The explosion of telehealth services since the beginning of the COVID-19 pandemic has been key to the effort to reduce the spread of the virus. Many clinics began offering telephone and video visits with a variety of health care professionals for outpatient care.
Last March, fear kept patients from coming into the Rainy Lake Medical Center (RLMC) in International Falls according to Mickie Olson, director of marketing for RLMC. The clinic responded by utilizing telehealth to provide safer care by reducing in-person contact and limiting exposure to COVID-19. They also extended hours and added acute care visits via video.
“People were scared, and we knew we had to have a better option with less contact, so our team did the research to make sure we had an appropriate platform, and then we started promoting it,” said Olson.
Telehealth, also sometimes called telemedicine, is medical care provided remotely to a patient in a separate location, usually via phone or video. The U.S. Health and Human Services recommends it as a great way to get necessary health care while practicing social distancing.
The technology does come with a learning curve.
Koochiching County, where International Falls is located, has one of the oldest populations in the state, with 50 percent of its population over the age of 50. That, Olson says, created an additional challenge as patients grappled with technology.
“We quickly had to refine our system for an older population that may not be tech savvy, so that all they would have to do is go to our website and click,” Olson said.
Now, according to Olson, many consumers, especially busy families, are requesting the convenience that telehealth visits provide for acute care.
“I think we are forever changed. I don’t see us taking this service back when, for some, it’s been a blessing in disguise. This will be an option going forward,” she said.
In March of 2020 the Center for Medicare and Medicaid Services (CMS) issued waivers allowing greater telehealth flexibility. Over 80 new telehealth services were added for reimbursement, types of eligible providers were expanded, and coverage for telephone visits was approved.
Since then, the regulations governing and reimbursements for telehealth services has been updated multiple times. At this point, CMS is beginning to make decisions about what services will go on after the current crisis ends, and which services will most likely be temporary. By all indications, any health services over just audio, or telephone, appear to be temporary.
Greg Ruberg, CEO/president for Lake View Hospital and Clinics in Two Harbors says that a shift to remote treatment has had a powerful impact for those needing assistance with their mental health.
“For mental health, this has been a game changer. For practitioners, this is such an effective model. And for the patient who connects from home, there is less stigma. This has been so well received by patients and providers, I don’t ever see us going back to a majority of in-person mental health visits,” said Ruberg.
Expanding telehealth was already a goal before the pandemic forced limits on health care visits, but it was fraught with challenges. Primary among them, Ruberg said, was the frustration that went along with unreliable connections.
“Since then, we’ve put in a lot of time, resources and money into a reliable platform, and now it feels like a real clinic visit, except patients are not spending more time on the road than at their appointment,” he said.
Privacy regulations around telehealth pre-pandemic were difficult to navigate, but the overwhelming need to adapt during the crisis has pushed those to open up. Healthcare systems moved quickly to implement HIPPA compliant internet platforms with adequate privacy-preserving security.
“Telephone visits qualify for reimbursement now, and that will probably go away, but I don’t see them putting the genie back in the bottle on virtual visits,” Ruberg stated.
Wilderness Health, a collaborative of 10 independent health care systems located throughout Minnesota’s Arrowhead, the Iron Range, Duluth and south to Cloquet, received a $771,000 federal HRSA grant in 2020, intended to build more robust telehealth capacity and infrastructure for mental health in the region. Just in its early stages, a program manager based out of Lake View has been hired.
The addition of equipment and training resources is anticipated to help patients in remote areas access mental health care with less travel, as well as expand appointment opportunities in locations where patients have had to wait for several months to see a provider.
For providers, improvements will give primary care doctors better connectivity to specialists for treatment consults and medication management assistance.
At the pilot location in Two Harbors, the task at hand is to look at all the platforms in use across Wilderness Health facilities and to develop a model that can be used effectively throughout, even supporting area hospitals that do not have clinics attached.
Psychiatrist Dr. Steven Bauer has been working through telemedicine venues for about 15 years, starting at Sawtooth Clinic in Grand Marais.
A serious dearth of psychiatric providers had Bauer driving to Grand Marais from Duluth once a month. An obvious need for more consultation between visits, and more patients than he could see in person, motivated the addition of virtual visits.
Prior to the pandemic, Bauer says that the biggest challenge of virtual mental health appointments was that they required staff on-site to room people and connect them to the appointment. Now, the expansion of telehealth services during the pandemic allows the flexibility of “meeting” with patients wherever they are, only requiring a smartphone for the patient.
Bauer says another strength of telemedicine is his consultation with primary care doctors, which has grown stronger during the pandemic.
“Some providers preferred to meet in person. Now everybody’s gotten way more comfortable with video calls, and it’s a good way to save on drive time,” Bauer said.
On the Iron Range, difficulty with transportation was identified pre-pandemic as a top healthcare need in rural communities. The pandemic served to further highlight the need for remote care, said Heidi Lahti, vice president of Ambulatory Services, Fairview Range Health Services, Hibbing.
Fairview Range already had e-visits in its repertoire pre-pandemic, and saw them skyrocket from around 30 visits per month to over 100 visits monthly. E-visits are those with patients in a clinic but connected to a specialist via video. These use the clinic video hook-up, and connect the patient to a specialist at another location.
During the pandemic, Fairview Range implemented a second kind of virtual video visit in its telemedicine repertoire. These video calls happen between provider and patient and can originate anywhere; both the provider and the patient can be off-site and connect via phone, iPad, or laptop. These visits started in March 2020 and quickly shot up to 100 per month. Virtual clinic visits via video, with the patient and the clinician potentially in any location, were started at Fairview Range in March 2020, shooting up to over 100 visits a month.
Lahti says the sudden shift to relying primarily on medicine-from-a-distance had great challenges, and in the case of video visits required intense training of support staff who then guided patients through training about the process.
“We also had to help our providers and patients get comfortable with the technology. Definitely – learning technology was the biggest challenge,” said Lahti.
“It was difficult for health care providers to conceptualize how they could take care of a patient that was not in front of them, and the comfort level wasn’t there for patients either,” Lahti said.
Both providers and patients have developed a new level of comfort with virtual visits, she said.
While Lahti concedes that implementation was not smooth right out of the gate, the appointments improved rapidly and have become a venue that Fairview’s customers have made known that they want to stay.
“Now the majority of clinic visits are back in-person, but there is a great need for the virtual option, and we are going to keep it,” Lahti said.