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Telemedicine videos go from 80 to almost 8,000 this month at one health system

ProHEALTH Dental often handled patient concerns and emergencies

ProHEALTH Dental often handled patient concerns and emergencies via phone, but now is doing more video, said Dr. Bruce G. Valauri, chief dental officer and director of prosthodontics and a Lake Success dentist. Credit: ProHEALTH Dental

Telemedicine has exploded in popularity in the COVID-19 era, as concern about infection has led to a spike in remote video visits to the emergency room, doctors’ offices and dentists, a shift medical professionals predict will continue post-coronavirus.

“You’re never putting that genie back in the bottle,” said Kenneth Long, vice president of administration at Mount Sinai South Nassau hospital in Oceanside.

Throughout the Manhattan-based NYU Langone Health system, which includes NYU Winthrop Hospital in Mineola, the number of daily video visits increased nearly hundredfold, from 80 on March 1 to almost 8,000 this month, said Dr. Paul Testa, the chief medical information officer.

Most virtual urgent care visits since early March have been for complaints of cough and fever — common symptoms of COVID-19. A video interaction can determine whether the patient should be seen in person, Testa said.

“I can see you’re having respiratory discomfort. I can see that you’re working at breathing,” he said. “That’s the trigger to say we’ve got to get this person to the emergency room.”

Before COVID-19, relatively few patients used telehealth. In 2018, only 2.4% of enrollees in large employer health plans had a telehealth visit, according to an analysis released March 3 by the Kaiser Family Foundation, a San Francisco-based nonprofit that focuses on health policy.

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That’s partly because patients felt more comfortable seeing a doctor in person and weren’t sure they could get the same level of service via video, said Matthew Rae, associate director of Kaiser’s health care marketplace program.

Cost also was an issue. Some telehealth services are cheaper than in-person visits, but those often are through third-party vendors that employers contract with, Rae said.

For familiar local doctors and hospitals, insurance coverage was inconsistent, Testa said. When insurance companies paid, it typically was at a lower rate than an in-person visit, even though expenses were similar, Long said.

Medicare offered coverage only in very limited circumstances. Then, on March 6, in an effort to reduce the spread of the coronavirus, Medicare began broad coverage of telehealth, at the same rate as in-person visits. Insurers followed Medicare’s lead, Testa said.

New York on March 14 began requiring insurance companies to waive copays for telehealth services.

In addition, the COVID-19 crisis led to a loosening of rules on how secure equipment must be. Now, Medicare allows a simple FaceTime or Skype interaction.

The broadening of Medicare coverage is only for the COVID-19 public health emergency. The hope is that, post-COVID-19, the wider coverage will continue, said Iris Berman, vice president for telehealth services at New Hyde Park-based Northwell Health.

Some appointments, such as those requiring physical touch, will always have to be in-person, she said.

But, for example, a follow-up for a concussion “is really ‘how are you walking, how are you feeling, hold your hands out, how’s your vision,’ ” she said. “You don’t need to be in a doctor’s office for that.”

The convenience of telehealth means patients are more likely to keep preventive care and follow-up appointments, leading to better health outcomes, she said.

PM Pediatrics, a Lake Success-based chain of urgent care centers, expanded its telehealth program to New York last month, said Dr. Sheryl Cohen, a Nassau County pediatrician and the company’s vice president for Northeast clinical operations and telemedicine.

Patients have had concerns ranging from pink eye and stomach aches to seasonal allergies and sprains, she said.

Parents use an app with a secure portal where they can download photos of their child’s physical symptoms and injuries. Then they connect via video with a doctor who also can view and speak to the child. If it’s an illness that does not require a visit, the doctor instructs parents on treatment and, if needed, writes prescriptions.

“We are able to keep at home about 95% of the patients we see on telemedicine,” Cohen said.

ProHEALTH Dental often handled patient concerns and emergencies via phone and now, with video, “I would ask the same questions I would ask over the phone, but they can show me something in their mouth or on their face,” said Dr. Bruce G. Valauri, chief dental officer and director of prosthodontics and a Lake Success dentist.

Dr. Collin Brathwaite, the chairman of surgery at NYU Winthrop and a specialist in bariatric and abdominal surgery, said many pre- and post-surgery appointments don’t require an in-person examination.

"I can look at the patient, have them press on the abdomen and tell me where it hurts," he said.

Some of his patients drive from as far as the East End of Long Island or Westchester County for relatively short appointments, he said.

“That’s why patients love it,” he said of telemedicine.

A patient of Brathwaite, Sabrina Gilmer, 36, of Shirley, is preparing to have gastric bypass surgery once the state’s ban on elective operations is lifted. She is happy her 30-minute monthly visit with a nutritionist is now via video.

Discussions on healthier eating, weigh-ins and other parts of the visit can easily be done by video, without her having to worry about bringing her 7- and 9-year-old sons with her. With them there, “I wouldn’t be able to focus on what I have to focus on,” she said.

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