(May 5, 2020) HOUSTON - Social distancing required by COVID-19 has made providing health care via phone calls and video chats not just a convenient option but, in many cases, an imperative. Telehealth will continue to play an important role as businesses gradually reopen and “nonessential” health care services resume. In fact, many providers believe it will become a permanent and routine element of practice.
The utility and methods of telehealth vary depending on the types of service and treatment provided, but the pandemic has strengthened such technology’s toehold in many fields.
“I think telemedicine is here to stay, and this will change the way we practice in mental health,” said Cizik School of Nursing at UTHealth Assistant Professor Kelly Kearney, DNP, PMHNP-BC. “Health care providers who weren’t using the telemedicine platform previously will now see the benefits and the necessity of adding this to their practice as another avenue for patient appointments.”
Kearney is the school’s psychiatric nurse practitioner program track coordinator. She conducted a couple of sessions a week with patients prior to COVID-19 and has since converted her entire caseload to telehealth. Not only has it enabled her to “keep the doors open,” it all allows patients to continue their counseling and treatment.
“Anxiety is high across all patients. Quite a few of my patients are afraid if they go outside, they will contract the virus,” Kearney said. A few actually have tested positive, some have lost their jobs, and isolation has increased risks for those who suffer depression and live alone.
Associate Professor Rebecca Casarez, PhD, PMHCNS-BC, provides counseling at the UTHealth Services clinic. She has also increased the use of virtual appointments, and she is glad the clinic gives patients the option of in-person, telephonic, or video sessions.
“There are some people who really want to do online visits, and there are others who really want to meet in person because they miss that personal interaction since so many other things are not in person,” Casarez said.
In the long term, telehealth will remain an important tool for mental health care providers, Kearney predicts, not only because it facilitates treatment of patients in remote, rural areas, but because it makes counseling more convenient for those who would otherwise have to miss work or school for appointments.
Darrine Abouchelleih, RD, a nutritionist at UTHealth Services, has noticed fewer cancellations since she shifted to virtual classes and counseling, perhaps because of the convenience.
In addition to working with individual patients, Abouchelleih conducts several group sessions per week as part of the Centers for Disease Control and Prevention’s National Diabetes Prevention Program. She now hosts them via video conference.
“I can’t tell you it’s changed what I do significantly,” she said. “But I do love to see my patients in person. We used to do activities during our classes like marching in place or walking around the building. It’s harder to do that virtually.”
Homebound routines and stress related to the pandemic have made healthy eating and exercise more challenging for most of Abouchelleih’s patients, but a few say they are glad to be able to work from home and take daily walks around their neighborhoods.
The applications for telehealth may be more limited in the primary care setting, but they are no less vital when patients are being encouraged to stay at home as much as they can.
At UTHealth Services, patients still must be seen in person if they need lab work or have acute conditions that require hands-on examinations. But phone calls to check in on patients with chronic diseases and take care of prescription refills have been crucial during the pandemic, and video conferencing can work well for conditions that require visual examinations only, like skin rashes, said Angela Rutherford, MSN, ANP-C.
Mitzy Kobeissi, DNP, FNP-C, is a telehealth veteran who operates her own concierge practice on the weekends. Her average patient is a stay-at-home, suburban mom. She frequently made house calls early on, but these days sees most patients via video visits.
Kobeissi would normally handle colds, flu, and sinus and ear infections, but because those conditions share symptoms with COVID-19, she is currently referring such patients for in-person treatment in case they need a higher level of care. Treating minor health concerns for patients via telehealth helps take the pressure off of emergency departments, she noted.
Her experience following Hurricane Harvey proves the value of telehealth services – and of being prepared to implement it and ramp up in a crisis.
“I was so busy after Harvey because people couldn’t get to their health care providers,” she said. “I find that in times of disaster, I become a go-to because I’m already equipped to do everything online.”
Kobeissi is sharing her expertise at the Cizik School of Nursing. Last summer, she taught doctoral students how to set up a telehealth clinic, and this fall she plans to pilot a program for nurse practitioners. “We are going to teach them how to conduct a proper video visit and how to make a connection with the patient through the screen,” she said.
Billing Telehealth Visits
One of the most common challenges facing those adjusting to telehealth during this unprecedented health crisis is navigating the complexities of coding and billing. Until now, disparity in reimbursement practices between in-person and virtual visits created roadblocks for telehealth adoption. Even if a practitioner had the technological capability to conduct a virtual patient visit, he or she traditionally could not bill for it if it was not facilitated in an approved health facility.
Reimbursement may be available now for such telehealth visits, depending on the payer and the type of visit. Emergency rules established in response to COVID-19 loosened many of the restrictions on telehealth reimbursement for Medicare, Medicaid, and private insurance, but whether those changes become permanent remains to be seen.
Kearney encourages health care providers to be particularly diligent right now in keeping up with changes to insurance companies’ reimbursement policies. “Read all the email updates to find out how they are responding and whether they are making any allowances for their patients,” she said.
For example, Kearney recently learned that one insurer is waiving its 20% copay because of COVID-19. Office staff unaware of the change ultimately would have to refund copays collected at the time of visit.
Rutherford expects telehealth billing issues to settle out, and she looks forward to seeing more patients face-to-face again. “For me, the bottom line is we’ve got to take care of the patient, even if it’s just maintaining care right now,” she said.