Medical experts have spent years promoting telehealth as an option for rural areas with little access to in-person care.
Now, after West Virginia Gov. Jim Justice issued a “stay home” order that took effect on Tuesday, March 24, some medical providers are offering telehealth as a way to keep more people healthy at home during the coronavirus.
Dr. Jennifer Mallow at WVU Medicine describes telehealth as “the use of communication and information technology to share information.”
“We can provide clinical care,” Mallow said. “We can provide education, we can provide public health, we can provide administrative services at a distance.”
Telehealth spans several methods and types of technology, most prominently phone and video conferencing.
Mallow and Dr. Steve Davis, a WVU associate professor, are working on a pilot to provide telehealth options to patients with traumatic brain injuries, disabilities and the elderly.
Davis said he foresees elements of the project helping those who are particularly vulnerable to the coronavirus.
“The patient can [stay] at home, because we don’t want them to come in and be exposed, or expose other people, to COVID-19,” Davis said.
Virtual Urgent Care Visits, Free Of Charge
WVU Medicine is offering video urgent care appointments at no cost, for anyone more than five years old who is experiencing symptoms potentially related to the coronavirus. The WVU-owned Ruby Memorial Hospital in Morgantown also has been operating a 24-hour phone line, at 304-598-6000, option 4, since mid-March.
On Thursday, March 26, WVU reported going from six to 538 video visits in the course of three weeks. Their phone appointments experienced a similar spike, from 20 to 671 in the same length of time.
In Kanawha County, the Charleston Area Medical Center is opening up its 24/7 Care app for urgent video appointments to the public.
“As a nation, as a world actually, you’re trying to flatten the curve and get ahead of this virus,” said Rebecca Harless with CAMC’s ambulatory services.
Normally, Harless said an urgent care visit at CAMC would cost $49 out of pocket. Right now, anyone who may be displaying coronavirus symptoms can use a “COVID” coupon to get a free appointment.
“They’re able to speak to a provider, one of our employee providers, and understand where they fall, where their symptoms fall in that algorithm of, you know, ‘Am I okay to stay home?’” Harless said. “A lot of people are really scared out there right now.
Rather than everyone flood the hospitals and clinics at once, West Virginia Commissioner for Public Health Dr. Cathy Slemp recommends people stay at home if they are experiencing symptoms at a non-life-threatening level.
“If you are waiting for test results, or you are thinking you might have this, or you know you have it, you want to treat it as if you do,” Slemp said at the governor’s March 24 press briefing. “So what you do is, first, you want to stay home. If you need to go to the grocery story, someone else goes for you. At the pharmacy, you don’t want to be around other folks.”
Efforts To Loosen Federal Restrictions On Reimbursement
Slemp told the press on Wednesday she and the West Virginia Department of Health and Human Resources are working on educating providers throughout the state about telehealth, and what options providers have for implementation.
Traditionally, getting paid for telehealth has been a challenge. Regulations from the federal Department of Health and Human Services, which regulates Medicare for people 65 years old and up, only reimburse telehealth services when there’s an available video option.
This makes it difficult for most providers to offer phone-only services, which could aid elderly patients living in rural areas without reliable broadband access.
The West Virginia Bureau for Medical Services, which oversees Medicaid for low-income people and families, normally enforces the same requirement for telehealth.
According to Commissioner Cindy Beane, the state already allows Medicaid to reimburse phone and audio-only appointments, to keep more people at home.
“Truly, we’re in an emergency. We’re waiving all your normal things that you have to worry about, as providers,” Beane said. “Especially when we know that the person’s sick, we don’t want them going to the ER. We want you to call, and route them the appropriate way.”
The coronavirus response bill that passed the Senate on Thursday, March 26, gives federal officials the authority to waive the video-only requirement.
The U.S. Center for Medicare and Medicaid Services already announced on March 17 it temporarily waiving certain HIPAA requirements, such as restrictions that forbidding patients and providers from using “everyday communications technologies” such as Skype and Facetime, and other restrictions barring certain patients from taking their calls in-home, versus an approved facility.
The Struggle With Broadband
“Broadband, I mean, is an issue, pandemic or no pandemic for us,” said Williamson Health and Wellness chronic care director Amy Reed.
The Williamson Health and Wellness Center in Mingo County is a federally qualified health center that offers patients a range of services including behavioral, dental and pediatric. It recently began offering and promoting video and phone appointments to its patients who are technologically able, as Medicare and Medicaid allow.
Reed said she and others at Williamson Health have noticed the development making a difference for some.
“We know that our population, the patients that we serve, are more vulnerable, they’re more at risk,” she said.
The U.S. Census estimated in 2018 almost 19 percent of the Mingo County population was over 65 years old. That same year, the U.S. Census estimated almost 20 percent of the entire state was over 65.
The Centers for Disease Control and Prevention reports people older than 65, and those with pre-existing health conditions like HIV and asthma, are at a higher risk for catching the coronavirus than others.
“So, it’s made a huge difference in being able to provide them what they need, and not send them to the hospital, not send them to the emergency rooms,” Reed said. “We’re actually able to look at them and have those conversations.”
Reed says she wishes telemedicine was something she could offer to every patient year-round, due to the age, health needs and lack of transportation of the population they serve. But she’s worried the waivers won’t remain in place after the pandemic ends, and that these services won’t be allowed to continue.
Reed also said the health center would have more requirements to meet, as a federally qualified health center offering several types of practice, than other primary care providers in the state.
“There’s a huge risk just because, you know, you get your patients dependent on that, they see that it’s there. ‘Oh, you’re doing it now, why can’t you do it later?’” Reed said.
Davis at WVU said he hopes once the pandemic subsides, some of the changes in federal regulations will remain in place.
“As we look at sustainability,” Davis said, “one of my hopes is that, one of the good things about the COVID-19 is that we’ll come out of it and will realize, ‘ah, we can use telehealth for all of these things, and we ought to be paying for it.’”
Marshall Health through Marshall University is partnering with the Mountain Health Network in Cabell County to develop telehealth options for residents there.
Mon Health in and around Monongalia County is collaborating on services with CAMC. As of Friday, March 27, Mon Health announced that entails virtual video visits for primary care, psychiatry, behavioral health and urology with plans to expand into neurology, obstetrics and cardiology appointments.
This service requires reliable internet access and is for patients with minor medical conditions. Mon Health said Friday they are waiving associated patient fees for this service.
Emily Allen is a Report for America corps member.
