For millions of Americans these past few months, a visit to the doctor has meant sitting down at home with a smartphone or tablet and being evaluated remotely.
Capital Region telemedicine providers say electronic visits increased 10-, 30- or even 150-fold during the height of the COVID-19 pandemic, when many people were avoiding medical facilities and many health care providers were limiting patient visits, both out of caution.
- Albany-based insurer CDPHP said its telemedicine services went from 110 visits a day to an average of 3,400 a day, more during the peak.
- UCM Digital Health, a virtual emergency room based in Troy, said its call volume peaked at 500% to 1,000% above normal.
- Ellis Medicine in Schenectady rapidly developed a telemedicine service that has accommodated 5,000 video encounters and 7,500 phone visits since its rollout in late March.
- MVP Health Care in Schenectady has seen use of its two platforms surge and has simultaneously reached out to more than 70,000 of its most vulnerable members to proactively check on them during the crisis, which has isolated many of them at home.
As the Capital Region and the rest of New York gradually reopens its economy, telemedicine volume is easing down from its peak but the caregivers and insurers both hope and expect it will remain in far greater use than it was before the first COVID-19 case was confirmed in the state on March 1.
Telemedicine is a simple concept: Patient and doctor use any one of many apps and tools to have a video conference via smartphone, tablet or desktop computer. Patients who don’t have access to that technology or don’t know how to use it can have a verbal conversation via telephone.
The doctor can visually examine a rash or swelling or other physical conditions through the video link and can evaluate the patient’s overall appearance and demeanor. If no further treatment is needed, this is a great time saver for patients who need not take a half-day off from work or cut into their home responsibilities to drive to the doctor’s office.
While a portion of the population was carrying around the COVID-19 virus in their bodies, telemedicine eliminated the possibility of a healthy patient contracting the virus at the medical facility or a sick patient infecting others at the facility.
Before the pandemic, several factors held telemedicine back including reluctance by patients and doctors alike to dive in, regulations that vary at state and federal levels, technology gaps that limit video conferencing in rural areas and income shortfalls among the poor that limit access to technology.
Numerous emergency waivers granted nationwide during the COVID-19 pandemic have helped telemedicine usage soar this year, and many providers hope the changes will become permanent.
Some steps are being taken in this direction, including:
- Broadband internet access has proved critical for distancing during the pandemic, and funding for expanded access for more Americans is on some legislators’ priority list for economic stimulus spending.
- Federal telehealth funding is coming to hospitals through a previous stimulus package via the Federal Communications Commission; U.S. Rep. Paul Tonko, D-Amsterdam, announced $61,515 for Saratoga Hospital late last month and $131,261 for Ellis Hospital last week.
- Gov. Andrew Cuomo on Wednesday signed into law an expansion of Medicaid and CHIP coverage of telemedicine services.
UCM Digital Health is a young company that was positioning itself to ride the surge of telemedicine usage that it thought was inevitable.
“We were built to scale up. We never thought we would have to do so quickly,” president Keith Algozzine said.
“We knew this was coming. What we thought might have taken three years took three months for us. Everything got pushed up dramatically, all those timelines got pushed up.
“We actually hired 25 emergency medicine clinicians over the course of two and a half weeks,” he said.
Telemedicine providers have found that people who’ve used the remote services like them and would continue to use them, but those who’ve never tried them are reluctant to do so for the first time, skeptical that a smartphone chat can be as effective as an in-person visit.
CDPHP spokeswoman Ali Skinner said many, many people were forced by circumstance to make that first visit this spring.
“The peak, the first weeks of May, we averaged over 4,000 a day,” she said. “It was a huge tipping point. I think it got a lot of people over that hump.”
CDPHP’s goal now is to keep its members from reverting to the old, expensive habits of going to emergency rooms or urgent care when they don’t need to.
“We’re really hoping people continue using telemedicine,” Skinner said.
There’s also been a big spike in telemedicine use for substance abuse and mental health issues, she said, rising from an average of 16 visits to 120 a day. The immediacy of a video chat can be critical for these groups of patients when they are descending into a crisis.
“The fact that they’re able to get help instantly is a really good thing,” she said.
Christopher Del Vecchio, CEO of MVP, said telemedicine has been an evolutionary process for the insurer. It debuted a traditional outpatient service in January 2017 and added remote mental health care in 2018.
The evolution was kicked into high gear in March, when MVP moved almost all its employees to remote working in five days and its members ratcheted up their use of telemedicine.
Telehealth visits were 15 times higher in March than they were in February, 130 times higher in April and 153 times higher in May.
It was, Del Vecchio said, five or six years of market progress in eight weeks.
Surveys indicate a very high level of member satisfaction and suggest repeat usage is likely, he added.
Ellis Medicine’s introduction to telemedicine was a rush project during the greatest public health crisis in living memory. Ellis Hospital was barred by the state from doing a lot of its normal work so as to reserve space and resources for COVID patients; simultaneously, hospital officials and the general public alike were both trying to avoid all non-urgent visits.
So a lot of health problems would be treated remotely or not at all.
Colleen Hammond, operations manager for primary care, said Ellis quickly devised a telemedicine program and rolled it out in the fourth week of March, as the COVID crisis was building to a peak in New York state.
It was built around the Zoom videoconferencing service and did not require much in the way of new equipment. Ellis has made extensive use of that first system and more recently the Mend telemedicine platform, Hammond said, with more than 12,000 patient encounters so far.
The rollout has broken a stereotype some might have guessed would present itself — that older patients would be intimidated by the technology and avoid telemedicine. In fact, Hammond said, the elderly have been highly isolated for three months as a precaution and welcome the interaction. Some telemedicine patients have even been in their 90s.
The technology becomes another tool available to Ellis.
“Physicals and things like that can’t be done. But those are not usually not urgent appointments,” Hammond said. “It’s been a crutch in this time but going forward, patients like that convenience.”
Tonko and Del Vecchio both said telemedicine helped beat back the pandemic: It allowed COVID patients with milder symptoms to quarantine at home, and be monitored there without venturing out, where they might infect other people.
Future public health crises are just one of the ways the technology will prove valuable, advocates say.
Algozzine said the technology will evolve as popularity spikes interest in improving the practice and providing the resources to do it.
“Believe it or not, the telehealth today that most people see is almost outdated, in our mind,” he said. It’s a bit less expensive and more accessible that traditional office visits but still the same general concept: addressing immediate patient needs.
“The future is really much broader, it’s digital health, it’s not just a video conference with a doctor. How do you create a world where most health care starts digitally? How can we make that a seamless patient experience that drives value for the whole medical group?”
Del Vecchio and Hammond both noted the convenience factor. To take 10 minutes in a break room at work for a quick consult with a doctor about a nagging problem is far more appealing than driving to that doctor’s office, waiting, being seen, and driving back.
Usage remains high even as the pandemic eases, Del Vecchio said. “A lot of it has to do with time and convenience. I think that’s appealing to people in today’s society.”
Correction 6/22 1:21 p.m.: A previous version of this story misspelled the name of UCM Digital Health President Keith Algozzine and incorrectly identified the company by an earlier name, as well as his title.