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Telehealth visits down, but concept here to stay, health care officials predict

Stony Brook Medicine went from about 20 monthly

Stony Brook Medicine went from about 20 monthly telehealth visits pre-pandemic to nearly 20,000 a month in spring 2020 and roughly 8,000 each month for the past year, said Kristie Golden, Stony Brook's associate director of operations. Credit: Newsday/John Paraskevas

The sharp rise in video and phone medical visits at the beginning of the COVID-19 pandemic in early 2020 has subsided, but telehealth appointments remain far more common than they were before the pandemic, health care system officials say.

"It’s absolutely here to stay," said Iris Berman, vice president for telehealth services at Northwell Health, where 10% to 20% of appointments are now telemedicine.

Convenience is the biggest draw for patients, she said. "They don’t have to lose time from work. They don’t have to travel," Berman added.

Like other health systems, New Hyde Park-based Northwell saw a surge in telehealth visits in the spring of 2020, when hundreds of New Yorkers were dying of COVID-19 every day and fear of infection with the coronavirus was especially high.

Pre-pandemic, there were only a few hundred telehealth visits per year across Northwell, the state’s largest health care system, Berman said. By April 2020, that number had soared to 4,000 to 5,000 per day. Today, she said, there are about 1,000 to 1,100 telehealth visits on a typical weekday. That number has been roughly stable for months, she said.

Other health systems report a similar trend: a sharp increase in the spring of 2020, a decrease as patients became more comfortable seeing medical and mental health professionals in person, and monthslong stability.

Stony Brook Medicine went from about 20 monthly telehealth visits pre-pandemic to nearly 20,000 a month in spring 2020 and roughly 8,000 each month for the past year, said Kristie Golden, Stony Brook’s associate director of operations.

By making a visit more convenient, telehealth increases access to health care, especially "for someone who can’t drive, someone who has difficulty with transportation, someone who lives far, someone seeking a second opinion in a region where they don’t live," she said.

It can be particularly helpful for mental health appointments, Golden said.

"When someone is feeling depressed or anxious, they may be less likely to want to leave their house," she said. After the rise in telehealth, "We saw a significant drop in no shows" for mental health visits, she said.

People with chronic medical conditions may be more likely to keep appointments as well, Berman said, because bad traffic, a sick child or work obligations no longer prevent someone from interacting with a doctor. Those regular visits make it less likely a condition will worsen, she said.

Northwell had been building in anticipation

A telehealth appointment should be similar to an in-person visit, Golden said. For example, before writing prescriptions, doctors and nurses may only need to review medical records or go over laboratory results, something that could be done just as well via telemedicine, she said.

"If a physician or nurse practitioner or physician assistant, someone who is doing that prescribing, is not comfortable based on the information they have, they’re going to ask that patient to come in person," Golden said.

Northwell already had been building up its telehealth infrastructure in anticipation of a significant expansion in telemedicine, Berman said. "The pandemic accelerated that," she said.

Paul Testa, chief medical information officer for Manhattan-based NYU Langone Health, which includes NYU Langone Hospital-Long Island in Mineola, said patients and doctors have become more comfortable with telehealth during the pandemic and recognized its benefits.

NYU Langone is looking into ways to expand telemedicine such as, for example, listening to patients’ hearts and lungs via home digital stethoscopes that can transmit sounds via patients' phones, Testa said.

Medicare's broadening of telehealth coverage was key to its expansion, Testa said. Before COVID-19, Medicare limited telehealth coverage to some services in rural areas. In March 2020, Medicare began paying for telehealth nationwide at the same rate as in-person visits, to reduce the spread of the coronavirus, and private insurers followed, Testa said.

Expenses for telemedicine are similar to what they are for in-person visits, and any out-of-pocket costs for patients would be similar, Berman said.

"You still have a licensed physician with office staff managing your records," she said. "You still have to keep the lights on."

Nationwide, 27% of Medicare beneficiaries had a telehealth visit during the summer and fall of 2020, compared with fewer than 1% pre-pandemic, according to a Kaiser Family Foundation analysis of federal data.

The Medicare change is still a temporary pandemic-related measure, but Testa, Berman and Golden hope it becomes permanent.

Biggest limitation is no human touch

At Port Jefferson Station-based New York Health, which has about 20 outpatient offices on Long Island and in New York City, "We’re trying to not push telehealth too much if patients can come in for a visit," said Dr. Razia Jayman-Aristide, the company’s chief medical officer.

Jayman-Aristide said the biggest limitation to telemedicine "is the physician/patient human touch of being able to do a physical exam. Those limitations can definitely modify your diagnoses and your next step in plan of care."

She cited a visit Wednesday with a patient who complained of abdominal pain.

"When I examined him, I was able to feel a lymph node," she said. "If I had just spoken to him over the phone, I would have treated him differently. Now that I feel a lymph node, I definitely have to send him for a CAT scan. I’m not just going to treat him with medication and say follow up in a month."

Even so, many patients like the convenience of a remote visit, and in the past several months, about 9% of New York Health visits have been by telemedicine, she said.

Dr. Collin Brathwaite, a specialist in bariatric and abdominal surgery, said people who live especially far from his offices in Garden City and Patchogue, such as patients in eastern Suffolk County and New Jersey, especially prefer telemedicine.

An in-person appointment is sometimes necessary, such as for an initial physical exam, said Brathwaite, chairman of surgery at NYU Long Island. But, he said, many preoperative appointments "can be done virtually, because it’s really more discussion with a patient, now that you’ve already assessed the physical issue."

For example, reviews of CAT scans and other imaging can be done remotely with no difference in care, he said.

What to know

Video and phone health care visits surged at the beginning of the pandemic and then decreased as people became more comfortable with in-person interactions.

But the number of telehealth visits remains far above pre-pandemic levels and is expected to remain that way, health care system officials say.

Many patients like the convenience of remote appointments, and officials say some visits can be done just as well virtually — although others still must be in-person.

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