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A year ago telemedicine was rare and few doctors relied on it, now virtual consultations are changing the trajectory of medicine.
A year ago, Dr. Tarun Mathur knew next to nothing about telemedicine. To one of the region’s top-rated cardiologists, the subject was peripheral at best. “I didn’t need it,” Mathur admits. “Telehealth was completely foreign to the docs in my practice.”
Mathur’s practice, Bryn Mawr Medical Specialists Association, is a multidisciplinary health network and one of the largest on the Main Line. And its reluctant embrace of telemedicine wasn’t unique to the region. Dr. Sharayne Mark didn’t consider telemedicine a necessary tool. “For all of the modern technology we use in our practice, we relied on the traditional in-person patient visit,” says Mark, a cardiologist with Penn Medicine’s Chester County Cardiology Associates in West Chester and Downingtown.
When the pandemic began, doctors had little choice but to move to telemedicine for patient visits. “The day we were told we could start telemedicine, BMMSA looked into the technology and found a platform that was compatible with ours,” says Mathur. “The first few days, we were using IT support all the time. But we figured it out as we used the system.”
Mathur and other doctors now consider telemedicine indispensable. Though COVID mitigation restrictions have eased, Mark will continue to use telemedicine to monitor patients. “With video appointments and sometimes even just a phone call, we can get a lot done and be of service to our patients,” she says.
Still, cardiologists emphasize that telemedicine is for routine care only. Those experiencing symptoms of heart attack or stroke should go to the nearest emergency room. “Patients are still hesitant to come to the ER,” Mathur says. “They’re having heart attacks at home.”
Many are afraid of COVID-19, but the truth is that hospital-related transmission rates are quite low. All medical personnel wear full PPE, and ERs are routinely sanitized. “It’s a risk evaluation situation, and the risk of COVID is very low compared to the risk of permanent damage or death because of an acute cardiac situation,” Mathur says.
Preventing acute situations is one of the goals of telemedicine appointments. Physicians have patients take and report their blood pressure, pulse and other measures of cardiac health. For older patients in particular, it’s a great option. Typically, some would need an ambulance or other specialized medical transportation to get to a doctor’s office. “Now they use telemedicine and we can monitor them more often,” says Mathur.
The question is why so many physicians were late to the telemedicine game. “We were trained a certain way,” says Mark. “It didn’t exist when were in medical school.”
Health insurance was another big obstacle. Until the pandemic, most insurance companies didn’t offer universal coverage for telemedicine appointments. The same was mostly true of Medicare, which only covered telemedicine visits in limited ways—like when care was difficult to access. That disqualified many patients in Chester, Delaware and Montgomery counties, where care options are plentiful.
Other rules involving what platforms and portals patients used tangled telemedicine in red tape. Faced with the potential of footing the whole bill for a doctor’s appointment, many opted for in-person visits or decided to forgo care altogether.
Independence Blue Cross enhanced telemedicine coverage back in 2016. In March 2020, it added to the specialties covered. Medicare also expanded its telehealth coverage in May, then again in October. Now, Medicare covers 144 telemedicine services, including cardiology, mental health and primary care.
When COVID hit, a surge of patients across the country took full advantage of expanded telemedicine options. Health Affairs noted an immediate surge in nationwide use of telemedicine this past spring. The national medical journal reported that, before the pandemic, about 13,000 Medicare beneficiaries were receiving telemedicine services in a typical week. That number skyrocketed to nearly 1.7 million beneficiaries in the last week of April. According to the Centers for Medicare & Medicaid Services, over 12.1 million Medicare beneficiaries took advantage of telemedicine services between mid-March and mid-August of last year.
Right now, the Medicare and private insurance extensions are still considered temporary. Mathur, for one, believes it should be permanent. “I’m hoping that extended coverage doesn’t go away,” he says. “I think a good chunk of patients have benefited from being seen and heard through telemedicine.”