Doctors Make Digital Transition Amid Outbreak
Physicians across Western New York and beyond have made significant steps to change their treatment methods in response the outbreak of Covid-19. In order to slow the community spread of the virus and keep health care workers safe from infection, medical professionals are making the switch to telemedicine. The transition has impacted the medical field at every level in just a few short weeks, with videoconferences and phone calls now becoming the new normal for doctors and their patients.
“Telemedicine does allow for the delivery of care, including the evaluation and management of care and care needs from a distance, from a physical infection perspective,” said Dr. John Haughton, innovation officer for the Chautauqua County Health Network. “Really, until this outbreak, you were supposed to be using sort of more formalized telemedicine portals and equipment and computer systems. People are realizing that things like Skype and FaceTime and so on work to give you good audio visual feedback.” The rapid outbreak of coronavirus has given rise to an equally rapid increase in telemedicine visits, as doctors offices endeavor to keep patients and staffs free of infection.
“The effort of all the practices is to quickly get up to speed on telemedicine as quickly as possible,” said Jim Sherry. “Then to be more proactive, and then to manage ill patients for as long as they possibly can.”
Sherry used the analogy of shock absorbers that are being placed within the medical field. Procedures and techniques like telemedicine are being implemented in order to flatten the curve of coronavirus infection and ease the impact for doctors, hospitals and medical support staff. These efforts are also aimed at preserving stocks of crucial supplies, like personal protective equipment, masks and ventilators.
While there is a significant change to treating patients virtually rather than in person, physicians are adapting well.
“I think it has been actually a very pleasant experience,” Dr. Tariq Khan said.
Khan serves on the Chautauqua County Health board and is the founder of Southern Tier Pediatrics.
“We are missing that experience of being able to listen to their heart and lungs and feel their tummies and check their ears and throats, but it is actually very pleasant. We are all used to technology now days. It is so much fun, I look forward to it.” Khan explained that consulting with patients virtually gives physicians a chance to utilize their observational skills, and rely on their knowledge of patient history and context to make diagnoses.
“You kind of have a little chit chat, and we are using a lot of our observations skills during those telemedicine calls. Seeing how the patient is looking, how they are interacting,” Khan said.
In the event that an office visit or a trip to the emergency room is necessary, screening tools are in place to limit transmission of the virus. These algorithms are designed and used based on New York state and Centers For Disease Control recommendations, and are in place at various levels of the health care field.
“There is a very well-planned algorithm that we have in place at all entry points,” Khan said. According to Haughton, these tools look for clusters of coronavirus symptoms including fever, dry cough and shortness of breath to identify patients who may be infected.
“There are a number of screening tools,” Haughton said. “They kind of boil down to asking some questions about having a fever, having shortness of breath, having a cough. Then asking some questions about exposure. From what you see, is this person a high or a low risk?”
While physicians have had their own set of tasks bringing telemedicine to the front lines for patients, insurance providers have also had to make changes. The use of telemedicine has lagged behind in Western New York compared to other areas of the country, in part because of reimbursement difficulties for physicians and their practices. “The health insurance companies always are dragging feet on covering these services, especially telemedicine,” Khan said. “Hence the reason telemedicine wasn’t used widely in Western New York. In this time of crisis they have responded. Our local physician leadership has direct, close contact with our major insurers in the area and they have responded well and have adjusted fees and reimbursements for the physicians. Knowing that the physician’s offices need to survive and stay open to provide service. I think it has been a wonderfully pleasant cooperation in the last few weeks and things are moving along.”
Khan said that reimbursement for these services is not quite up to the level of in-person visits, but that progress is being made.
“A lot of the acceleration of telemedicine in the last month has been directly related to the relaxation of some of the constraints around what devices and what activities (can be used)-and also around making some of the billing have more parity with an office visit,” Haughton said. “We’re very fortunate in Western New York that the dominant payers are nonprofits. Independent Health and Blue Cross are both non profits, the two larger ones. There is a long history of trying to work with the physicians.”
Haughton noted that near the end of March, Medicare made adjustments aimed at allowing more parity of reimbursement.
“Medicare, when they changed their rules on the 30th, they allow an emergency room consultation to be telemedicine now. In that case it might be through the glass of the room, and the doctor is using a cellphone in the hall and the patient has a tablet in the room and they are doing an interview back-and-forth.” That consultation may be facilitated by another health care worker, allowing doctors to limit infection exposure and the use of protective equipment.
While changes are being made to reimbursement for medical providers and physicians, the scale and timeframe of the coronavirus outbreak are likely to cause other financial problems in the field. “If we just have to base our longterm viability on insurances paying us for telemedicine I can tell you, if that (state or federal) stimulus wouldn’t be there or physicians won’t be able to tap into that, it’ll be chaos for healthcare in Western New York in a few months down the road,” Khan said. “A lot of the practices from here, Rochester and Buffalo will go out of practice. That will be a big calamity once that is all said and done.”
Khan was hopeful that the financial needs of these medical practices will be addressed by governmental aid if need be, and praised the work of the Chautauqua County Health Network in coordinating efforts during the crisis.
“We did a survey through Chautauqua County Health Network, and more than 85-90% of the physician’s within the first week or ten days of this emergency being declared were using telemedicine of some sort,” he said. “Whether it was televideo or telephonic medicine, in efforts to try and keep the patients out of the office and decrease the exposure.”