The University of Maryland Charles Regional Medical Group has been utilizing telehealth technology, a program that allows patients to schedule video calls for follow-up appointments through FaceTime, Skype and Zoom, to allow patients to receive care they need without potentially being exposed to the novel coronavirus.
Before the pandemic began, licensed physical and occupational therapists in the state were able to provide telehealth visits for patients, but insurance companies would not reimburse for the service. Over the first few weeks of the pandemic, most insurance companies changed policies to allow telehealth visits while covering them the same way as inside-the-clinic visits, according to Eleanor Wilkinson, DPT, lead physical therapist at Charles Regional Rehabilitation.
“As soon as the insurance companies started allowing telehealth, we began working on how to provide the service for the patients,” Wilkinson said. “We have now had around 50 telehealth visits and patients are finding this very helpful and enjoyable.”
Scheduling protocols were created for all specialities, including women’s health, surgical, diabetes and endocrinology, primary care and gastroenterology, according to Evalyne Bryant-Ward, director of operations at CRMC. Bryant-Ward said input was given from the respective physicians to determine what non-emergency was for their patients from their perspectives.
“Last year, due to our patients with various socioeconomic barriers to access, we implemented telehealth,” Bryant-Ward said. “After several months we were ready to go. However, the providers were not as sold on the program as they have been since the COVID-19 pandemic.”
Wilkinson said that policies for patients have changed per recommended Center for Disease Control and Prevention guidelines, the number of patients has been reduced to post-surgical and severe pain only. All others, new or follow-up, need a tablet, smartphone or computer with audio/video capability and a decent internet connection.
Wilkinson said the rehabilitation group will schedule an appointment with the patient and and send them a link to join through email or a smartphone number. The appointment has a password and specific meeting number that is randomly generated to guarantee security. The platform is compliant with the Health Insurance Portability and Accountability Act.
“We have someone contact the patients ahead of time to make sure they are comfortable with hearing and seeing the clinician,” Wilkinson said. “We also inform the patient what will be needed for the appointment, like a mat on the floor or open area, chair, weights or bands if available.”
The patient enters a virtual waiting room at the time of the appointment, and the clinician has to allow the patient into the meeting for additional security, according to Wilkinson. The appointment is performed, follow-up meetings are scheduled and the clinician ends the visit, with evaluations based on functional assessments rather than strength testing.
Bryant-Ward said that the procedures have been relatively successful so far. However, she said some marginalized patients and seniors are not able to take advantage of the services for various reasons.
“I think as it becomes more widely understood, patients will be more receptive,” Bryant-Ward said. “The appointments are convenient, thorough, and overall effective.”
Wilkinson said that initially patients were hesitant for their first telehealth visit, and she believed people were concerned that figuring out how to get the meeting together would be too difficult. She said that once patients saw how easy it was with the first visit, they have been happy to have follow up visits. Patients have commented that it is more convenient and saves time with no travel, and feel more comfortable at home.
“Just because this horrible COVID-19 pandemic is here and changing our lives, it does not mean anyone’s health problems stop,” said Wilkinson. “The longer someone waits to have a problem taken care of, the more advanced treatments may be needed later. Do not wait to get help.”
Both Bryant-Ward and Wilkinson said they believe that the telehealth method will become more commonplace in the medical industry. Wilkinson said that many medical problems can be addressed through a telehealth visit, and if a medical professional sees a problem that may need to be addressed in person, it can done with a visit.
“I have personally had three telehealth appointments and I don’t think I will ever go back to face-to-face unless necessary,” Bryant-Ward said. “The providers have adapted well. The patients who have the appointments were very pleased because of the thoroughness of the visits.”
Wilkinson said she has found unexpected benefits through the telehealth program. She said she can see exactly how and where a patient is performing in his/her exercise program, effectively making correcting mistakes easier.
“The patient can make actual corrections in the treatment session and get real time feedback, which actually seems more efficient,” Wilkinson said.
Wilkinson said the program did have some notable drawbacks, specifically that some patients require hands-on treatment to improve motion, flexibility or form. She said to combat this, she has had patients come into the clinic once a week for hands-on work and one visit at home a week. Other patients have started in the clinic and transitioned to telehealth when appropriate.
“I suggest that patients who are apprehensive, to give it a try,” Bryant-Ward said. “Telehealth improves access, is convenient, and really effective.”