Beaumont resident-physician Dr. Teresa Colelli conducts a video visit with a patient.

Beaumont resident-physician Dr. Teresa Colelli conducts a video visit with a patient.

Photo provided by Beaumont Hospital


Telehealth numbers rise drastically during COVID-19

Future usage to depend on tech and insurance coverage, doctors say

By: Nick Mordowanec | C&G Newspapers | Published January 12, 2021

 From left, Drs. Rajeev Sehgal, Roland Brandt and Michael Fleischman stand inside Straith Hospital for Special Surgery.

From left, Drs. Rajeev Sehgal, Roland Brandt and Michael Fleischman stand inside Straith Hospital for Special Surgery.

Photo provided by Straith Hospital

METRO DETROIT — The COVID-19 pandemic has forced not only hospitals and medical practices to reassess how care is delivered, but also patients.

As almost everything at the pandemic’s onset went virtual, so did conversations between physicians and patients. Telehealth instantly went from something used sparingly to something used in droves.

Dr. Kevin Frankel, who has practiced family medicine for 23 years, works out of Beaumont Hospital in Farmington Hills.

He said that, at the beginning of the pandemic, about 95% of his clients — from 1- to 2-month-old babies to seniors as old as 95 — were seen via telemedicine due to fears of in-person contact. Some older patients required family members to help them set up the technology for video conferencing or Zoom calls, completed via the Beaumont patient portal.

Now, with numbers fluctuating again among certain age groups, the fear has surged again. Telehealth utilization has fluctuated in the Beaumont system, where Frankel’s clients favor in-person appointments by an approximately 75-25 margin. Some of his colleagues, however, have complete opposite data metrics.

“I did not use (telehealth) at all, none, before COVID,” he said. “In the first two months of the pandemic, back in March or April, probably 95% of my visits were telehealth. We were able to kind of flip over with very little reduction in patient visits to telehealth.”

Dr. Jeremy Fischer is the program director for family medicine at Henry Ford Macomb Hospital, in Clinton Township. He started lightly using telehealth in early 2019, at a time when insurance coverage varied among patients.

“It was hard to offer it to patients because they didn’t know if their particular plan covered it or if they would get stuck with the bill,” Fischer said.

Now he estimates that between 20% and 30% of patients are using telehealth visits, depending on the day. That number hovered around 90% at the onset of the pandemic, when Henry Ford never closed its office but limited in-person visits due to a lack of personal protection equipment.

Numbers dropped in the summer, as some patients wanted to see their doctors in person due to comfort or to take care of preventative care visits that had been put off.

While acknowledging that technology like this will likely be routine and improve over the course of time, Frankel and Fischer said limitations presently exist.

Currently, patients utilize telemedicine for numerous reasons: management of diabetes, asthma, blood pressure and skin rashes, as well as discussions about depression and other mental health issues. Fischer said he had patients hold phones to their throats to show possible rashes, for example.

However, the “intuitive and cerebral” aspect of care, as Frankel described, is difficult to maintain via a computer screen — things like feeling an abdomen, conducting exams, checking if a bone is broken or a ligament sprained, or looking into someone’s ears.

“The hands-on part of medicine is kind of what makes medicine, medicine. … (Telehealth) is not a panacea for health care during the COVID pandemic, but it is a tool in our toolbox,” Frankel added.

Other factors include technological prowess, as well as doctors having to perform scheduling balancing acts with virtual and in-person patients. Frankel stated that physicians around 55 years and younger tend to be more comfortable with virtual care, while older physicians likely prefer in-person care.

Fischer said his patient base has been a mixed bag in terms of technological proficiency.

“Many of our elderly patients struggled with the technology a little bit more,” he said. “Younger patients in general are more comfortable with doing virtual visits. But I’ve had exceptions at both levels.”

 

Limitations exist for certain practices
At Straith Hospital for Special Surgery in Southfield, 218 telehealth visits were conducted last March and 465 in April. From May until December, that total number was 347 between five physicians.

Orthopedic surgeon Dr. Michael Fleischman specializes in the diagnosis and management of problems with bones, joints, ligaments, tendons and muscles.

“In my subspecialty of orthopedics, there are certain limitations by not being able to examine the patient,” he said. “However, other subspecialties of medicine, such as in dermatology, much of the history and exam can be performed via telehealth. Prior to COVID-19, physicians that specialize in dermatology, radiology, primary care certainly could have found telehealth valuable for their patients.

“With that being said, I believe nearly all medical subspecialties could utilize this technology. Even in a subspecialty such as orthopedics, where a hands-on physical exam is so important, I have found telehealth to be valuable with my patients.”

He added that his relationship with patients has not been affected by virtual appointments, and he actually has found telemedicine “a very effective tool” to determine whether screenings should be performed remotely — and it saves time on both ends in cases where blood tests are required.

“For all the same reasons that technology can make our lives convenient in areas such as ordering groceries from the comfort of our own home, telehealth can be applied, as well,” Fleischman said. “Child care can be much more easily managed, if you live in an area with inclement weather, or if you do not drive at all and transportation is not readily available.”

Dr. Rajeev Sehgal, a pediatric staff surgeon, has practiced for 24 years and routinely sees patients with bone, joint and soft tissue-type problems. He is a physician who finds difficulty in telemedicine.

“For my specialty, the lack of a hands-on exam is the main deficit,” Sehgal said.

Dr. Roland Brandt, the chief of orthopedics at Straith Hospital, said video capabilities before the pandemic were not as readily available as they are now.

“During the past six to nine months, telemedicine has by necessity come into widespread use to protect both the patient and the provider from the possibility of spread of COVID,” Brandt said. “With that, the ability to have interaction with a video that protects the privacy of the patient and allows the provider the ability to actually see a patient-administered exam directed by the provider has come into widespread usage.”

He said most virtual visits in his practice are conducted with established patients who can show him the range of motion of a joint that was operated on or whether everything is OK with a recent incision.

“With a little bit of direction, I can have them self-administer an exam — which saves them a trip to the office,” he said.

Now, telemedicine makes up probably 20% of his practice.

 

The next frontier of patient care
A paradigm shift of sorts could be occurring surrounding telehealth, notably as the technology itself becomes better over time.

Fischer said follow-ups for care related to depression or anxiety can be conducted virtually, rather than having patients take time off work or school, drive across town and sit in a waiting room. Some of his patients have checked in while in their vehicles, during lunch breaks.

The biggest hindrances are insurance coverage and the state of technology, although COVID-19 has brought upon uniform coverage in many cases, while technological advancements include remotely listening to heartbeats.

“I think virtual visits are here to stay, and we’re going to kind of coalesce around what works best,” he said.

Frankel also said that once the pandemic eventually reaches the rearview, telemedicine could be utilized for purposes of ease and convenience, saving long drives for some appointments.

“You are never going to have a total conversion when people don’t see their doctors,” he said.

Brandt said it is a form of patient care that “is here to stay,” especially as advances in technology streamline the process and patients continue to demand it. Insurance companies recognize the benefits, he added.

“Just like robots have changed the way we do orthopedic surgery and many other surgeries, we will see the technology of virtual medical visits improve to the point that it may become a standard for many types of medical problems,” Brandt said.

Fleischman said the shift was “inevitable, regardless of a pandemic,” but progress in the field has been accelerated. Now, as telehealth is not the main source of doctor-patient conversation at this juncture of the pandemic, efficiency in access is more doable overall.

“Moving forward in the next five to 10 years, I do envision telehealth becoming more prevalent,” he said. “We will need to create ease of access for patients that are secure, and as physicians continue to adapt, (we need to make it) so that our telehealth visits are as comprehensive as our in-person visits. If we make it available, I do believe that this will one day be a preferred method for many patients.”