Pandemic offers new vision for telemedicine

  • Dr. Luc Shippee, medical director of Monadnock Health Partners, conducts a telehealth visit. Tim Goodwin / Monadnock Ledger-Transcript

Monitor staff
Published: 8/3/2020 3:00:36 PM

The COVID-19 pandemic has been a historic challenge for the healthcare system – exhausting staff and depleting resources. But amid the havoc, it may have sparked a golden age in telehealth.

Telehealth has existed in America for more than 20 years but has had difficulty finding its footing in mainstream medicine.

For the most part, telehealth was marketed as a special service offered to patients when their regular doctors weren’t available. Jon Michel Vore, the chief medical information officer for Southern New Hampshire Health, said his network of providers averaged about 50 telehealth appointments a year before COVID-19.

To provide medical care remotely, providers had to jump through a multitude of hoops. They couldn’t prescribe medications unless they met with the patient in real life. They couldn’t call a patient in another state because of state limitations on malpractice insurance. Even if they did meet all of these requirements, insurers usually reimbursed providers just a fraction of what they would get from in-person appointments.

However, since the pandemic closed doctors’ offices across the state, many of these restrictions were relaxed in order to keep health care accessible.

An emergency order issued by Gov. Chris Sununu required that health care providers were reimbursed for telehealth appointments at the same rate as in-person appointments during the duration of the order. The regulation that required patients and their health care providers to be in the same state was also loosened nationally.

The eased regulations gave way to a national burgeoning of telehealth use.

“Almost overnight, the health care industry had to transform how we provided care,” Vore said.

In the first month and a half of the pandemic, there was a 11,718% increase in the number of Medicare beneficiaries using telehealth. Just in the last four months, Vore said, his providers reported about 76,000 remote appointments.

Now, some legislators and health care providers are using the momentum from the pandemic to keep telehealth in the mainstream.

Peter Clark, a special assistant for projects and policy for U.S Sen. Jeanne Shaheen, said the pandemic has sparked bipartisan support for the permanent relaxation of telehealth restrictions. Several bills, including the Health Care at Home Act and the Mental and Behavioral Connectivity Act are currently in Congress, which would prohibit restrictions on the conditions that can be treated via telehealth and permanently allow mental health treatment to take place remotely.

In New Hampshire, the governor signed a bill last month that stated doctors are not required to meet with their patients in-person before they can prescribe medications or seek Medicaid coverage.

Legislators are also working to expand access to broadband to ensure patients in rural areas will reap the benefits of new telehealth regulations.

Companies like Connection, an information technology company headquartered in Merrimack, are envisioning a new and ambitious direction for telehealth.

Keith Nelson, the director of health care strategy for Connection, said telemedicine has the potential to change the way health care operates in a variety of settings, such as nursing homes, prisons, and rural areas. Patients who have historically had difficulty accessing health care could be instantly connected to a specialist based hundreds of miles away. Those seeking second opinions might not have to be limited by their geography – a patient in Minnesota could send their scans to a doctor at Johns Hopkins.

In rural areas that are isolated from large hospitals, providers may be able to set up offices staffed with nurses that follow directions from a doctor who is video-conferenced into the exam room. Patients can also look forward to autonomous robots that roll around the hospital, live streaming a doctor’s face as it makes rounds to patients.

Telehealth providers have reported positive feedback from both patients and doctors.

Some mental health care providers have seen patients who previously struggled to hold appointment times consistently show up for video calls in the convenience of their home, Clark said.

“It isn’t just related to the public health emergency,” said Tess Kuenning, the president of Bi-State Primary Care Association. “It’s been metamorphic as to how we’re treating patients.”




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