As the coronavirus pandemic has emptied clinics and kept people at home, St. Louis doctors quickly began using phones and the internet to reach patients.
Changes to federal rules and efforts to reduce exposure to the coronavirus have led many patients and physicians to try telemedicine for the first time.
Proponents hope that access continues after the coronavirus pandemic is under control.
In the past, “telehealth services were considered something less-than,” said Karen Edison, senior medical director of the Missouri Telehealth Network, a telemedicine training program at the University of Missouri. “And now with the COVID-19 crisis, people are recognizing the standard of care applies no matter what technology you’re using.”
Telemedicine, in which patients and doctors meet using secure video, web or phone connections, has been in use in Missouri since the mid-1990s. But for decades, federal regulators have limited its use.
Patients and doctors first needed to meet in person, or patients needed to live in a rural area to qualify for coverage from the federal Medicare insurance program and private insurers.
Many of those rules have been put on hold until the national emergency ends. The Centers for Medicare and Medicaid Services, which operates the federal Medicare insurance program, has announced it will reimburse providers the same amount for telehealth services as it would for in-person visits. Several private insurers have waived co-pays on phone and internet visits.
Privacy laws also limited telemedicine access. But regulators have said they won’t penalize health providers for using platforms such as FaceTime that don’t meet health privacy laws to consult with patients until the national emergency declaration ends.
“We’ve really moved about 20 years in regulation and policy around telehealth in the past three weeks,” Edison said.
The immigrant health clinic Casa de Salud had never seen patients through telemedicine before, said President Diego Abente. But on March 11, a patient appeared at the St. Louis clinic who had a presumed case of COVID-19.
“We had our first taste of what it might feel like to be an in-person clinic in the middle of a pandemic, and we realized quickly that our facility just wasn’t set up to safely treat folks that were potentially carrying COVID,” Abente said.
Within five days, the clinic had started meeting with mental health patients over the phone. Soon after, the clinic started using telemedicine for all its patient visits.
The transition was more difficult than it would be for a traditional clinic, Abente said. Many of Casa de Salud’s patients don’t speak English, and some don’t have reliable access to high-speed internet. The clinic needed to find a way to meet with patients over a phone line that allowed an interpreter to conference in.
The clinic eventually “cobbled together” multiple software programs such as Zoom and Microsoft Teams to allow for calls with many people, Abente said.
“Being able to connect that to our clients and patients over the phone took a little effort,” Abente said. “Once a couple of patients and clients had that experience, they started to communicate with other communities and let them know this is actually a good alternative.”
Haven Recovery had a similar rush to set up telehealth at the residential center for people with substance use disorder, founder Callan Howton said. Most people at Haven visit counselors and other providers to receive addiction treatment.
“It was definitely fast, within three to four days,” she said.
The center bought tablets using money it received from the Gateway Regional Response Fund, which has funneled charity donations to nonprofits affected by the coronavirus. Now 95% of Haven residents are meeting with counselors using the tablets.
“In-person is the last resort, and telehealth is the new norm,” Howton said.
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