Telehelp in the time of coronavirus

In the wake of the COVID-19 pandemic government agencies, insurance companies, and healthcare facilities loosened the restrictions on providing initial and follow-up appointments for new and established patients. In particular, the use of the telephone to provide services. This enabled medical, mental health practitioners as well as support personnel to continue to provide help to those in need. Codes for billing were amended, progress notes required a statement to the effect, “in person visit not available due to COVID-19,” and all sections of the submitting document had to be completed (even those that normally require a hands-on or visual assessment, like vital signs). As can be imagined, there were advantages and disadvantages to these procedural and process changes. Yet telemedicine, telehealth, teladoc has been around a while since it’s first mention in an 1879 article citing doctors using the telephone to cut down on office visits. But more recently telehealth started to gain footing in the 1960’s, and has become more in vogue in the 21st century due to the shortage of physicians and practitioners (for the most part) in rural areas of the country.

As a mental health provider these past three months, there are three notable advantages I have found to telephonic communications with established patients:

1. Reduction in no-show rate — in general, a no-show rate averages 30% for medical and mental health in person appointments. This not only cuts into revenue, but wastes the provider’s time that could be better spent caring for people in need. Patients with no available transportation, no resources for bus or Uber fare, or working full-time and unable to take time off — are more easily contacted for routine follow-up visits over the phone.
2. Flexibility/fluidity/convenience (for provider and patient)— a phone visit can be set on a usual schedule; however, if an attempt is made at the appointed time, and call goes to voice mail (some cell phones have restricted access for unknown numbers) a message can be left to either call back to reschedule (main office number — provider number is blocked) or that the caller will try again at another specific time. The provider then can proceed without delay to the next call on the list. She/he can also has the flexibility to try to call multiple times throughout the day (if so inclined). In my experience these last months, I have had some zero no-shows days.
3. Reduced overhead — with the addition of phone visits that can be placed from any locale (home, for instance) there is less need for dedicated provider office space, support staff, and equipment — other than a secured system (Doximetry, LifeSize, etc. that also has video/visual capability) downloaded to phone, and a laptop. E-scripts can be sent to pharmacies (some are now providing home delivery of medications to complement phone visits), confidential, encrypted e-mails sent to schedulers for further appointments, and three-way teleconferencing can be done if interpreters/translators or immediate consults are needed.

On the other hand, there are some distinct disadvantages to these types of visits. I’ll offer three from my recent experience:

1. The importance/seriousness of the appointment time itself — not answering a call because napping, haven’t awakened yet, or in the bath or shower at the time of appointment. Answering but out shopping, driving in a car, or at work in a noisy warehouse. In my experience, phone visits seem to be taken more casually than an office visit where you actually have to show up on time. They also tend to be shorter in duration. Some people don’t seem to feel comfortable talking for long periods of time over the phone — especially about private, health matters.
2. Reduction in billing/collectible amounts — in short, phone visits (codes) generate less revenue for the agency/provider. To be feasible in the future phone visits billing rates would have to be on par with office visits.
3. Updated demographics — having the most recent telephone/contact number and that of emergency contact (if can’t get in touch with patient after sometimes repeated calls) is imperative. Some people switch cell phone plans/ numbers on a regular basis for one reason or another; it’s not like in the past when landlines were less likely to be changed — even with a move one could usually keep the same number.

Telemedicine via encrypted, protected Skype-type software is here to stay. However, this service requires either the patient still come into a dedicated office space with support personnel assisting with the logistics, or requires the patient to have access to a laptop with internet access or a smart phone with video capabilities and/or the ability/capability to navigate both. Going forward, regardless of cited disadvantages, incorporating telephone contact as a continued option offer benefits to both the provider and patient. However, I would recommend for use only for established patients, not new patient assessments/evaluations.