Story published: May 4, 2020
Nurse practitioner Jennifer Murphy sees a patient through a video screen at Open Door Health Center in Mankato, Minn. The check-up would normally happen in person, but because of the pandemic and shelter-in-place orders, the clinic and the patient are instead using telehealth options.
"Good to see your face. Have you had a sore throat before in the last couple months? Murphy asked.
"No," replied the patient, who requested anonymity because of healthcare privacy.
"Any fevers, chills or night sweats?" Murphy prodded.
"A little bit," the patient answered.
Visits like this now make up about half of all care currently being administered through Open Door, a federally-funded safety net clinic that offers services on a sliding fee scale. Offering telehealth services was something the clinic had planned to research this year and perhaps start in 2021.
"But the problem was, because of the pandemic, our behavioral health team said, 'Whoa, these patients have to be seen, we’re going to have to figure out telehealth now,'" said Mandy Gault, a spokesperson for Open Door.
And in less than a month, they did. It was by no means easy, especially for a clinic that runs on federal and state funding, as well as private donations. And then there was the issue of whether patients, many of whom were low-income, had the devices needed for telehealth visits.
"Is this going to be a barrier for patients? Are patients going to be comfortable with the smartphone, the tablet? And we found in all cases that, yes, they are ready," Gault said.
Telehealth has been around for about 25 years, though it had primarily been used in rural settings to deliver specialty care. Funding came with restrictions, and not many patients took advantage of it overall. For example, in 2016, less than one percent of Medicare patients had ever utilized a telehealth visit, according to the Medicare Payment Advisory Commission. At nearby Mankato Clinic, they weren't doing it at all.
"The way it was governed by Medicare, Medicaid and CMS, a patient would have to go to an originating site for a telehealth visit. So if they wanted to have a visit with a specialist, they would have to get out of their house, drive to a clinic, check in to that clinic, go to a room with a computer, and through their computer they would then see their specialist. And patients didn’t really want to do that," said Dr. Andrew Lundquist, chief medical officer of Mankato Clinic.
Editor’s Note: As the COVID-19 crisis unfolds in Minnesota, certain details in our stories about the impact of the virus may become outdated within hours, days or weeks of our publication. For the most up-to-date information about the coronavirus in Minnesota, please visit the websites for the Office of Governor Tim Walz and Lt. Governor Peggy Flanagan or the Minnesota Department of Health.
The pandemic has changed the equation. Restrictions were loosened to allow payer reimbursements to equal an in-patient visit. And healthcare providers such as Mankato Clinic quickly ramped up their telehealth capabilities. Lundquist reported that, in one week, all 180 of the providers at the clinic were trained and ready to go. He said telehealth now makes up 45 percent of all visits at the clinic.
"Physicians and nurses really like it also, it’s a great way to see a patient without having to see them - I mean that in a good way. It’s something that our patients are seeing a quicker response from us, they call us with a problem, and we can see them in 30 minutes, and they don’t have to leave their house," he said.
But one question remains: For how long with telehealth last? The payment structure is set to continue for only as long as the pandemic and various states' stay-at-home orders last.
"Once the genie is out of the bottle, we don’t know if we can put it back in," Lundquist said.
Jonathan Neufeld leads the Great Plains Telehealth Resource and Assistance Center at the University of Minnesota. He said the rapid conversion to telemedicine will leave a lasting imprint on how health care is practiced in the future.
"We don’t know how long this will last, and there may be resurgences of Covid-19 and other pandemics and that’s something we’re going to need to be prepared for going forward," he said.
Telehealth has also played a role in keeping healthcare providers afloat. Healthcare systems everywhere have struggled under bans on elective procedures and a spike in fears that some have over going into clinics. At Mankato Clinic, revenues are down by 70 percent, and some staff have already been furloughed. Despite telehealth replacing many in-person visits, Lundquist said that there are still a lot of people going without healthcare services.
"We do 200 mammo screenings a week, and we will diagnose breast cancer once every week. In the four weeks we’ve stopped, there may be four people with cancer out there who don’t know it," he said.
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