Ring, ring, your telemedicine doctor will see you now.

In a world gripped by a pandemic, medical attention is now just as likely to come through a phone camera, and not from a medical professional holding a light to your throat and asking you to say "ah."

Doctors have had access to telemedicine for decades, but COVID-19 made it prolific. Health care providers had been avoiding using alternative appointment method because it was not as profitable as face-to-face visits. The pandemic has changed that and going forward medical professionals will continue to use this way of reaching their patients.

"I view our entry into telehealth as one of the silver linings of COVID-19 pandemic," said Dr. Matt Mullane, a Mosaic Medical family practitioner. "It's time for the medical community to be investing in telehealth. It increases access to care and can make care more affordable as well."

Telehealth, or telemedicine, can be used for medical visits such as monitoring the chronically ill, psychiatric and counseling appointments, routine re-checks for medication, going over lab results or monitoring opioid addiction, Mullane said.

Amy Tatom, a family nurse practitioner at St. Charles Family Care in Redmond, kept her schedule filled with telemedicine calls while medical centers were closed to non-emergency patients during the COVID-19 containment efforts. Immediately after Oregon Gov. Kate Brown closed hospitals and medical centers, medical professionals sought to rejuvenate patient lists by combing through cancellations, patients who were no shows, patients who needed follow-ups and well-baby check-ups, Tatom said.

"With the transition of everyone staying at home, our patients evaporated," Tatom said. "We told patients that there were alternative ways to see them. We called them to make them telehealth appointments."

The telemedicine visits diverted the need for patients to seek care in emergency rooms.

"The time I have to do  outreach is beneficial because they may have trouble getting in touch with us, that could help the system that we otherwise couldn’t reach out to," she said. "Most of the time it’s two months to see me because I have a patient load.

"Through our outreach effort, I’ve been seeing 18 to 20 patients a day. I‘ve been managed to get my volume back up to pre-shutdown levels."

The pandemic forced the medical profession to travel lightyears in a span of weeks to expand telemedicine and add the technology to its doctor's bag of medical treatments. 

Looking at the numbers

At St. Charles Health System's four hospital facilities in Central Oregon, a team of about 260 providers have all known they could use telemedicine to reach patients, but it was not used with any kind of regularity, said Mike Richards at St. Charles Medical Group vice president of operation. But since the pandemic forced the medical community to eliminate all face-to-face visits except for those in critical need, the number of video and phone visits soared.

In February, the hospital system had 106 phone visits and no video visits. By the end of April, the hospital logged 6,212 phone visits with patients and their providers and 3,500 video visits.

"I expect the video numbers to keep rising," Richards said. "Telemedicine is something we wanted to incorporate into our practices as a way to supplement what we already do with face-to-face. 

"We had envisioned this as a months and years project. We were doing some work on it. The pandemic put us into overdrive, and we did a couple of weeks worth of work that we intended to do over a couple of months and years."

Even with the orders allowing in-person visits, the health system is encouraging video or phone visits where appropriate to maintain social distancing, Richards said. 

Before COVID-19 telemedicine was something that some providers dabbled in, and hadn’t really seen widespread adoption. Neither providers nor patients were really sold on it, said Dr. Steve Kassakian, Oregon Health & Science University associate chief information officer. 

Telemedicine use went from 300 calls and videos in February to 16,000 in April at OHSU, Kassakian said. About 60% of all visits at OHSU were telemedicine vs. brick and mortar. 

"Telemedicine, like anything, has its limitations and isn’t the right tool for every scenario,” Kassakian said. “Telemedicine is here to stay.”

At Mosaic, a community health center with 15 locations in Central Oregon, telehealth services allows patients flexibility and is a time-saver, Mullane said. Telehealth also cuts down on no-shows because of transportation issues or having to take off time from work.  

"It can be a lot more convenient," Mullane said. "As we adopt more telemedicine services, we will be able to improve access to care for hourly wage earners who do not have benefits or (paid time off)."

A different skill set 

While medical professionals are skilled listeners, who have honed their ability to snag even the tiniest detail to reach a diagnosis, using telemedicine takes those skills to a higher level, Richards said. Telemedicine requires doctors to not only be active listeners but hear what is not being said and to be ultra observant.

Normally everyone would be trained in the technology and how to adapt the bed-side manners to phone or video. There is a different skill set needed for medical professionals who are used to laying a hand on a patient, Richards said. Now they have to learn how to talk to elicit the same kind of information. 

Prior to the pandemic, medical staff from St. Charles would spend hours in planes and cars traveling from Bend to remote areas to care for patients. A heart surgeon traveled by personal plane to John Day, other specialists would drive to Lakeview or Burns.

"It's a different dynamic, for sure," said Dr. Matt Clausen, a primary care doctor at St. Charles Family Care Bend East Clinic. "We’re figuring it out as we go.  It’s important to the therapeutic relationship."

It does require a new skill set, Mullane said. Medical professionals who use telemedicine have to learn how to open and close a meeting with patients, setting the right backdrop for the video session, understanding computers and remaining professional.

Overall, telehealth saves time and in many cases, works better for the patient.

"If we have an established relationship with a patient and nothing has changed with their health, then in many cases they don't necessarily need to come in for an office visit," Mullane said. "But care providers need to be cautious. If there is something different, even a subtle change, then you need to see the patient. And sometimes a patient doesn't tell the whole story. Sometimes we pick up something on an exam, like an abnormal heart rhythm, that would have otherwise gone unnoticed."

It's a question of money

Prior to the pandemic, private health insurance companies and Medicaid would reimburse telehealth visits at a lower rate than standard office visits. Richards said that patients appear to like the use of telehealth service for convenience and for the preservation of social distancing mandates.

Physicians will receive equal payments for the duration of the pandemic, but what happens after the emergency is over is anyone's guess. Keeping the reimbursements the same, since the skill needed is the same, will enable telehealth to survive past the pandemic, physicians say. It's seamless for patients, who are charged the same as if visited the doctor's office. 

"I think we want to keep this as one of our tools in our toolbox to serve our patients," Richards said. "Social distancing and the pandemic will be with us for a while. "

At Mosaic,  doctors also are finding they can maintain their schedule.

"The patients and providers are enjoying the seismic shift in health care," Kassakian said. "Always possible, but unintended outcomes. Patients will realize that it benefits them and that telemedicine makes it easy for them."

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