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New Normal: Telehealth becomes standard practice

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Courtney Pedersen
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Dr. Jinu Puthenparampil demonstrates how MidMichigan Healthcare utilizes doxy.me July 20.

During the COVID-19 pandemic, doctors appointments joined the ranks of school and work as things most people no longer had to wear pants to.

As the world starts to open up, many health professionals are still seeing some patients via telemedicine while others are starting to come in-person more.

When COVID-19 shut down most businesses and forced operations into virtual settings, health insurance providers had to pay for services they didn’t have to before, including telemedicine.

Dr. S. George Kipa, deputy chief medical officer for Blue Cross Blue Shield of Michigan, said before COVID-19, less than 10 percent of primary care providers were actually offering telemedicine. Since the pandemic, it is nearly 80 percent.

“When COVID hit it (telehealth) became a lifeline not only from patients who were scared to go to the doctor's office, or, you know, access was obviously like the person the doctors suddenly had no income unless they provided by telemedicine," Kipa said. "So the fact that we were able to pay them for telemedicine and much of this was already in place was really extremely helpful."

Telemedicine has been around in Michigan for nearly two-decades.

Doctor Kipa said Blue Cross Blue Shield started to pay for some virtual appointments in 2002. Medicare started paying a year before. But the appointments had to follow very specific rules… the patient had to live in a rural area and they had to attend their appointments at a designated location… often a doctor’s office. At the time telehealth was mainly used for connecting with specialists through a very limited network.

Today the network is wide open. Patients have the ability to visit their doctor from the comfort of their own couch.

But virtual visits have their downsides, including a bad WiFi connection, an app crashing or acting up.

Dr. Jinu Puthenparampil, a physician at the MidMichigan Medical Center in Mount Pleasant, said there are times he can't hear the patient, but they may be able to hear him or vice versa.

“There have been times where mid visit, we have to change it to a phone call just because sometimes they couldn't hear us, they couldn't see us, we couldn't communicate very well," Dr. Puthenparampiol said. "Usually my staff gets the patient on the video call and just makes sure everything is okay before the call and the visit actually starts."

In addition, there were patients, primarily those who did not grow up with technology, who struggled with online appointments.

April Missias, director of Leelanau County Senior Services, said it was mostly seniors who did not have internet technology that struggled.

"A lot of the seniors who have the technology, or have internet, they're able to, they're able to navigate that pretty well," Missias said.

She said it was challenging when seniors couldn't get out to see doctors and didn't have that technology to facilitate a virtual meeting or an appointment.

Telemedicine brought new challenges when it came to protecting private health information.

Dr. Kipa with Blue Cross said the Health Insurance Portability and Accountability Act rules were relaxed during 2020, with some doctors even using FaceTime. But today providers must use technology that protects privacy.

An entirely new side of challenges arose in terms of treating mental health care virtually. Some people who have done virtual therapy visits from home have faced more struggles than just faulty technology.

Dr. Larissa Niec Davila, the Director of the Center for Children, Families and Communities at Central Michigan University, said there are a lot more distractions including phones, TVs, pets, siblings and parents in the home environment.

“As a therapist, you can't control the environment," Niec Davila said. "Families may be in small living situations, so there's not privacy."

Another downfall of telemedicine is regular physicals and tests have been delayed due to not being considered essential procedures.

Jeff Meden, the regional director of operations for the MidMichigan Physicians Group, said healthcare professionals started to see negative consequences from people missing things like mammograms and colonoscopies.

"We're starting to see a lot of people return now for those preventative visits, and from what I'm hearing from hospitals and staff and other peers is there's a lot of people that are sick, prartially it could be due to a delay in care also," Meden said. "The total rates of people infected with COVID are going in the right direction, but a year or two of not having good preventative medicine and health care is going to take its toll.”

The longer it’s in use, telemedicine continues to grow. It started as only being used for acute care, like the flu or a cold, and is now addressing more chronic care capabilities, like diabetes.

As the COVID-19 pandemic ends and technology continues to advance, many experts say telehealth will continue to be a tool doctors use.

Dr. Christine Nefcy, chief medical officer for Munson Healthcare, said she believes telehealth will remain an integral part of how health care is provided in the future.

She said it took a pandemic to prove that telehealth can be convenient for patients and cost effective for providers.

“I think, payers realize it is actually kind of cheaper for everybody to do it that way," Dr. Nefcy said. "You don't have to take off work, you don't have to drive, we don't have to have a big office space, we just need an office for the physician to sit in there, we don't have to have a waiting room.

Dr. Nefcy said that all of those little things add to the cost of the provided care.

A Harris Poll conducted with American Well found that 76 percent of respondents indicated they were likely to continue using telehealth after COVID-19.

And although, the future of virtual visits is unknown, the cost and time benefits seem to have professionals as well as patients hoping it sticks around.

This story is part of the Michigan News Group Internship. A collaboration between WCMU and eight newspapers, including Leelanau Enterprise.