Telehealth and Remote Care - Evolving in the Age of COVID-19

Most hospitals and physician offices have changed their normal protocols and practices to prepare for and handle challenges associated with COVID-19. For many, this has resulted in postponing routine care visits and elective procedures, limiting the number of individuals in waiting rooms, and engaging in pre-screening of patients before they enter facilities.¹

A primary goal of these measures is to support social distancing efforts and to lessen the spread of the virus. But for a number of patients, such as those with chronic illnesses (diabetes, heart disease, etc.), the need to be seen by a physician cannot wait until a cure for the virus is found. 

For the purposes of this article we are defining “telehealth” as the use of technology and tools that allow clinicians to interact, diagnose, or provide care for patients virtually. 'Telemedicine' typically involves audio and video conferencing with a physician or therapist, in real time. Remote care may not involve a telephone or video conference, but rather, a mobile phone app or device that sends information directly to your doctor. You may have heard of, or have already used, one of these options yourself. Great! Here is some more information you may like to know.

The most recent concerns of COVID-19 have increased the awareness of telehealth, but it has been used for years.² In fact, 48 states in the US and the District of Columbia provide some level of Medicaid reimbursement for telemedicine. 39 states also have some form of Medicaid coverage and reimbursement for telemental health services.³

Recently the Centers for Medicare and Medicaid Services (CMS) have lifted restrictions related to telemedicine, so more healthcare providers can use this important tool to care for their patients during the pandemic.⁴ Some of the changes include expanding Medicare telehealth services to include physical therapy, speech language pathology, and counseling. The move also now allows payment for services that are audio-only telephone appointments, in addition to the previously approved video-conferencing services.⁴

1. Rural health

Approximately 1 in 5 people in the United States live in rural areas and thus have increased barriers to receiving specialized care.⁵ Some of the challenges in rural areas are travel costs for patients, limited medical facilities, and recruiting and retaining necessary medical personnel (who may prefer to live in urban, higher paying areas).^5-7 Telehealth options are effective solutions to these problems. For example, the Alaska Tribal Health System (ATHS) has provided telehealth services across remote areas in Alaska for over 20 years. According to one study, prior to the introduction of telemedicine for ear, nose, and throat (ENT) and audiology services, 47 percent of new patients would be forced to wait 5 months or more to be seen in-person. Since the implementation of remote services, this has drastically decreased down to 8 percent.⁶ ATHS has also reported that utilizing telemedicine services has opened up availability for in-person appoints, reduced patient wait times, and resulted in approximately $8 to $10 million of patient travel cost savings.⁶  

Start Moving Start Living also offers great information for people living in rural areas. For more information, click here.

2. Chronic disease management

There are many chronic illnesses such as diabetes, cardiovascular disease, arthritis, etc. that require frequent medical appointments to monitor and manage the disease. The use of telehealth increases access to specialists for people with these conditions and has been shown to be effective in their treatments. For example, the Veterans Health Administration’s expansion of telehealth has reduced hospitalizations of patients with chronic conditions by 40 percent.⁷  

Another study that used telehealth to link hospitals and a federally qualified health center (FQHC) found that the telehealth program increased the number of diabetics who brought their blood sugar under control.⁷  A study that examined telemedicine between 2014 to 2016 found over 90 percent of telehealth services were provided to beneficiaries with one of 17 common chronic conditions, such as heart failure, diabetes, or depression.⁷  

For the treatment of neurological disorders such as stroke, telehealth has shown certain forms of treatment to be as effective when delivered via telemedicine as they are from in-clinic programs.¹⁰  And, the number of patients receiving such care is increasing. While stroke affects less than 10 percent of Medicare telehealth patients, between 2014 and 2016 there was an increase of 113 percent in the use of telehealth services among Medicare beneficiaries with stroke diagnoses.⁷ Others have noted that neurological care may be done through video conferencing with similar outcomes to in-office care and increased efficiency.¹⁰

3. Mental health

Right now, there’s an increased awareness of the impact mental health plays in our society. According to the CDC about 1 in 5 Americans aged 18 or older have dealt with a mental illness within the previous year. These numbers are similar for children, as just over 20 percent have had a serious debilitating mental disorder.⁸ The prevalence of disorders like anxiety, depression, dementia, and bipolar disorder have wide-sweeping economic and physical health consequences. An approximate $193.2 billion dollars in lost earnings is attributed to serious mental illness each year.⁸ And those living with serious mental illness have a greater risk of heart disease, diabetes, and other health problems.⁸

Telehealth offers the opportunity to connect individuals in need with licensed mental health professionals. Across a variety of conditions, telemental health has been shown to lead to high patient and provider satisfaction and often has achieved health outcomes equal to those getting in-person care.⁹ One program noted that patients are 2.5 times more likely to keep their remote telepsychiatry appointments than in-person psychiatry appointments.⁶

4. At-home (remote) care

If for no other reason, the simple fact that telehealth options can be enjoyed in the comfort of your own home, make it appealing for some. Not only can you talk to your doctor and their staff, but they may also be able to provide options for you to continue progressing your care remotely. Depending on your condition, there might be apps or programs that you could use to track your progress, provide exercise tutorials, send you reminders, and then send all that information straight to your doctor as well. 

1. Castellucci, M. and Meyer, H. (2020, Mar 17). Physician practices modify operations to cope with COVID-19. Modern Healthcare.  www.modernhealthcare.com/physicians/physician-practices-modify-operations-cope-covid-19
2. Nesbitt, TS. (2012, Nov 20). The Evolution of Telehealth: Where Have We Been and Where Are We Going? National Academy of Sciences. www.ncbi.nlm.nih.gov/books/NBK207141/
3. Rural Health Policy Brief: Providing Access to Mental Health Services for Children in Rural Areas (2018, May 11). Centers for Disease Control and Prevention.  https://stacks.cdc.gov/view/cdc/59696
4. Press release Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic (2020, Apr 30). Centers for Medicare and Medicaid Services. www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid
5. Xu, T., et al. (2018, Jan 25). Telemedicine in the Management of Type 1 Diabetes. Centers for Disease Control and Prevention. www.cdc.gov/pcd/issues/2018/17_0168.htm
6. Hays, H., et al. (14, Dec). The Success of Telehealth Care in the Indian Health Service. American Medical Association Journal of Ethics. 16(12): 986-996. https://journalofethics.ama-assn.org/article/success-telehealth-care-indian-health-service/2014-12
7. Information on Medicare Telehealth (2018, Nov 15). Centers for Medicaid and Medicare Services. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Information-on-Medicare-Telehealth-Report.pdf
8. Learn About Mental Health - Mental Health – CDC (2018, Jan 26). Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/learn/index.htm
9. Yellowlees, P. (n.d.). Telemental Health – Convenient, Effective and Here to Stay. Anxiety and Depression Association of America. https://adaa.org/learn-from-us/from-the-experts/blog-posts/professional/telemental-health-convenient-effective-and
10. Bloem, BR., et al. (2020, Apr 24). The Coronavirus Disease 2019 Crisis as Catalyst for Telemedicine for Chronic Neurological Disorders. Jama Network.  https://jamanetwork.com/journals/jamaneurology/fullarticle/2765073

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