‘There’s no place like home’: Speaker reviews telehealth during COVID-19 pandemic
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A speaker at the virtual Global Innovations in Patient-Centered Kidney Care: International Summit reviewed the benefits of telehealth, which was expanded by CMS in March as a response to the COVID-19 pandemic.
Janice Lea, MD, MSc, FASN, professor of medicine and director of telenephrology at Emory University, first defined telehealth as an “umbrella term for all services that utilize some type of technology” and telemedicine as that which centers on clinical services for patient care.
“We’ve been in a very serious pandemic that has limited a lot of contact in all areas of our lives, including medical appointments,” she told the audience. “There’s been an urgency to expand the use of technology to help people who need routine care and, at the same time, to keep vulnerable persons and those with mild symptoms at home while maintaining access to the care they need.”
With the implementation of the 1135 waiver (also known as the CARES Act), CMS allowed for Medicare to pay for hospital, office or other visits that were conducted via telehealth across the country. According to Lea, prior to the waiver, the patients’ place of residency determined ability to access telehealth services; only patients living in rural areas were covered for these visits and sometimes the patient would still need to travel to a nearby clinic to remotely interact with a physician. Now, visits can occur in the home and Medicare beneficiaries can also undergo medical health counseling and preventive health screenings. Virtual check-ins (5- to 10-minute phone calls between the patient and physician), electronic visits through an online portal and inpatient remote consultations are all part of the expansion of telehealth, Lea said.
She emphasized the value of doctor-patient interactions conducted via telehealth while the patient is hospitalized, noting that facilities can use less personal protective equipment (PPE) and limit potential exposure to the virus for both patients and physicians.
Another benefit for physicians, Lea said, is that they are reimbursed for these telehealth visits at a rate equal to physically seeing patients in a room.
In addition to the benefits of telehealth in these realms, Lea addressed using telehealth for outpatient dialysis visits.
She said this CMS allowance is worth noting because dialysis personnel have never before been able to conduct their rounds via telemedicine.
As for a typical telehealth dialysis visit, Lea said the nurse talks to the patient using a platform (such as FaceTime or Zoom; her center uses iPads) and conducts key physical exams (eg, checking legs for signs of edema or looking at vascular access). The nurse may also use an electronic stethoscope, which Lea said is not widespread but is available, to examine the heart and lungs. Lea then has a nurse direct the camera to the dialysis machine so she can monitor blood pressure, see how much fluid is being removed and to determine if there is any cause for concern (such as blood flow not meeting target goal).
The rounds are interdisciplinary, with dieticians and social workers participating in the visits as well.
“Patients are getting the full service of what they’re used to but in a remote fashion,” she said.
According to Lea, dialysis visits via telehealth provide similar benefits to hospitalized patients interacting remotely with their physicians by preserving PPE, reducing medical staff exposure and minimizing exposure of patients to health care workers (many nephrologists, she noted, are still working at hospitals where they may be exposed).
Although Lea said the trajectory of this pandemic remains uncertain, she sees this as a good opportunity to perfect the telehealth process so that it can be smoothly applied, if necessary, in the future.
“We’ve all learned from this pandemic that there is a lot that can be accomplished at home and that it is possible for patients to access [quality] health care,” Lea concluded. “As Dorothy says in the Wizard of Oz, ‘There’s no place like home.’”
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Lea J. Session 2. Presented at: Global Innovations in Patient-Centered Kidney Care: International Summit; July 16-17, 2020 (virtual meeting).
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