chronic conditions, including chronic obstructive pulmonary disease (COPD) and chronic pain from a spinal issue, Colin was relieved that he could skip the difficult and risky trip to the doctor’s office.
“You watch on TV and there are six different categories (for COVID-19 risk) — five of them have me pinned right on as very vulnerable,” Colin says.
So, when his COPD lung condition flared up and he found himself gasping for breath, he decided to try telemedicine instead of risking an office visit. Making the virtual visit happen was as simple as clicking a link he received in an email from his clinic. Using his smartphone, he was able to see a tiny picture of the doctor on his screen and the practitioner was able to see him as well. It was a different doctor than he usually sees because his usual practitioner was off that day.
After looking over Colin’s chart, the doctor was up to speed and ready to help, prescribing Colin antibiotics. The medication helped at first, but two weeks later, he needed to reach out once more and was able to speak with the same doctor, who prescribed some additional medication.
Colin found the whole process very easy. “It was like calling up a friend and talking to him,” he says.
Likewise, Paul Fraser, 37, another patient at USC, found using telemedicine pretty straightforward. He opted to give the virtual approach a try, rather than the in-person follow-up visit he would have needed for the undiagnosed intestinal issues he was having.
“It was like calling up a friend and talking to him.”
With COVID-19 on the rise, and serious diagnoses already ruled out, Fraser felt it would be easier to use telemedicine for his follow-up exam. The technology was simple to use on his laptop, he says. After clicking the link that was emailed to him, he first spoke with a customer service rep, who then directed him into a virtual waiting room. After a couple of minutes, Fraser’s primary-care doctor showed up on the screen and the follow-up visit began.
Lin describes using the Mt. Sinai platform as very similar to a regular doctor’s visit.
“The first time you register, you have to enter a little bit more information to help us get to know you,” she says, adding that this includes standard information, such as your date of birth. Once patients input this information, they then fill out a quick questionnaire and enter a virtual waiting room, which alerts the doctors that they are there. “Then we open our video and you open yours,” Lin says, adding that the visit proceeds much as it would in the doctor’s office.
Telemedicine for Mental Health
Many people are now using telemedicine for mental health as well as physical health, moving forward with psychiatric follow-up appointments or psychotherapy sessions.
These days, Lauren Saletan, a licensed clinical social worker and psychotherapist in Nyack, N.Y., is conducting most of her therapy sessions virtually.
“I would say eighty percent or maybe eighty five percent have moved to online,” she says.
Saletan had to persuade several clients who had never used the video-chat app she uses before. Taking part in such a session just requires clicking on a link. Saletan encourages her clients to give it try, assuring them that it will be a lot like an office visit, and she’s found her clients agree. “Everyone has said, ‘Wow, it’s really like we’re together,’” she says.
In fact, she says it’s easy to forget it’s not an actual office visit. “I have been a therapist for over twenty-seven years and when we’re engaged and we know each other, it’s like we’re in the office,” she says. “As long as we’re connecting, it doesn’t matter whether it’s over a screen or in the office, is what I have found.”
Even after the pandemic subsides, Saletan believes some of her clients may wish to continue with telemedicine. “Some people may prefer it moving forward, because they’re working and life is busy. So, that will be a wait-and-see,” she says.
Maxine Lipner is a long-time health, medical and business freelance writer, with a specialty in ophthalmology. She is the senior contributing writer at EyeWorld magazine. Her work has also appeared in a variety of other publications, including New York magazine, Women’s Sports and Fitness, Compass Readings (Northwest Airlines magazine) and Nation’s Business.
