February 16, 2020
The grandmother who speaks to a therapist for the high level of stress she has from caring for her young grandchildren because their parents struggle with addiction.
The woman in her 60s who received a COVID-19 test right after a phone visit with a clinician.
The blind man in his 40s on dialysis who lost his mother to COVID-19 and got help processing his grief.
The unemployed single mother of four who needed a referral to a surgeon for a health condition she had put off because of the pandemic and also received information about our free food market to help feed her children.
The woman with an abusive partner who can’t risk having a counseling session on video while at home.
These are the stories of some of our patients. For the many patients who do not have access to the technology to have a video visit, are not technologically savvy or aren’t comfortable speaking to someone on video, phone visits are a lifeline. That’s why Venice Family Clinic is advocating for phone visits to be fully reimbursable, to care for our patients after the pandemic is over.
A clear need
Because of the pandemic, we are limiting the number of patients coming for in-person appointments. In January, nearly 69% of all visits were done via telehealth, the overwhelming majority of which were held on the phone.
The agencies that administer Medicare and Medi-Cal, which cover people 65 and over and low-income Californians, respectively, along with some private insurers, have been reimbursing health care providers for both video and audio-only phone visits during the COVID-19 pandemic emergency declaration. Some insurers have signaled that they will continue to fully reimburse for video visits after the emergency is over. But there seems to be limited appetite to continue to do the same for phone visits.
That would be more than just a shame. As the pandemic and economic downturn wear on, many people continue to struggle to make ends meet and will likely do so for months or years to come. Many of our patients don’t get paid sick time from their employers; taking time off to visit the clinic means forfeiting income, which our patients can little afford to do. Also, many of our patients rely on time-consuming public transportation. Being able to speak to their clinician over the phone saves them precious time and money.
For the Clinic, offering telehealth visits as an option allows us to free up space to see those patients who need to be seen in person, such as someone who needs a blood test. Telehealth creates efficiencies that we don’t have in-clinic; there’s no time spent waiting for patients to register or for exam rooms to become available. Virtual visits cannot replace every visit, as there are some circumstances where our ability to examine a patient in real life are vital. But over the past year, we’ve learned that quality, effective care also can be delivered over the phone and using videoconferencing technology.
Quality care over the phone
Dr. Margarita Loeza recently treated a man in his early 50s over the phone who had tested positive for COVID-19, as had his wife and son who live with him. When Dr. Loeza first spoke to him, she gave him instructions for how to safely quarantine, care for himself at home and monitor his oxygen levels. A week later, they had another phone visit. This time the man said he was experiencing severe fatigue, fever, cough and shortness of breath. Dr. Loeza advised the patient to have his adult son take him to the emergency room, where he was admitted to the hospital for three days and treated for COVID-19 pneumonia.
When Dr. Loeza spoke to him again via telephone, the man was back home and feeling better physically. But the experience left the man traumatized, like so many of the Clinic’s COVID-19 survivors. Dr. Loeza then referred him to our Behavioral Health program, where he can receive counseling – also via telehealth.
Nearly all of Venice Family Clinic’s patients, even those experiencing homelessness, have access to a telephone, but not all patients have the high-speed or data plans needed for video visits. Having the option to talk to a clinician over the phone offers patients the flexibility to make their own privacy, which is important when living in close quarters with several other people, as many of our low-income patients do.
All this makes it easier for clinicians to follow through with patient care. Our patient no-show rate for primary care visits has dropped more than 30% since this time last year. And while our no-show rate for all visits is at 11%, that rate is just 4% for phone visits.
This pattern is reflected in what substance use counselor Rose Dominguez has seen over the course of the pandemic. Not only have phone visits made continuing treatment easier for the patients she worked with before the stay at home orders were declared, but new patients are just as involved, even if she has never met them in person.
“I just hope that we can continue to do the work that we’re doing. This is the new way of life, and we need to embrace it,” Dominguez said. “We need to engage patients any way that’s easier for them. We need to do whatever we can to support them and help them see their clinicians.”