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Seminal moment for medicine: Doctors make more virtual house calls due to coronavirus, a trend likely to continue

Holly Zacharia The Columbus Dispatch

The doctor settled in - the ultraviolet light atop his desk adjusted just right to cast what he hoped was a comforting glow - and hit the key on his laptop to summon his next of 11 patients this day.

In short order, Amanda Shaw’s face popped up on the screen.

“How are you doing today?” neurologist Dr. Obi Moneme asked.

“I’m OK,” Shaw answered. And off they went for what was about a 10-minute appointment by video with Shaw in her living room and Moneme in his office at OhioHealth Neurological Physicians.

It was the first time since her stroke a year ago that the 43-year-old’s follow-up appointment was virtual rather than in-person.
She approved.

“Of course you want to be safe in these times,” she said of the coronavirus pandemic that hit Ohio with a lethal punch beginning in mid-March. “But honestly, I am so comfortable with my doctor that this works. I know he knows what to ask and is trained to look for troublesome things.”

Though telemedicine - whether by phone or video - has crept up in use particularly for primary care physicians the past couple of years, this COVID-19 pandemic forced the hands of even specialty doctors and clinicians to re-examine the way they practice medicine and adapt.

Necessity to isolate led to a sudden relaxation of federal privacy rules that had prohibited some less-secure forms of patient/doctor communication such as social-media applications like FaceTime or not allowing doctors to communicate from home, where others might overhear.

More importantly, the rules have been relaxed and Medicaid and private insurers who previously wouldn’t pay for most virtual health-care visits now do so.

So the industry has simply exploded. And doctors say there will be no going back. This, they say, is a seminal moment for medicine.

“If we build this model the right way it will really revolutionize medicine,” said Moneme, who is service line chief for virtual health at OhioHealth.

The numbers from Columbus, Ohio’s biggest hospital systems underscore the seismic shift in delivery of health care since the coronavirus pandemic and stay-at-home orders began in mid-March.

- At OhioHealth there have been about 7,500 video visits and 75,000 telephone appointments with more than 950 physicians and specialists since March 2.
- At Ohio State University Wexner Medical Center, there were 134 video visits and 39 telephone appointments in January and February. Those numbers jumped to 30,944 video visits and 35,710 calls from March 13 through April 27.
- Mount Carmel Health System had 19 virtual health-care visits from March 15 to April 27 in 2019. From this March 15 through April 27, the number of visits totaled 19,532.
- Nationwide Children’s Hospital in all of 2019 had 19 behavioral health visits that were virtual (the only part of the hospital utilizing the technology). Since March, the hospital has now performed more than 45,000 telehealth visits in multiple disciplines, with more than half of those by video.

At Nationwide Children’s, Dr. David Stukus had never seen a single patient by video until six weeks ago.

As an allergist and immunologist who treats a vulnerable population of kids - both for the fragility of their conditions and because two-thirds of them come from impoverished families and Medicaid qualified - not having them risk coming to a hospital setting even during normal times is a good thing.

In the past two months, his patient no-show rate has dropped to almost zero.

“Think of it: You don’t have to miss work. You don’t have to find transportation or spend money on gas to drive Downtown to see us,” Stukus said. “Wouldn’t it be great if you could live in Portsmouth and can hop on the phone and see an allergy specialist at Nationwide Children’s Hospital? I think patients will soon demand this option.”

He said the key to whether this lasts will be whether, after the pandemic ends, government regulations remain in place to allow telehealth to continue and insurers continue to reimburse for it.

Doctors agree, however, that virtual visits will never replace all in-person care. And they say there are pitfalls to be mindful of for practitioners.

Dr. Megan Schabbing, a psychiatrist and director of psychiatric emergency services at OhioHealth, has long been seeing patients virtually when they show up at a hospital in crisis and she is needed but can’t be on the ground.

“If you would have told me many years ago that we would be delivering care this way, I would have been very, very skeptical,” Schabbing said. But OhioHealth has been using video as a way to help patients in crisis in its 10 emergency departments since 2015.

And it works, Schabbing said. But she cautions that bedside manner remains key even if you aren’t actually bedside.

“I am very old school in many ways. I want to look you in the eye. I want to be in the same room sitting across the table from you,” she said. “My work as a psychiatrist is so much based on my ability to make a connection, on showing empathy, showing the patient that I really care and I am willing to meet the person where he or she is.”

So how do you do that on a video?

“I still say to them ‘look me in the eyes’ and people respond the same way,” Schabbing said. “They’re just so happy to have someone that speaks their language, someone who is finally hearing them. If you have that same degree of comfort and openness and honesty that you would have in an office, it translates.”

Though telemedicine before this pandemic had been used largely by primary-care doctors, now that specialists are embracing it, the adaptations are amazing, said Dr. Arick Forrest, a surgeon and medical director of ambulatory services at Wexner Medical Center.

For example, Forrest said orthopedic specialists have found ways to have patients move bones in front of the camera so that the doctors can evaluate them. As the pandemic abates and the need for isolation to protect both doctors and patients eases, he said traditional medicine will return but not to the same degree it once was.

“There will always be a need for face-to-face evaluations and visits. Always,” Forrest said. “But this will be our new normal. The biggest mistake we could make is to go back to giving care the way we did.”