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COVID-19 in Maryland Health Care

Why Telehealth Is Poised to Change Medical Care Forever

Photo by Mayur Kakade/Getty Images

Before COVID-19 struck, a person who felt bad and wanted to see their doctor was forced to drag themselves to their provider’s office for an evaluation — even if the trip was going to make them feel worse, and even if travel would risk exposing them and others to who-knows-what illness.

Overnight, almost everything has changed.

Thanks to recent changes in insurance law and an urgent need to reduce social interaction, the use of telemedicine — medical care delivered online — is in the midst of an historic spike, in Maryland and around the U.S.

According to nearly a dozen health care providers, insurers, consumer advocates and industry experts interviewed by Maryland Matters, the surge has functioned smoothly for the most part, and is almost certain to change how people get medical treatment in the future.

“This is going to become more and more the future of health care,” said Arif M. Khan, vice president of Clinical Programs and Evaluation at CareFirst BlueCross BlueShield, a leading insurer in Maryland the Washington, D.C., region.

The technology needed to bring providers and patients together online has long existed, of course. But hardly anybody used it — mostly because insurance wouldn’t cover it. There was also reluctance on the part of patients and practitioners alike to shed traditional notions of what it meant to “see” a doctor.

“It’s kind of like Amazon and online shopping,” Khan said. “They were around for 20 years and couldn’t turn a profit — and now they are ubiquitous with anything and everything that people think about in their daily life. We actually believe that telehealth will also have a similar trajectory.”

Since the COVID-19 crisis hit Maryland the use of telehealth has tripled.

“We’ve done more video visits year-to-date this year than in any prior year,” Khan said. “If in a given month we used to have 800-1,000 video visits, we’re now seeing closer to 3,000 [or] 4,000 visits in a month.”

Older patients have a strong attachment to face-to-face care. Younger people crave the convenience of a virtual visit and tend to be more comfortable with technology.

The General Assembly approved a telehealth bill in the closing days of this year’s session, a session that was cut short by the wave of COVID-19 cases hitting the state. The bills (House Bill 448 and Senate Bill 402) passed almost unanimously hours before lawmakers left Annapolis.

They were two of just a handful of bills that Gov. Lawrence J. Hogan Jr. (R) actually signed this year.

“To get through this unprecedented crisis, we have to be adaptive, innovative, and inclusive in our response,” Hogan told Maryland Matters in a statement.

“Expanding telehealth ensures that Marylanders can continue receiving essential care, and further demonstrates the great capacity and compassion of our health care providers.”

MedChi, the Maryland Medical Society, has long lobbied for increased telehealth.

“When it became available, the uptake was incredible,” said the organization’s CEO, Gene Ransom. “This has just changed everything.”

Ransom said virtual visits will never replace the need for doctors to see patients in person. But where they are appropriate, they reduce the potential for people to spread disease, they allow practices to conserve personal-protective equipment, and patients welcome the convenience.

“If the matter is one that can be handled over tele-medicine, it’s a lot easier to be at home… pull the iPad out or the iPhone and have a discussion with your physician than it is to figure out how you’re going to get to the office and deal with it.”

Dr. Ron Elfenbein, medical director of First Call Medical Center in Gambrills, said he first used telehealth early in his career, during his residency in a remote village in Alaska.

He said telehealth visits are particularly useful when doctors are doing follow-up visits on a patient they have already treated.

“It’s been around for so long, but nobody embraced it,” he said. “But this COVID-19 thing has really made it a necessity.”

Advocates tout the benefits of telehealth

Among the advantages of virtual doctors’ visits, advocates say:

  • Helping those with transportation challenges receive care

“A working mom who has to spend an hour and a half or two hours to get to a 20-minute physician appointment and spend that same time coming back, that’s difficult,” said Amy Goodwin, head of communications for the Maryland Hospital Association.

“When you make things easier for patients, they do better. They’re more compliant. They’re more likely to follow-up.”

  • Connecting people in rural and under-served communities with specialists
  • Helping people access mental health specialists

“If you think about all the barriers of access to mental health [and] behavioral healthcare, video visit is an excellent resource for that,” said Khan of CareFirst. “Because a lot of times there is the stigma of just going in, or being seen, and you can eliminate all of that by being in the comfort of your own home.”

  • Helping women who’ve just given birth with lactation and nutrition advice
  • Giving providers a glimpse into a child’s home life

“They can work with the family and they can see the home environment,” said Jennifer Witten, the hospital association’s vice president of Government Affairs. “They can see if there are triggers or other things within the home that would hinder a child’s ability to progress in their care.”

Because of gaps in internet access caused by cost and availability issues, the hospitals association is pushing insurance companies to make coverage of “audio-only” telehealth — phone calls — permanent.

“That was completely not allowed by carriers in terms of being reimbursed before, but there’s been great value,” Witten said.

MedChi’s Ransom is also concerned about geographic gaps in the rollout of telehealth.

“We believe that in certain areas of the state telehealth has not been picked up as much,” he said. “I have anecdotal data — and the billing data confirms — that in Prince George’s County and certain underserved areas — telehealth has not been implemented as much as it has in others. And we’re trying to understand why that is, so we can reach out to the physicians in those areas and help.”

Deciding whether the changes will stick

Insurance companies, researchers and others are already poring over the data to see how telehealth outcomes compare with traditional visits.

They will look to see whether doctors who treat patients online prescribe medication at the same rate as they do for in-person visits.

“You want to make sure that video visit functionality doesn’t just become like a quick-and-dirty way for people to get ahold of antibiotics even though they haven’t been checked,” said Khan.

Another key metric is patient satisfaction — and on that score it seems to be working.

CareFirst patients, on average, rate their experience around 4.75 out of 5 stars, Khan said. “So that’s always a very good indicator that people — unbiased and unprovoked — are saying ‘yup, this went well and I enjoyed my experience.’”

Several other factors are also likely to determine whether telehealth is delivering on its promise, said Joe Weissfeld, director of Medicaid Initiatives at the advocacy group FamiliesUSA.

Among them:

  • Do patients feel satisfied with their treatment?
  • Can physicians increase efficiencies, allowing them to treat more patients?
  • Can technology make it easier to get an appointment and reduce the amount of time patients spend waiting to see the doctor?
  • Will regular access to a provider lead to reduced use of the emergency room, a costly component of healthcare spending in the U.S.?

Weissfeld said that if insurers, doctors and patients “are pushing for this to stick, it will be hard for it not to become more of a permanent feature of the health care system.”

Ransom said it’s important that “arbitrary barriers that were lifted as a result of the crisis” don’t return once it’s over.

“We need to fight to keep access to telehealth alive going forward. Because I really do think this going to be a big benefit for patients.”

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Why Telehealth Is Poised to Change Medical Care Forever