Gone are the days when a person would visit their doctor only through an in-person appointment.

In many places in the upper Midwest and across the country, patients can now receive medical advice with their health care provider over the telephone and through video conference sessions.

Patients still need in-person visits with physicians for more serious health issues, but for many less serious issues an appointment online will suffice. It was a trend before March 2020, but the coronavirus pandemic has accelerated these efforts.

Essentia Health, for example, prepared for more than a year to use video tools to better serve its patients, particularly those who live in rural settings. In mid-March, however, Essentia fast-tracked its plans and launched virtual visits to keep patients at home during the social distancing orders in an effort to slow the spread of COVID-19, the respiratory disease caused by the coronavirus.

“We knew that was where health care was going,” said Essentia Chief Medical Officer Dr. Rich Vetter. “But this pandemic has raised the issue to really a patient-safety and staff-safety issue, and so this was an ideal platform to launch it.”

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Aside from a few hiccups along the way, Vetter and others said the new service has been welcomed by patients and caregivers alike.

Physicians like it because online visits cut down on administrative tasks, and patients like it because they don’t have to leave their home to receive treatment.

Vetter shared the experience of an 87-year-old woman, just one of many, who said how much she appreciated the new service because it made her feel safe not having to leave her home to follow-up with her physician.

He said were are hundreds of other examples across the region, as the company was expecting about 77,000 virtual visits by early May. It started with only seven.

Al Hurley, the company’s chief operating officer, said he foresees virtual health care visits playing a larger role with the network in the future.

“Many of our follow-up visits tend to be of a shorter duration, like 15 or 20 minutes,” he said. “And if that patient travels 25 or 100 miles to see a specialist for a follow up … well, now they can do it at home and get the same quality of interaction and evaluation without spending that time traveling, and so there’s a tremendous value to the patient.”

Taylor Mertz, a family physician with Essentia, said the virtual visits are good for follow-up visits and consultations. He said he likes the virtual meetings because it allows him to still give quality service to his patients without all of the administrative tasks that go with it. The administrative work is done prior to the patient signing into the visit, such as filling out paperwork and answering a questionnaire. It is all done and taken care of before logging in to visit with the doctor.

Most of Mertz’s colleagues are on board with virtual visits, he said, and the few who were not excited about it are slowly being converted as they learn more about its benefits.

“We’re probably about the 80-20 rule,” he said. “We’re never going to be 100%.”

Mertz still prefers in-person visits with his patients, he said, but explained that some diagnostic treatment can easily be done virtually.

“I can’t hear a heart murmur,” he said, noting patients still should come in for more serious issues, “but I can visualize them. I can say, ‘show me your rash; show me the swelling on your leg,’ things like that. There’s a lot we can document just through the visual aspect.”

Seeing a patient in their own home environment sometimes also is helpful to physicians, he said.

Michelle Knockson, a physical therapist, said much the same thing about physical therapy patients. It’s good to walk through therapy tips – or go through whole therapy sessions – with patients in their own environment.

Through video therapists also have been able to diagnose vertigo and guide patients through exercises to help them overcome their dizziness. This exercise, called the Epley maneuver, usually needs a second person to help the patient, however, Knockson said, and so it’s good to have a family member or friend there to direct the camera to the patient’s eye and help them through the maneuvers.

CHI St. Alexius Health, which operates medical facilities in several parts of North Dakota, also launched its own virtual service in March for people experiencing minor medical issues.

“This is the first time CHI St. Alexius Health has offered a service like this,” said the hospital’s marketing coordinator, Chelsey Kralicek. “Virtual Care is great for assessing options for treatment or testing. It is not intended to replace in-person care visits, but it will help reduce patient volumes at care sites during this pandemic.”

Long term, she said the hospital plans “to continue this service after the pandemic for the convenience of our patients and community.”

At the end of March Essentia announced that it had laid off 500 employees, but Hurley said it had nothing to do with the technology application and everything to do with the pandemic.

As for the cost of virtual visits at Essentia, Hurley said it might have been out-of-pocket for what a patient would pay for an office visit, but during the pandemic Medicaid and Medicare waived those fees. He said Essentia plans to fight to keep it affordable for patients going forward.

“We certainly hope that everyone will see the value statement of this and to keep the cost of care down,” he said. “We are really going to advocate that this continues far past this pandemic.”



What about Telemedicine?

Virtual healthcare is not the same as telehealth, though it is a component of it. Likewise, telemedicine and telehealth are terms that often are used interchangeably, but a difference is that telehealth refers to a broad range of services and technologies to provide patient care, including non-clinical services, while telemedicine specifically refers to electronic communications and software to provide clinical services, often over long distances.

Mike Delfs, chief executive officer at Jamestown Regional Medical Center, said the 300-bed hospital that he’s in charge of in Jamestown, N.D., is all for more telehealth options, including telemedicine. But he’s concerned about the cost issue associated with telemedicine.

“We've heard some things, even nationally, about how telemedicine is very new. But it's not really very new. It's been around for about 20 years,” he said, explaining that Jamestown has done telemedicine for at least the past two or three years.

He said although much of telemedicine is compliant with the Health Insurance Portability and Accountability Act (HIPAA), “the piece that is missing at this point is, literally, how it gets paid.”

In a related matter, President Donald Trump earlier this year signed a waiver that allowed the Centers for Medicine and Medicaid Services (CMS) to broaden access to Medicare telehealth so that patients could receive a wider range of medical services without having to visit a care facility during the pandemic.

“Right now most of the hospitals that use telemedicine are remote hospitals that have a difficult time getting the right kind of staff and so they rely on doctors who are coming through on the telemedicine side to guide us,” Delfs said. “For us in Jamestown that’s not really an issue so much. What is an issue is that some of the specialists that this community could really use, the federal government doesn't pay for telemedicine in any way that's meaningful whatsoever, so if you have a doc who is going to call in on telemedicine service life, the payment for that is $25 right now.

“That's not enough to pay for anything. It doesn't pay for the staff to room the patient. It doesn't pay for the space to be able to see the patients, it doesn't pay for the doctor who's doing that.”

Delfs said he hopes trends in the health care industry caused by the coronavirus will be a wakeup call for legislators and others to pair telemedicine with other services and fees.

“I would see that it's at least possible the federal government may look a little more closely at this once this is all done, because telemedicine is a wonderful resource,” he said. “We just have to make sure that there's parity with the other services that we provide, so that we can provide a lot more locally.”