CLEVELAND — Since COVID-19 shutdowns started in March 2020, two-time transplant recipient Colleen Gerber has, necessarily, been very careful.
“I’ve gotten two vaccinations and a booster but I just want to make sure,” said Gerber, describing the precautions she takes to stay healthy.
Gerber has spent 35 years taking medicine to weaken her immune system so her body doesn’t reject her kidney transplant. That makes her especially vulnerable during a global pandemic, especially when she has to continue seeing a long list of doctors to treat the side effects of the transplants.
“Telemedicine has been a Godsend for me,” said Gerber.
Gerber has been able to attend at least a quarter of her yearly doctor visits virtually partially because of changes to how those visits are regulated in Ohio.
Emergency rule changes
The State Medical Board of Ohio “suspended enforcement of regulations that required in-person visits, effective March 9, 2020, until the expiration of Executive Order 2020-01D,” said a medical board spokesperson in an email to News 5 referring to the State of Emergency Governor Mike DeWine declared in March 2020.
That change expanded what kind of doctor visits could happen virtually and expanded reimbursements requirements for health plans so patients wouldn’t be stuck with the bill.
But, the suspended enforcement didn’t permanently change the state’s telemedicine regulation and the pre-COVID enforcement rules were due to resume on Sept. 17, 2021.
“At the Aug. 11 medical board meeting, the board decided for the sake of patient safety to extend the date until Dec. 31, 2021. In-person patient requirements will resume for specific situations on Jan. 1, 2022,” said the medical board spokesperson.
Permanent options
People who support expanded access to telemedicine tell News 5 there are two main avenues to making those changes permanent: the medical board could change its rules to make the emergency measures permanent or the Ohio Legislature would have to codify new standards into law.
“Any changes to current medical board rules would require a board vote and progression through the state administrative rulemaking process,” the medical board spokesperson told News 5.
The route through the Ohio Legislature has been making more progress so far, with House Bill 122 passing through the Ohio House in just about two months in early 2021. It’s scheduled for a second hearing in Ohio Senate’s Health Committee on Sept. 29, 2021.
“What we see is improved medical outcomes through telemedicine,” said Primary Sponsor District 71 Representative Mark Fraizer (R-Newark).
Rep. Fraizer says an important part of his legislation is not only expanding access to telehealth and making sure insurance plans cover the cost, but also preventing healthcare providers from charging maintenance or facility fees that often show up in bills for in-person visits.
“Our whole mindset is that the cost for a telehealth visit should be cheaper than an in-person visit,” said Rep. Fraizer. “And that ultimately, those fees cannot be passed on to insurance companies or the individuals because those are fees that are not necessary because you’re not going to a physical facility.”
Using and improving telehealth
All three large hospital systems in Greater Cleveland tell News 5 they’ve been using and improving their telehealth capabilities since COVID started.
The Cleveland Clinic says it only held about 1% of outpatient visits virtually before the pandemic, compared to about 70% now.
MetroHealth says it only did a few thousand virtual visits a year pre-pandemic and it expects to do more than 500,000 a year going forward.
University Hospitals similarly says its virtual visits increased 40-fold over pre-pandemic statistics.
Cleveland Clinic Lead for Virtual Health Dr. Steven Shook says besides the obvious COVID-related issues that make telehealth useful for patients, the reduced time to carry them out makes it much easier for healthcare providers to monitor patients in between in-person trips.
“[Physicians are] collecting data from patients between office visits in order to predict patients that aren’t rending properly,” said Dr. Shook.
That allows the clinic to catch potential problems early before they become more serious to a patient’s health and more expensive to treat.
He says the chance to have shared meetings for patients with similar ailments has also expanded with the increased willingness to hold virtual meetings.
At MetroHealth, where the patient population tends to be more vulnerable than at other facilities, telehealth has made it easier for patients to show up in the first place.
“Our no-show rate dropped from 20 to 25% to 5% because people were ready and willing to engage with through this new medium,” said General Internal Medicine Director Dr. David Margolius.
Margolius points out that it’s also drastically easier for patients to see a doctor virtually because of the time it often takes to get to a doctor’s office. In-person visits can often take hours between transportation to and from the office, meaning patients need to take time off from work, if they can.
Virtual visits often take about a half hour and can be snuck into a lunch break.
MetroHealth’s Director of Telehealth Albert Ferreira came to Cleveland in July 2019 primarily to help grow the hospital network’s virtual visit capabilities. He says the pandemic provided a test of MetroHealth’s existing system and quickly-expanded program in a way that likely wouldn’t have been possible otherwise. The result is a new population of patients and caregivers that are much more comfortable with a relatively new way to provide care.
“I like to think of it like banking,” said Ferreira. “There was a time when you had to go to the bank to cash your check.”
Now, the Ipsos-Forbes Advisor U.S. Weekly Consumer Confidence Survey found that, “toughly three in four Americans (76%) have used their primary bank’s mobile app within the last year for everyday banking tasks like depositing checks or viewing statements and account balances,” according to Forbes.
Ferreira says in-person doctor visits aren’t going away but the future will be a hybrid of in-person visits and virtual appointments depending on a patient’s needs. The key is making sure the regulation is created correctly and that the systems supporting telehealth work and are secure.
“You have to feel like that experience is positive and valuable enough that you want to be able to do it over and over again or at least in the moment of need,” said Ferreira.
To close the Digital Divide that became clear during the pandemic, Ferreira says MetroHealth’s Institute for H.O.P.E. has been working on connecting parts of the community to the internet while also training people on how to use new digital devices. It allows them to see doctors more often over the internet while also teaching them other skills that can help outside healthcare.
University Hospitals is in the process of partnering with an outside company that will allow every virtual visit to happen through one uniform platform no matter which patient is seeing which caregiver.
Telehealth Director Dr. Brian Zack says only about three percent of UH caregivers used telehelath before COVID, compared to 83 percent now.
“It really taught us that there are different ways that we have traditionally learned to see our patients, be part of their lives, and give them the continuity that they are looking for,” said Zack. “Our physiology and psychiatry colleagues are 90 percent virtual right now and we don’t want that to end. Patients are doing so much better with it despite the anxieties of the pandemic and everything around it.”
He says UH had been using ambulatory virtual clinics before COVID, where patients could go to one location to visit with a healthcare provider at another location. Now, they’re also partnering with libraries and other organizations to help give more people access to virtual visits and teach them how to use them successfully.
Avoiding a bureaucratic gap
Rep. Fraizer says he’s pretty confident that House Bill 122 will eventually pass through the Ohio Legislature and be signed into law but he’s less sure that it’ll happen in time to take effect by the end of 2021 when the Medical Board’s rules will return to their pre-COVID standards.
“The nightmare scenario is that we learn nothing from all this care transformation that we’ve done over the last 18 months,” said Dr. Margolius.
Rep. Fraizer hopes the Medical Board would consider extending its deadline one last time, if that’s the case, to cover any gap so patients like Colleen wouldn’t have a period of weeks or months where they wouldn’t be able to access healthcare providers virtually.
“The board is aware of the proposed telemedicine legislation and will continue to monitor its progression in the General Assembly,” wrote a Medical Board spokesperson when asked about such a gap.
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