In March 2020, Dr. David Rich planned to use vacation time to tackle some projects at home, but that didn’t go very far. In the middle of the month, with the Coronavirus spreading rapidly across the United States, the federal government declared a national emergency. Within a week, organizations from all industries closed their doors.
“We realized we needed to find alternatives,” says Dr. David Rich, director of medical information for the health system at West Virginia University.
WVU Medicine had a nascent to consumer telehealth program serving staff and some post-operative patients. “Because of the payment issues, I don’t think we can call them more than pilots,” says Shannon McAllister, assistant vice president of Population Health and Telemedicine.
But WVU Medicine was able to immediately expand the telemedicine infrastructure it recently completed. “There was no trial and error. We managed to change the situation and 95 percent of our suppliers lived in less than a month,” he remembers. They went from 25 telemedicine visits at home in the whole of 2019 to 50,000 in April 2020 alone.
The rapid switch to telemedicine has proven challenging even for large urban hospitals, but it has been particularly daunting for those who live in rural areas, where budgets are often smaller and need larger due to higher poverty rates and patients with chronic illnesses. Rural hospitals face the additional challenge of low rates of high-speed broadband in their communities, making telemedicine efforts more difficult.
But healthcare organizations that increased the demand for telemedicine during the start of the pandemic are now exploring ways to build permanently on this basis so that they can improve access to healthcare in the areas that need it most.
“Looking across the country how people have mobilized quickly for this, I think this is a great example of how healthcare technology can make a difference,” says Rich.
Telemedicine Gives Rural Hospitals a ‘New Lease on Life’
Telemedicine offers more than the hope of replacing personal care; By providing greater access to more accessible professionals and routine exams, care can also be expanded in remote areas.
“Before the outbreak of the pandemic, rural hospitals were struggling financially and closing at a faster rate than ever,” says Niraj Buru, assistant professor of health management at Florida Atlantic University. “The adoption of telehealth technology has given the rural hospital itself a new lease of life.”
The potential of telemedicine has long been recognized, but obstacles have slowed its growth, including lack of demand from patients, resistance from doctors and unwillingness from insurers to compensate for many telemedicine services, according to a report last June from Pure Y Scott Feyereisen, associate professor in the FAU Health Administration. But they believe that expanding telemedicine during the pandemic helped reduce these obstacles.
Several developments in the last year have accelerated the adoption of telemedicine. The Coronavirus Relief, Relief and Economic Security Act addressed infrastructure issues by providing millions of dollars to fund rural broadband loans and grants and telemedicine services and devices during the pandemic. The Centers for Medicare and Medicaid Services (CMS) added 144 telehealth services to its coverage, 60 of which will continue to be available to rural areas after the pandemic.
Meanwhile, patients’ demand for telemedicine has increased in the past year. Due to concerns about exposure to COVID-19, 2 in 3 people who responded to the IDC survey in September said they had postponed critical medical care, which includes everything from routine care to emergency visits. Telemedicine has restored access to care without the risk of exposure, says Lynne Dunbrake, vice president of the IDC Public Sector Group.
“I call the pandemic our unfortunate opportunity,” says McAllister. “For our providers and our patients, even if it was not comfortable, it was more comfortable than coming to the clinic in person, and everyone was more willing to try it.
How to Expand Telemedicine Offerings for Remote Facilities
This was the goal of WVU Medicine in 2018, when it began its telemedicine program: to provide options. But it had limits.
Before the pandemic, CMS only reimbursed telemedicine costs in areas of healthcare deprivation, and WVU medical hospitals were close enough to cities in neighboring countries that they were not eligible.
That being said, WVU Medicine wanted to provide specialized consulting to its remote facilities, such as the 20-bed Critical Access Hospital in Keyser, Virginia, more than two hours from Pittsburgh and Washington, DC, so it began exploring alternative ways to support the cost of telemedicine. “We used to keep people from going to the emergency department and save that cost there,” says McAllister.
The health system has opted for a telemedicine platform integrated with the Epic electronic medical record system, so that patients can initiate visits through their MyChart accounts. Clinicians can use an iPad Pro or their own desktop computer with a webcam or monitor with a built-in camera; Or they can use a cart. In the fall of 2019, WVU Medicine established two standardized telemedicine vehicles.
The first cart contains a 12.9-inch iPad Pro with an optional Jabra Speak 510 speaker and stand. The second is a Capsa M38e powered car, a Lenovo ThinkCentre M920 computer with a Jabra Speak 510 or 710 speaker, a Logitech PTZ Pro 2 camera and bracket, and a Lenovo ThinkVision 24-inch or Microsoft LifeCam monitor. Strollers also have digital binoculars, dermatoscopes, and stethoscopes.
The impact of the epidemic on rural health institutions will continue to evolve, but for WVU medicine, the plan is to keep telemedicine a valuable practice. “Hopefully in the future we will not have to recover much of this,” says McAllister.