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Age of Coronavirus: Pandemic Prompts Surge of E-House Calls 

Telemedicine Meets Its Moment

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Above image credit: Brian Skow, an emergency room specialist, and nurse Amanda Sandager respond to a video call at Avera eCARE telemedicine center in Sioux Falls, South Dakota. (Courtesy | Avera eCare)

The COVID-19 pandemic might forever change the world as we know it, whether it’s working from home or streaming worship services while wearing pajamas.

Look no farther than the University of Kansas Health System to see how technological advances might alter the nation’s health care landscape.

In the matter of weeks, as the coronavirus exploded, the system launched a statewide telemedicine network that was not slated for a full build-out until perhaps two years from now. The system and its main hospital are based in Kansas City, Kansas.

About 2,700 telemedicine practitioners are now operational, thanks to a 15-day-straight stretch of work in mid-March.

In about a week, the number of patients seen daily via computer or mobile device has increased 20-fold to about 1,000. Officials expect to double that number of encounters within a couple weeks, or sooner.

One “phenomenal feat,” said Jason Grundstrom, executive director of continuum of care, was establishing a roving system of iPads in its Emergency Department’s COVID-19 unit in the span of six hours. 

Telehealth has been around in some form or fashion for years, with the idea of better serving rural communities, nursing home residents, and other patients who can’t — or shouldn’t — make it to an office visit.

KU Health has been using telehealth for a couple decades, Grundstrom said.

But the response to COVID-19, with all its precautions against community spread, has prompted temporary regulatory changes at the state and federal levels. Having a bunch of people in a waiting room doesn’t seem wise, nor does it seem prudent to encourage face-to-face contact between patients and providers.

So for now authorities have allowed reimbursements for more remote consults through government programs, such as Medicare and Medicaid, by waving requirements that the patients must live in a medically underserved area and be treated in a healthcare setting.

At least in Kansas, Grundstrom said, private insurers seem open to following suit. 

Next Door

In Missouri, the Department of Social Services has relaxed some of its telemedicine requirements for Medicaid recipients.

For the time being, for instance, physicians do not need to have an established relationship with the patient. The department has also waived the patient co-payment for telemedicine services.

The state and federal waivers are certainly welcome, said Dave Dillon, spokesman for the Missouri Hospital Association.

But the absence of broadband internet service in rural areas is the biggest barrier to the expansion of telemedicine in Missouri, he said.

Rural providers are likely to have access to broadband, but that does not make up for the “last mile” connection to a home. Improving internet connectivity is one facet of the association’s “Reimagine Rural Health” initiative. 

“Our push is for the infrastructure as much as it is for the telehealth side,” Dillon said. “Once you’ve got the infrastructure, you basically open the door for that.”

As it stands now, he said, broadband connections between health institutions facilitate physician-to-physician consults and continuing education.

Broad Vision

As an institution with a statewide mission, KU Health has long advocated for expansion of telemedicine. Recent efforts on the state level have foundered over whether it covers medication that can be prescribed to induce an abortion.

As Kansas Gov. Laura Kelly put it in a COVID-19 executive order on March 20, “any impediment to receiving health care through telemedicine impedes our ability to promote and secure the safety and protection of the civilian population.”

Grundstrom has seen the benefit of an e-visit firsthand, with a recent remote consult following surgery. One of the biggest pluses, he said, was having the doctor and all the support staff online at the same time — no waiting in the room while each one shuffled in and out, and no need for a follow-up huddle among the personnel.

The convenience of telehealth is undeniable, he said.

Why force an outstate patient to miss time from work, find childcare, and then potentially drive all the way to Kansas City for a consult they could do from their own home?

As more patients experience the convenience of e-health during the coronavirus outbreak, Grundstrom hopes regulators won’t try and put the genie back in the bottle once the crisis passes.

“How are you going to tell patients across the entire state, if not the United States, you can’t do that anymore in three months?” he asked. “We are hoping as a healthcare system that we can still do this beyond that, because this is a good way to deliver care.”

Dr. Andrew Sauer, cardiologist, University of Kansas Health System
Dr. Andrew Sauer, cardiologist, University of Kansas Health System. (Contributed | University of Kansas Health System)

Telehealth has been a game changer for KU Health cardiologist Dr. Andrew Sauer, whose practice includes heart transplant patients. For the past year, he has been conducting e-health follow-ups rather than flying out monthly to Hays.

That allows him to better monitor patients for complications, such as the body rejecting the new heart. “If we don’t see them,” Sauer said, “a lot of bad things could happen without us realizing it.”

Most of his patients are frail and elderly, exactly the type of people who should not be out and about during the COVID-19 outbreak.

With the quick expansion of telemedicine by Grundstrom and his team, Sauer said he has been able to reschedule many of the outpatient visits that had to be cancelled a couple weeks ago at the start of the outbreak.

That’s good for the patients, and for the hospital, he noted, since facilities are paid based upon the services they provide.

Sauer, too, hopes the temporary relaxation of reimbursement rules become permanent. Crises often have silver linings, he said, and the legacy of COVID-19 could be spurring reform in a U.S. health care system that has long defied modernization. 

“It really is pretty antiquated when you think about it,” Sauer said.

Mike Sherry is senior reporter for Kansas City PBS. He can be reached at msherry@kcpt.org or 816.398.4205.

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