As the coronavirus pandemic drags on into a third month, patients across Minnesota have become increasingly reliant on telemedicine.
Locally, Mayo Clinic Health System has dramatically increased their use of telemedicine, where physicians conduct office visits via video chats. The Rochester-based outfit, which serves more than 60 communities throughout Iowa, Minnesota and Wisconsin, has instructed its providers to utilize telemedicine whenever possible.
Similarly, Allina Health, which operates District One Hospital in Faribault as well as Owatonna Hospital, now conducts more than 60% of its appointments online, compared to less than 1% before the pandemic.
Allina’s new emphasis on telemedicine is at the heart of its newly launched Virtual Care Campaign, which seeks to reassure patients that it’s safe to receive medical treatment even as COVID-19 continues to ravage communities Allina serves.
Across the state, medical institutions like Allina Health have seen significant decreases in the number of patients seeking essential care. Those patients who do come in are often very sick, facing severe complications and a long road to recovery.
Fear of contracting the virus is certainly understandable. According to the Minnesota Department of Health, 295 Rice County residents have tested positive for COVID-19 as of Wednesday, putting the county in the top five counties for case count outside of the seven-county Twin Cities metro.
Nonetheless, Dr. Amy Elliot, who serves as Director of Medical Affairs at District One, strongly urges patients to seek the medical care they may need, and not to wait until they’re even sicker. She said that if in-person care is necessary, Allina Health staff work assiduously to keep patients separate. In addition, Allina staff work round the clock to keep their facilities clean, and staff, visitors and patients are expected to be masked at all times. Patient-facing staff wear a mask and face shield, while patients are given cloth masks.
“As care providers, we don’t want people skipping care because they’re worried about getting infected,” she said. “We’re trying to offer lots of ways to help people get around the risk.”
However, Elliot said that patients can receive a surprisingly wide range of care via telemedicine, enabling them to avoid having to leave the comfort and safety of their own home. For patients in rural areas, that can save not only peace of mind but time and money as well.
While the technology enabling the significant shift to telemedicine has been in place for years, most providers have preferred to stick with face-to-face appointments. In addition, Medicare and other health insurance often haven’t reimbursed care providers for virtual appointments.
On both counts, change has come rapidly. On March 30, the Centers for Medicare and Medicaid Services announced that it would reimburse physicians for telehealth visits at the same rate as for in-person visits.
Effective March 1, the change covers checkups and medical care provided for any reason, not just coronavirus care. Medicare also expanded access by scrapping a rule that required all telehealth visits to take place on devices meeting federal online privacy and security standards.
U.S. Sens. Tina Smith and Amy Klobuchar feel that doesn’t go far enough. Together, Minnesota’s two senators introduced the Health Care at Home Act last Friday, with the backing of the National Alliance on Mental Illness, the American Psychiatric Association and other organizations. The bill is designed to reduce the gap in coverage for telemedicine visits in comparison to in-person visits. It also prohibits restrictions as to which particular medical issues are eligible for telemedicine reimbursement.
Other restrictions existed at the state level, including limits on the number of reimbursable telemedicine visits per week and a requirement that telemedicine appointments be conducted over video chat rather than by phone.
Maisha Giles, the Minnesota Department of Health’s behavioral health director, said her agency has worked rapidly to help care providers across the state adapt to telemedicine. In addition, she said, the department has provided flexible grant funding for providers.
Thanks to that support, care providers like Fernbrook Health Center have been able to rapidly switch to a telemedicine-based model. Fernbrook, which has six offices in southern Minnesota, barely utilized telemedicine before the crisis but now uses it almost exclusively.
Peter Miller serves as a psychiatrist and medical director for the Community-Based Services in Direct Care and Treatment for the state, providing crucial services for people dealing with mental illness, developmental disabilities and chemical dependency.
Faribault is one of five communities in the state which has a community clinic through the program, known as Southern Cities Clinic. It provides crucial care to patients with developmental disabilities, severe mental illness or traumatic brain injury.
Since the pandemic hit, Direct Care and Treatment’s clinics have been closed but have continued providing consultation via telemedicine. Miller said that is likely to continue even once the pandemic lifts.
“It’s been very well received,” said Miller. “We’re hoping to keep doing the same thing once we get back to a more normal schedule.”
Miller said that DHS is examining how teledentistry could be used in the long term to help dentists treat their patients. He said he’s excited to see the state expand its telemedicine services to serve patients in a convenient, yet efficient manner.
Bryan Carleton, a registered nurse who treats Psychiatric Patients at Southern Cities Clinic, said that the clinic had experimented with providing telemedicine for years as a way to help homebound patients.
Just before the pandemic, Southern Cities began experimenting with “E-Prescribing,” submitting prescriptions to pharmacies electronically. Thanks to that and other trials over the years, he said his department was as well-prepared as any.
“When the pandemic hit, we had the tools and experience we needed to hit the ground running,” he said.