It’s strange to look at anything related to medical care with optimism right now. Between reports of hospital staff burnout and exhaustion, and now—due to the Omicron surge—the reemerging threat of emergency room overrun, it doesn’t seem there are any possible wins to celebrate.
But if the mad scramble to adapt to the reality of the past nearly two years had one silver lining, it’s that it made one aspect of medical professional jobs easier—telemedicine is now a part of almost every patient’s life, in large part because it had to happen.
Back in March 2020, when the novel coronavirus began rampaging through the U.S., clinics and hospitals still needed to see patients for all kinds of stuff: coronavirus, yes, but also medication refills and check-ins.
“The ramp-up was pretty quick, Zachary Nelson, a patient services specialist and union steward at the University of Washington, tells WW. “Within the first few weeks of March of 2020, we were rolling out telemedicine and educating patients about it. Doctors were converting pretty much all of their appointments to telemedicine. Any appointment that didn’t require a physical component, if you didn’t have to check, for instance, that someone had a torn ACL or MCL, we conducted it with telemedicine.”
The adjustment period was “pretty rough,” Nelson adds. Before teleconferencing was folded into the software suite that UW used, it would have to send out individual Zoom links to every patient. It could be…a little awkward.
“A lot of the Zoom we had wasn’t HIPPA approved.” Nelson says. “We had occasional instances of patients showing up for their appointment and dropping into an appointment that was already happening.”
Before the pandemic, providers had been toying with telemedicine in small doses, mostly for rural patients and the homebound. There was a desire for online doctor visits, especially for benign, commonplace appointments—anything that didn’t require a doctor to check a patient’s vitals or run lab tests. But widespread adoption of the practice ran up against the American insurance complex’s ambivalence toward the practice (there weren’t even billing codes for telemedicine visits until the pandemic) and the lack of dedicated, secure video conferencing software designed for use by medical professionals.
Only about 1.6% of Oregon Health & Science University’s appointments were being conducted over the internet at the time. But when the COVID wave crashed into the boardwalk, everyone in the medical field had to adjust, fast. In the early days, when reducing contamination was the only thing on anyone’s mind, OHSU had a few days when it was seeing around 65% of its patents remotely. In the intervening months, as the pandemic reached its terrifying heights, that number evened out to about 40%.
Nowadays, OHSU is conducting 28% of its appointments with telemedicine—more than 20,000 appointments a month. There are some disadvantages. “You can’t do a physical exam,” says Dr. Anthony Cheng, a mountain biking enthusiast and family medicine provider at OHSU. “You can’t administer procedures or vaccines or draw up lab tests. In family medicine, we really like to have comprehensive services. When someone comes in the door, we try to get as much done as possible in one visit. You can’t do that same scope of care in a video visit.”
But for follow-ups, or anything that doesn’t require the laying on of hands? Cheng is unambiguously enthusiastic. “Love it. Say you’ve got someone who sees you for depression and you start them on medication and you want to check in with how it’s going. That’s a conversation. It doesn’t have to be a visit.”
Mark Lovgren, OHSU’s director of telehealth, is optimistic that this status quo can continue even after the heady days of the pandemic are over. Oregon law already required insurance companies, famously fond of seeking loopholes to avoid paying for services, to cover telehealth visits, and in April 2021, the Oregon Legislature passed House Bill 2508, which provides coverage for phone visits and some forms of email exchange.
One of the results is that Nelson says his office is far more flexible now, able to reduce canceled appointments on the fly by simply shifting them over to telemedicine. It clears out his schedule, too. “Once the patient is in the system, it’s more hands off,” he says. “We do a batched check-in of all our telemedicine appointments at the beginning of the day, all in at once.
“Our priority is always going to be the patient in front of us. But with the patient not physically there, it increases the amount of time we have at the front desk to answer messages, referrals, stuff like that.”
Lovgren would like to see this flexibility more evenly applied because what impacts patients often impacts their medical providers. “Where we see there needs to be more work is at the federal level, with Medicare,” he says.
Medicare fee-for-service patients are currently covered by a waiver that allows them to be seen in the home, but that waiver isn’t backed up by any legislation and could be subject to dismissal by whatever executive figure occupies the White House at any given time.