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.

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.

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.

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