At her son’s medical checkup last week, Nicole Gantz told the doctor she’s trying to toilet train 8-year-old Joshua, who has Down syndrome and attention disorder, while his school is closed because of COVID-19.
“Sometimes having concentrated time at home ends up being in your favor,” said Dr. Maria Stanley, his developmental behavioral pediatrician at UW-Madison’s Waisman Center, who prescribed a medication to help Joshua focus.
The visit took place by video, reducing potential spread of the coronavirus and sparing Gantz a 180-mile round trip from Dubuque, Iowa, where she and her husband are raising three young children.
“It was awesome,” Gantz said. “It saves us from having to take time off work and having to travel.”
Telehealth, used in a few health care situations during the past 10 to 15 years, has suddenly become a mainstay of everyday medicine. In response to the COVID-19 pandemic, the federal government last month eased rules on telehealth and boosted payments for it. That led many private insurers to follow suit and most providers to join in, including hospitals and clinics in Madison.
“In this pandemic, we really want to put as much space as possible between our providers and our patients,” said Dr. Tom Brazelton, medical director for telehealth at UW Health. “With COVID-19, the silver lining is that it’s really allowed the jump-starting of telemedicine.”
Even if rules are tightened again once the outbreak dies down, some expansion of telehealth appears here to stay, said Dr. Larry Elfman, chief medical information officer in Wisconsin for SSM Health. Much of it is aided by software from Verona-based Epic Systems Corp., which is seeing a big increase in telehealth among customers nationwide.
“This is a genie that’s going to be hard to put all the way back into the bottle,” said Elfman, who estimated 40% of outpatient visits at St. Mary’s Hospital and Dean Medical Group are now done by video or phone, compared to less than 1% before COVID-19.
Wisconsin on Saturday reported 331 new cases of COVID-19, the largest single-day increase since the outbreak began, for a total of 5,687, including 266 deaths. Dane County reported two new cases, for a total of 401 and 21 deaths. Brown County reported a significant spike Saturday: 115 more positive COVID-19 cases, for a total of 720.
Until recently, telehealth in the Madison area was mostly limited to online visits for urgent care — sometimes called virtual visits or e-visits — and specialty doctors examining patients and consulting with providers in rural settings.
With online visits, patients fill out a questionnaire for basic problems like rashes or respiratory ailments, and providers respond by computer or phone, prescribing medication if appropriate. Sometimes video is used.
For several years, cardiologists, infectious disease doctors and other specialists in Madison have used video to examine patients at rural clinics or hospitals. UW Health has two programs — telestroke and eICU, or electronic intensive care unit — in which Madison specialists routinely provide such service for smaller hospitals. Through a state contract, UW Health also does video visits with inmates at more than two dozen correctional facilities.
On March 17, the federal Centers for Medicare and Medicaid Services made payments for telehealth video visits the same as in-person visits, up from less than half that amount before, and added some payment for phone visits during the COVID-19 emergency. The agency stopped limiting telehealth payments to patients in remote areas or for short checkups, and allowed doctors to do telehealth while patients are at their homes.
The Trump administration also said it would stop enforcing parts of a health privacy law called HIPAA in regulating telehealth during the COVID-19 emergency, removing another barrier that had kept some providers from expanding the service.
Now, telehealth is transforming inpatient and outpatient care.
At UnityPoint Health-Meriter, doctors known as hospitalists are using telehealth carts and digital stethoscopes to check on hospitalized patients by video, relying on nurses already in patient rooms to assist. The goal is to preserve protective equipment and minimize potential COVID-19 exposure, said Dr. Cate Ranheim, a Meriter hospitalist and inpatient medical director for Iowa-based UnityPoint Health.
“You can listen to the patient’s heart and lungs,” Ranheim said, but to do something more complex, such as assess abdominal pain, an in-person exam is typically needed.
Since early April, many clinic visits at Meriter have been conducted by video or phone, with some appointments becoming a blend of virtual and in-person, said Dr. Wendy Mortimore, a primary care doctor at Meriter and chief medical information officer for UnityPoint Health.
A couple of Meriter pediatricians have done visits for earaches mostly by telehealth but then asked parents to bring the children to a clinic parking lot to be sure they had infections requiring antibiotics before prescribing the drugs. “The doc has come out with an otoscope really quick and looked at their ear from the car,” Mortimore said.
Peter Felknor, 63, of Deerfield, woke up one morning in late March with tingling in his mouth and a swollen lip that he said “looked like a flat tire.”
He drove to the SSM Health Emergency Center in Sun Prairie, where a doctor gave him steroids for a possible reaction to a blood pressure drug. That afternoon, Felknor had a follow-up visit via telehealth with his regular provider, Dr. Albert Musa.
By seeing Felknor and viewing photos he sent from when his face was still swollen, Musa agreed the problem was likely a reaction to the drug and switched him to another blood pressure medication.
Telehealth is “a very pragmatic way to further care,” Musa said, adding that many of his patients who are elderly like it.
“For the purposes of what we were trying to get accomplished, it worked really well,” Felknor said. “He didn’t really need to see me, and there would have been more risk involved if he had.”
Even addiction treatment is embracing telehealth during COVID-19. Wisconsin has relaxed its rules on how often patients must come to clinics to get daily methadone treatment during the emergency.
At Addiction Services and Pharmacotherapy in Madison, that means some patients who used to have to visit the clinic daily are now coming once a week, said Dr. Christopher Harkin, a provider at the clinic. Required counseling is mostly being done by phone, instead of in person, Harkin said.
“We’re trying very hard to contact each patient on a daily basis as a check-in to make sure they are safe and well,” he said.
Here to stay?
At UW Health, video visits for urgent care started two years ago and expanded last month with COVID-19, Brazelton said.
In recent weeks, dermatology, oncology, transplant and other clinics started offering video visits, with more types of care expected to follow, he said. At least half of UW Health’s 35,000 outpatient visits per week could be done by telehealth, he said.
Inside UW Hospital, provider teams, including pharmacists, nutritionists, chaplains and others, are “virtually rounding” with patients so they don’t have to enter their rooms, thanks to technology set up this month.
“It’s been a whirlwind,” Brazelton said. “We’ve done in five weeks with telehealth what we hadn’t been able to do in five years.”
There are limits to telehealth, said Elfman, of SSM Health. “If you think your leg might be broken and you can’t stand, you need to come in and be evaluated,” he said.
But many patients and providers like the convenience and believe the care is just as good, said Mortimore, of Meriter. If the government or insurers try to reduce telehealth payments after the COVID-19 emergency, leading to fewer offerings, she expects patients will speak out.
“They’ll be asking and demanding that their insurance companies continue to pay for these services,” she said. “This may revolutionize how health care is delivered across the country.”
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