Originally published in Capitol Weekly – May 20, 2020
The patient was relieved when the physician offered to conduct her medical visit over the phone. So was the doctor when the patient described the common symptoms of COVID-19 and living with a brother who had the virus.
As we prepared for Venice Family Clinic’s 50th anniversary this year, many people asked what we expected for the next 50 years. We predicted there would be more of what happened on that call – the advancement of telehealth so we could offer more primary care, counseling and other services over the phone or through other technologies.
Because of the COVID-19 outbreak, the future came far more quickly than expected. The need for infection prevention opened the door for telehealth, and we cannot let that door slam shut after the pandemic. Telehealth is essential to expanding people’s access to health care and the health system’s capacity.
The agencies that administer Medicare, which provides insurance coverage to people age 65 or older, and Medi-Cal, which provides insurance coverage to low-income Californians, announced in March that they would reimburse healthcare providers for telehealth visits – including audio-only phone visits – during the public health emergency. Several private insurers announced similar policies.
But neither Medicare nor Medi-Cal, which provides coverage for one in three Californians, has said they will pay for telehealth services when the emergency ends.
We need that commitment now.
Healthcare providers around the country have increasingly shifted to videoconference and telephone consultations to keep patients and staff safe and reduce the use of personal protective equipment. At Venice Family Clinic, healthcare providers conduct 76% of billable appointments over the phone.
The percentage of telehealth appointments will decline when the COVID-19 risk declines and patients return to doctors’ offices for services they have postponed. Moreover, telehealth cannot replace the in-person exams or personal touch that helps patients struggling with serious illnesses or chronic conditions.
But conducting medical appointments by phone or video, when appropriate, improves access to care for people in need or living in rural locations. Most of the nearly 28,000 men, women and children living in poverty that we serve have limited transportation options and may have to take several buses to get to a clinic site. Also, they frequently work in jobs with limited or no sick leave, so they may have to give up all or part of a day’s pay to see a doctor.
A virtual visit saves them time and money, and it increases the healthcare system’s capacity by freeing up exam rooms and other clinic space to accommodate more patients who need to be seen in person.
The lack of Internet and computer access is often cited as an obstacle to telehealth. But almost all our patients – even the 4,500 patients experiencing homelessness – have a phone or access to one. Venice Family Clinic staff can conduct appointments with voice-only phone service or with a new technology platform that uses patients’ cellphone cameras to help healthcare professionals visually connect with patients.
For the patient with the COVID-19 symptoms, a phone call was adequate to give her the information she needed to treat her symptoms and understand how to isolate herself. The doctor also refilled her asthmatic son’s inhaler and provided medical advice to the patient’s sister, who lived in the same apartment and had the same symptoms.
For the next two weeks, clinic staff continued to check on the family by phone — until they were all healthy again.
Now that we have seen the future of healthcare delivery, we cannot slam the door on progress. We call on state and federal officials to make reimbursement for telehealth services permanent after the pandemic ends – and announce that decision now.
Doing so will give providers the certainty to invest in telehealth technologies that will improve patients’ access to care, expand the healthcare system’s capacity and ensure we are better prepared for any future pandemics.
Elizabeth Benson Forer is the Chief Executive Officer of Venice Family Clinic, a nonprofit community health center that serves people in need, regardless of their ability to pay or their immigration status.