Virtual Health Care

When society shut down last March, many people turned to telehealth, often for the first time, to connect with medical professionals. 

Instead of traditional in-office visits, patients and physicians consulted via laptops, tablets and phones. 

Although it’s been around for decades, telehealth came of age in 2020, according to data from IQVIA, a human data science company, which tracks the impact.

The numbers offer a telling story: During the last week of March 2020, the number of telehealth visits skyrocketed by 154 percent compared to the same time period in 2019, according to the CDC. 

Even more striking: About 60 to 90 percent of physicians are now using some sort of telehealth services, according to the American Medical Association.

And the trend is expected to continue.

Prior to the coronavirus pandemic, many insurance providers, like Aetna and Florida Blue, offered telephone and video health visits as a benefit. But when the coronavirus public health emergency was declared at the end of January 2020, Medicare expanded its coverage for telehealth, and health care providers did the same.

The number of insurance claims for televisits soared with the pandemic, says Christopher Ciano, president of Medicare for Aetna, a CVS Health company. While he couldn’t speak specifically to the number of claims, Ciano, who is based in Miami, said COVID-19 significantly accelerated the timeline for telehealth usage. 

“For example, in May, clinicians were already seeing 50 to 175 times the number of patients via telehealth than they did pre-pandemic,” Ciano reports. “According to a survey from Deloitte (a British multinational professional services network), more Medicare Advantage members said they used telehealth or virtual health through the first four months of 2020 than during all of 2019.”

In response to the pandemic, Aetna extended waivers for Medicare Advantage member co-pays for in-network primary visits, whether done in-office or via telehealth, and telehealth visits for in-network specialists, through Jan. 31, 2021. Specialist visits include mental and behavioral health providers. 

This year, all Aetna Medicare Advantage plans will offer virtual primary and urgent care visits to help members access care, including after hours or weekend care and prescription refills, Ciano explained. Select plans will also cover virtual mental and behavioral health visits.

“It’s convenient” 

With the reopening of doctors’ offices, the number of telehealth visits dropped, but the trend appears to have a healthy future.

And that’s welcome news for Sara Greene, coordinator for the Department of Biomedical Science at the Charles E. Schmidt College of Medicine at Florida Atlantic University. The Boca Raton mother of three says she’s made the most of telehealth visits last year, not only for herself, but for her children as well – and she is a fan.

After hip surgery, she used telehealth for follow-up visits with her surgeon and for appointments with her physical therapist. During a televisit with her dermatologist to discuss a rash, the doctor instructed Greene to turn the camera around so she could see the rash. Then the dermatologist directed Greene to go to her medicine cabinet to see what creams she might have that could treat it. “She said ‘use that one,’” Greene remembers. “It was simple.” 

When her son suffered from stomach pains, his gastroenterologist, via a televisit, used Greene as an assistant. “He said ‘tap here, tap there’ and gauged my son’s reactions to determine what he felt was the problem.” 

Greene appreciates how doctoring this way results in both time and cost savings for her. “I didn’t have to take time off work to drive to an appointment, then wait in the office; and my insurance covers copays for telehealth,” she says. “It’s convenient.” 

Medical experts agree there are definite advantages to telemedicine, but emphasize that online or over-the-phone appointments don’t work for all ailments or all patients.

Dr. Leonard Berkowitz, director of FAU Medicine Primary Care, says patients seem to really like telehealth visits for diagnosing and treating nonemergency conditions. The practice has been offering online visits since March but maintained office visits for patients with conditions that would be difficult to manage with virtual care. 

“I think it’s particularly helpful for patients during times like this where they are staying home and being safe,” he says. “We’re able to help manage their care without them leaving the house. Whether it be discussing medications, discussing results, things along those lines that do not necessarily require that you come into the office, televisits have been good. It helps for patients with transportation problems, patients who don’t drive anymore. This offers a service for them that that could be very helpful.”

The virtual visits are generally on time, Dr. Berkowitz adds, so patients don’t have long waits.

“We tend to do very well in general with regard to time because we understand our patients’ time is important,” he explains. “With televisits, we run pretty much on time and we’ve gotten pretty adept at it. Our staff usually makes sure that the pieces are in place for us to be starting on time. They assure the patient has the link to the televisit, etc., so that when I get on the call it usually runs very smoothly.”

But televisits are not a substitute for in-person visits. Dr. Berkowitz explains, “I can’t listen to heart sounds over the phone. I can’t listen to breath sounds over the phone. There are certain things that really do require in-person visits for better care and we do our best to try and bring those patients to us for in-person visits when televisits would not quite be as effective.” 

Mental health is a large part of primary care, in general, according to Dr. Berkowitz. “Obviously, with the pandemic, it has really come to the forefront and is a large issue. So, not only can we help in treatment, but we can make a referral if necessary to mental health professionals and others who might be able to help our patients.” 

Psychotherapist Mya Breman, an Ocean Ridge resident who has an office in Palm Beach Gardens, treats clients worldwide. A licensed clinical social worker, Breman has been using telephone psychotherapy sessions for many years and had added video sessions prior to the pandemic. Throughout the pandemic, her patients have spoken about the anger, fear, anxiety and grief it has generated. Some clients, she adds, prefer televisits and some insist on phone sessions as opposed to FaceTime. 

“I think they feel less embarrassed because they’re not having to look you in the eye,” she explained, especially for those who are suffering from OCD or sexual issues. “Some people are very private about their personal life and they don’t want you to see their house is a mess or maybe they’re in their pajamas or in bed. They prefer the phone.”

On the other hand, Breman mentioned a client in California who prefers face-to-face online sessions. “She thought it was more important to connect that way,” says Breman. “Everybody’s different.”

Challenges For Those Who Aren’t Tech Savvy

Since the pandemic began, Robyn L. Wallace, a licensed psychologist based in Jupiter, has been doing more virtual visits with her clients, especially those who are older than 65 and/or have chronic medical problems that put them at higher risk for COVID-19. 

“Many of my clients are very happy with the virtual visits, as they would not otherwise have access to therapy during this stressful time due to their health risks,” Wallace notes. “The virtual visits are more convenient for some clients. However, one problem I have observed is that some of my older and less technologically savvy clients have difficulty managing the technology required for the virtual visits. And occasionally technology does not work properly (i.e. Wi-Fi goes down, computer crashes) thus impacting my ability to provide services to clients virtually.”

Wallace has mixed opinions about telehealth. “I like the expanded and more facile access to mental health services for my clients that are tech savvy,” she says. “I am very pleased that Medicare has begun reimbursing for virtual visits so that my elderly and often most needy clients now have the same access to mental health care that my private pay clients have enjoyed for years.”

However, confidentiality is a challenge with virtual visits, Wallace asserts. “As psychologists, we must use technology that protects the confidentiality of our sessions, which can sometimes be burdensome for the provider and client. Additionally, there have been occasions during the pandemic when my clients have had trouble finding a private place to participate in therapy. For example, I have had clients participate in therapy while sitting in their car because their home does not offer adequate privacy,” she explains. “I have not observed that my clients are more willing to discuss their concerns via virtual visits. Actually, it is my assessment that most of my clients prefer the quiet privacy of my office to discuss particularly distressing or disturbing problems.” 

Once the COVID risk has been mitigated, Wallace intends to continue seeing clients in her office with occasional virtual visits on an as needed basis, as she did prior to the pandemic. “Aside from my own observations and opinions, there are many other legal and ethical risks with virtual visits for psychologists, which are too detailed to go into for this forum,” Wallace says. “Our national and state professional associations have provided some initial guidance on these issues. However, these challenges will need to be addressed by our profession if virtual visits for mental health services continue to be covered by health insurance companies.” 

No matter what professional mental health associations decide regarding virtual visits, health experts are confident the future for telemedicine in general remains bright. 

Besides being helpful for many patients and medical professionals, the telehealth market is set to be valued at $175.5 billion by 2026, according to a report by Global Market Insights. Those numbers signal the need for telehealth today and for years to come.