“There was a time at which 100,000 video visits was considered a pretty important milestone,” said Ethan Booker, an emergency room physician and medical director of Medstar’s telehealth innovation center and video visit programs. “And so to be at five times that number is to my mind — someone who’s been doing telehealth now for five years — just an astronomical number.”
Telehealth visits became a central part of trying to manage the spread of the novel coronavirus, with many hospitals and medical offices expanding their online capacity so patients who were under shutdown orders or concerned about exposure could still receive care.
Both local and federal officials temporarily eased telemedicine restrictions to ensure that people had access to remote appointments, with the Centers for Medicaid and Medicare Services granting waivers to make telehealth more accessible and easier for insurance coverage.
At one time during the pandemic, MedStar Health — which includes physician offices, urgent-care centers and 10 hospitals in the D.C. region — offered about 4,500 visits a day, compared with an average of seven a day before the crisis, officials said.
With some restrictions eased, telehealth video visits now make up 15 to 20 percent of the system’s outpatient visits, with providers offering about 10,160 visits a week in October. Such visits could spike again as the number of coronavirus cases creeps up throughout the area.
MedStar Health began using virtual care 10 years ago and has expanded those offerings in recent years to include urgent-care visits as well as less pressing medical care.
In that first decade, MedStar providers learned the importance of sending patients reminders before their appointments, as well as an online tool to make sure they could connect with their providers from their electronic devices, Booker said.
At the time of the virtual appointment, patients receive a link via email or text message; the video experience starts as soon as the link is clicked. And just like an in-person visit, a medical assistant speaks to the patient first — not only to ask general intake questions but also to make sure the connection is solid.
“We had all of the technologies to do this, and many people, certainly within the health system, had a lot of enthusiasm for the ability to do telehealth, and certainly we heard from subsets of patients who very much wanted it,” Booker said.
At the same time, he said, it’s important to think of telehealth “as a complement to the overall toolbox that we have for delivering care and not thinking of it as a substitution.” Surgeons, for example, may still choose to inspect patient’s incisions in person.
Telehealth allows providers to touch base far more frequently with their patients, Booker said, an ease of communication that can be crucial. Many adolescents with diabetes, for example, are making the transition from parents taking care of their illness to managing it themselves, which makes the ability to easily communicate with their pediatric endocrinologist that much more important.
And while patients with hypertension might initially meet their doctor in person to manage their blood pressure, including for laboratory tests, telemedicine allows them to go home with a blood pressure cuff and then send data to the physician regularly.
But whether telehealth will continue to be used this often depends on what rules stay in place once the health crisis eases.
“A lot depends on what happens with the regulatory and reimbursement framework,” Booker said. “For a lot of individual doctor’s offices and for health systems, including our health system, if the payment structure doesn’t allow us to continue to do this work, it’s going to be very hard to do this work in all circumstances.”