Doctor visits online not expected to end following pandemic

Medicare, Medicaid rule changes have driven boom in telemedicine in older adult population

The coronavirus pandemic brought with it a boom of doing things virtually — education, work, happy hours and even routine doctors’ visits.

While some have returned to in-person school and work days, medical experts told the Dayton Daily News they expect telemedicine will stick around long after the pandemic ends.

Rules governing Medicare and Ohio’s Medicaid programs have been relaxed during the pandemic to give patients access to their doctors during the pandemic. Before COVID, the way telemedicine could be used was extremely restrictive, said Dr. Dale Block, the market chief medical officer for Ohio for CareSource.

The option for using telehealth is now open for everything from physical therapists to mental health providers to optometrists, Block said.

Block said both Medicare and Medicaid will continue to give telehealth options permanently.

“Without a doubt, telemedicine will continue to be used,” Block said.

Prior to the COVID-19 outbreak, about 13,000 Medicare-eligible adults – those 65 or older, or younger adults with certain conditions – received telemedicine services during an average week. In the last week of April 2020, that number had jumped to 1.7 million nationally, according to research published in the Public Affairs Journal.

Block said telehealth has improved continuity of care, improved delays in care and helps patients and their families feel more empowered.

According to a University of Michigan survey, 26% of people from 50 to 80 years old reported using telehealth since the pandemic started. Four percent of that group had used telehealth in all of 2019, the study found.

Dr. Catherine Kiley, who works for Premier Health, said she thinks telemedicine can help all sorts of people, especially older adults. Telehealth can be especially helpful for monitoring chronic illnesses or going over test results, she said.

“There’s a lot just looking at someone, I can tell. There is so much observational medicine that can go on during a telemedicine visit,” Kiley said. “The biggest part of medicine is taking a good history and observing what is going on.”

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Credit: Chris Stewart

Credit: Chris Stewart

Most of the older patients Kiley sees are in-person and she said many of these appointments are monitoring chronic illnesses, which could be done via telehealth. Those patients would still need to go out to get various tests done, but if they’re homebound, someone comes to them to take their tests anyway, she said.

This is different from 15 years ago, Kiley said, where people waited until they got sick to go to the doctor.

“A patient population like mine would be better served by telehealth, especially in this winter weather,” Kiley said.

Kiley said she walked into her office Tuesday morning after all of the snow the region got and her first patient was an 88-year-old man who had driven there himself.

“The side roads were terrible. He doesn’t have four wheel drive,” Kiley said. “I was worried about him going home.”

Improving telehealth

Kiley, who mainly sees adults over 65, said some of her patients over the age of 80 have a lot of difficulty with telehealth virtual appointments.

“This is an area where we need to figure out how to put these tools into the hands of our older population to help them do telemedicine,” Kiley said.

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She suggested that patients who already have a home health aide could use that person to help them get set up with their telehealth visit or teach them how to do it. Block, with CareSource, said this could also mean family members help that patient get the telehealth portal set up or doctors do a “dry run” with patients when they’re physically in the office with them.

Kiley said telemedicine visits can also have a social component to them.

“I have had very good telemedicine interactions,” she said. “And it’s great right now because I can actually see them (without a mask, face shield or googles on) and we can interact better.”

Kiley said for these older patients, telehealth makes access to doctors easier because they don’t have to worry about getting their walker or finding transportation to get to the office. These aspects also are reasons telehealth can be beneficial for working people, developmentally disable children and other patient populations. Block said he thinks the “sweet spot” would be 25% to 30% of one’s care being virtual in the future.

“It’s getting the mindset changed. Think of how much time you’re saving. You don’t have to take time off to drive there, drive back,” Kiley said. “I think telemedicine is a way to have physician or provider visits for any population.”

Block said telehealth, in the near future, will lend itself to more remote patient monitoring with smart technology, like vital signs or blood pressure or diabetes. This could alert the patient to contact their medical provider earlier when there is a problem.

“It can help your physician give you better care,” Block said. “Technology will play a really important role going forward.”

Both Kiley and Block said although telemedicine is an extremely useful tool, it can’t replace all in-person medicine. Kiley said acute care is one area that telehealth can’t serve very well.

“Until the technology is really really good, nothing substitutes from laying your hands on your patient while you’re doing the physical,” Block said.

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