Reprinted from the winter 2021 Issue of The Ohio Family Physician.
By: Stephen Auciello, MD, Program Director, OhioHealth Riverside Methodist Hospital Family Medicine Residency; Edward T. Bope, MD, Deputy Chief of Staff, Chalmers P. Wylie VA Ambulatory Care Center; and Emily Gorman, DO, Assistant Program Director, OhioHealth Riverside Methodist Hospital Family Medicine Residency
The COVID-19 pandemic altered the way most family physicians provide patient care. As a result of focusing on patient safety and limiting COVID-19 exposure, we struggled to maintain a personal connection with our patients. In addition, it was difficult to keep patients current on preventive care items. More than 40% of U.S. adults either delayed or avoided medical care due to concerns about COVID-19.1 Due to decreased cancer screenings early in the pandemic, later-stage cancers are now being diagnosed more often.2 Without access to in-person care, telemedicine quickly rose from a novel option to a necessity for our patients.
Telemedicine includes both telephone visits and video visits. National telehealth visit use rose from well under 1% of all billed claims in June 2019 to nearly 7% in July 2020.3 In response to patient care needs, the Center for Medicare and Medicaid Services (CMS) quickly expanded the role and reimbursement for telemedicine. They also expanded the interpretation of direct supervision in residency training to include real-time audiovisual technology. The evolution that telemedicine has undergone since the beginning of 2020 has brought many new, exciting opportunities into family practice offices. Without the previous payer and supervision restrictions, family physicians are free to think creatively about the marriage of telemedicine and in-person visits. By removing transportation logistics and travel time, frequent follow-up visits have become attainable for more patients. Patients are able to connect with their physicians from the comfort of their homes.
At OhioHealth Riverside Methodist Hospital Family Medicine Residency, one of the earliest interventions to promote safety during the pandemic was to cancel or reschedule non-urgent visits. We spoke with patients over the phone to address care gaps outside of any reimbursable visit structure. Prior to 2020, telemedicine use was mostly non-existent in our practice. The exception to this was the option to schedule an e-visit, but patients rarely elected to schedule this type of encounter. After the expansion of CMS’s visit type, supervision regulations, and the State Medical Board of Ohio’s (SMBO) regulations, we quickly changed eligible encounters to telephone or video. The majority of our early telemedicine visits were telephone only, mostly attributed to the lack of access to video technology or ease of use. From March-December 2020, telemedicine accounted for 21% of our visits, with two-thirds of those being telephone only. With office quality improvement projects and improved video integration within our electronic medical record, the portion of video to telephone visits rose significantly. The supervision expansion also allowed us to use residents and faculty for care and supervision without physical presence. By early 2021, the vast majority of our telemedicine visits were video visits. Currently, telemedicine remains an integral part of our care, accounting for 5-10% of our overall visits.
- Patients new to the practice should have the visit scheduled face-to-face.
- Telemedicine patients should have at least one in-person annual visit.
- Patients receiving prescriptions must have initial and periodic in-person visits.
The upheaval caused by this pandemic has challenged us to find new ways to partner with our patients. We cannot pause preventive care and must continue to advocate for our patients’ health, even in times of crisis. Many patients have embraced telemedicine as it allows them to access care while considering their other personal constraints. Patients will expect telemedicine to be an option going forward, so family medicine trainees must be educated in telemedicine best practices, as well as evolving regulations around its use. This exposure for all family medicine residents will be paramount in deciding which conditions are appropriate for telemedicine versus which require in-person evaluation. While the rules of engagement for telemedicine continue to evolve, it has established itself as an integral part of the practice of family medicine and will continue to endure.
References available on the Ohio Academy of Family Physicians website.