Seeing a doctor became much easier in the pandemic for many people who avoided travel time, office waits and the risk of exposure to COVID-19 by attending appointments through their home computer or by phone.
Physicians and other health care professionals who used telemedicine in the past year, many for the first time, discovered that it helped them assess patients.
While it doesn’t work in all cases, the option is one that many clinicians are confident will remain after the pandemic ends, assuming health insurers don’t lower reimbursement rates for the service.
Under a state executive order, telemedicine, or telehealth, has been offered for the past year at the same cost as traditional office visits, and physicians were allowed to bill at a comparable rate.
Some state legislators want to expand telemedicine permanently. A bill that would extend the executive order into law is under review in the General Assembly.
Many of the Rhode Island-based physicians, therapists and counselors who have used telemedicine see the advantages of continuing it, for patients and practices.
Brown Emergency Medicine launched its telemedicine program, called Telecare, in July. It offers virtual visits for patients seven days a week, from noon to midnight, according to Dr. Jeremiah “Jay” Schuur, president of Brown Emergency Medicine, an academic physician practice of the Department of Emergency Medicine at Brown University’s Warren Alpert Medical School. The practice is also affiliated with Lifespan Corp. hospitals.
‘The typical doctor visit can take up to two hours, ... traveling and filling out forms.’
DR. JAMES SULLIVAN, Butler Hospital chief medical officer and Women & Infants Hospital chief of psychiatry
After a slow start, patients started booking more frequently in the fall, said Schuur, who is also physician-in-chief of emergency medicine at Lifespan.
“We thought it would serve two purposes. First, we were seeing patients who didn’t come to the hospital because they were concerned about potentially contracting COVID,” Schuur said. “[And] it continues to offer the convenience of a virtual visit.”
In emergency medicine, telemedicine works well for problems such as wounds that a physician can use a camera to examine. It also can be used for the evaluation of symptoms associated with COVID-19 or chronic illnesses.
Erin Cooney, a patient at Thundermist Health Center in West Warwick, credited telemedicine with saving her life.
A barber, Cooney fell while working on converting a bus into a mobile salon. Initially, she thought she had pinched a nerve because of tingling in her hands and pain in her upper back.
Over several weeks, her symptoms grew more severe. During a videoconference appointment, Cooney described her symptoms as her doctor looked at an X-ray she had taken the day before. When Cooney told the doctor she no longer had bladder control, she was told to go to the hospital immediately.
Cooney had broken a piece of vertebrae in her neck. Surgeons installed “a titanium plate, three screws and two cages in my neck,” she said.
“[The doctor] was able to spend the time with me that I needed,” Cooney said of that initial virtual appointment. “The quality of our conversation was almost better because there were no distractions.”
Dr. James Sullivan, a psychiatrist who is chief medical officer at Butler Hospital and chief of psychiatry at Women & Infants Hospital, said that at the start of the pandemic, people with psychiatric disorders did not want to go to appointments for fear of contracting COVID-19.
Initially, telemedicine was a safe option. Over time, Sullivan said he realized more people were seeking help because of telehealth’s ease. “The typical doctor visit can take up to two hours, much of that traveling and filling out forms and much less time with the provider themselves,” he said.
Alana DiMario, a licensed mental health counselor who specializes in working with new mothers, said the ease of telemedicine made it a good option for many of her clients.
“It can be a challenge for a mom to make an appointment outside of the house every week,” DiMario said.
DiMario found it easy to make the transition herself, particularly if her patient was someone that she already knew. “It was more difficult with the new people, meeting them for the first time by video,” said DiMario. “It’s a little harder because you have those micro-second delays that sometimes mean a joke, or a sense of humor, doesn’t quite land the same way.”
Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and director of its partial hospital, which features group therapy, said the initial turn to virtual meetings required a lot of time as staff worked with patients to make sure they could access the videoconferencing platform.
The hospital tracked the experiences of 25 patients who previously had in-person visits and then turned to online programs. Over seven months, there was a 90% satisfaction rate, he said.
Many people reported they felt more confident in speaking in the digital therapy sessions, he said.
For it to continue, the state will need to ensure that the telemedicine sessions are appropriately reimbursed by health insurers. “From the provider perspective, it is more costly to deliver telehealth treatment than in-person treatment,” Zimmerman said.
Mary MacDonald is a PBN staff writer. Contact her at Macdonald@PBN.com.
