Our COVID-19 crisis is greatly impacting all Americans, particularly our healthcare workers. We want quick answers to our COVID-19 questions. Primary care providers (PCP’s) are using telehealth to improve access, but are challenged to meet the surging demand. This crisis will be a catalyst to future expansion of telehealth services.
While sheltering in place, I decided to write this article about the COVID-19 crisis and expansion of telehealth services. I expect this will be the first in a series of articles about how this crisis is impacting our health system and all Americans.
American COVID-19 cases are increasing more rapidly than other countries (Country by Country graph). We will soon have more cases than China, Italy, or Spain. Our COVID-19 cases are growing exponentially, with New York State reporting nearly 50% of total cases (Source – Worldometer). During the past week, total US cases have increased from 6,400 to 54,800 (as of March 24th). Cases are doubling every 3 days!
Due to delays in testing, I believe we have significantly underreported our COVID-19 cases. New York has increased their testing from 1,000/day to 16,000/day. As other states ramp up their testing, I expect we will see their numbers grow exponentially.
During this crisis, telehealth can help us provide more convenient and safe health services. Providers face great risks in contracting coronavirus, due to exposure to undiagnosed patients. Telehealth enables providers to minimize contact with COVID-19 patients. On the other hand, patients want to avoid a clinic waiting room full of potential COVID-19 patients. Telehealth provides patient visits at home on their smart phone.
I reviewed health systems offering telehealth services in the SF Bay Area, Seattle Puget Sound, Milwaukee, and Philadelphia (all places where I have lived). Kaiser now provides more telehealth visits (through email, phone, and video visits) than in-person visits. Although Kaiser has a well-established telehealth program, their video visits represent a small percentage of total telehealth visits.
Americans want to know, “How can I quickly get answers to my COVID-19 questions?” These health systems offer on-line symptom checkers and/or provide a phone number for initial screening and recommended next steps. Telehealth visits may be scheduled or provided on-demand. Because of increased demand, consumers can expect delays in arranging virtual visits with longer than normal wait times.
Health systems are ramping up telehealth services as quickly as possible. A major barrier to expanding telehealth has been the limited payments. In response to this crisis, the federal government has passed emergency regulations to improve telehealth payment and licensure requirements for Medicare services.
Our limited primary care provider (PCP) staffing will be a major challenge. We have a shortage of PCP’s with many working part-time to improve their work-life balance. Many PCP’s are over-whelmed by current practice demands and will have difficulty adopting new technology during this crisis. Health systems are freeing up PCP time by deferring elective visits and closing some of their clinics.
Well-established telehealth programs, such as Kaiser, Providence, and Penn Medicine, should have an easier time ramping up their services. They can offer the options of email, phone, or video visits. Their PCP’s are already very familiar with their telehealth systems. National telehealth companies want to quickly hire more PCP’s. But with our shortage of PCP’s, it may take months rather than weeks to hire additional PCP’s.
We must effectively utilize the time of our PCP’s, since they are at high risk for contracting COVID-19. We can more easily increase email and phone visits, rather than video visits. According to Dr. Ezekiel Emanual, we have fourteen days to defeat coronavirus and flatten the curve. After working through this crisis, we will determine how best to utilize telehealth and expanded care teams in providing more convenient, affordable health services.