In October 2019, Bergen New Bridge Medical Center in Paramus, NJ, began using telemedicine to check in with patients who are discharged from the ED and ensure appropriate follow-up appointments are in place.
As it turns out, the timing of its implementation was fortuitous, because the hospital has been able to quickly expand its telehealth platform to help with patients who might have contracted COVID-19.
“It is really for anyone who feels they have been exposed or has symptoms that suggest they could be a COVID-19 patient,” explains Deborah Visconi, MHA, president and CEO at Bergen New Bridge Medical Center. She adds the service is available to anyone in the community who wants to speak to a clinician without going to a hospital.
The Health Insurance Portability and Accountability Act (HIPAA)-compliant service is designed to help identify patients with the virus, expedite care to them while limiting community exposure, and easing potential burdens on the ED or urgent care centers. Visconi is hopeful the telemedicine service also will encourage people to seek early care and evaluation, and ease fears about the pandemic.
To access the service, patients call a hotline that will connect them with a nurse via two-way video hookup. The nurse will screen patients based on the latest guidelines from the Centers for Disease Control and Prevention (CDC) for evaluating persons under investigation for COVID-19.
A primary care or emergency medicine physician will conduct an assessment. If that provider determines the patient should be seen by an infectious disease physician, he or she can receive that assessment right away via the telemedicine hookup or at a later time, depending on availability, Visconi explains.
“If the infectious disease provider is available, and the patient is available, we will do that [assessment] right away,” she says. “Sometimes, we have to make that arrangement after the initial telemedicine call.”
The infectious disease providers involved with the telemedicine service can arrange for COVID-19 testing in cases where they believe it is appropriate. Visconi acknowledges the health system has struggled to access testing services just like other hospitals around the country. She expects that problem to ease as commercial labs are allowed to conduct testing for the virus. “We are hoping soon that hospital labs will have access to those test kits, and we can test right here in our medical center,” she adds.
Primary care offices, urgent care centers, and EDs in the community are referring patients to the service as a first point of contact for patients with concerns or symptoms. “Initially, we didn’t get a lot of calls, but as things are evolving ... and there is a lot of movement with the viral spread, we are getting at least 10 calls a day, if not more, into the telehealth platform,” Visconi observes.
The health system continues its efforts to spread the word about the virtual visits through media and other efforts. It also has posted information about the telemedicine option for patients concerned about COVID-19 on the front page of the medical center’s website. Further, while some insurance companies are paying for the virtual visits, the option is available to anyone in the community regardless of their ability to pay.
“We are absorbing the cost,” Visconi says. “We are a safety net hospital, and we don’t worry about people’s ability to pay for services.”
Many other hospitals and EDs are in the process of rolling out similar services to respond to the virus. Visconi’s advice is to start simple. “Get a team in place that can serve as your frontline providers,” she says. “We [also] needed to get infectious disease physicians lined up. That was different than the initial rollout [of the telemedicine service in October]. We had to make sure we had providers on board who were willing to be part of this process.”
A virtual service like the one unveiled at Bergen New Bridge is just one way telemedicine is leveraged to address the virus. Other hospitals, such as Providence Regional Medical Center in Everett, WA, and Massachusetts General Hospital in Boston, are placing iPads or telemedicine carts in patient rooms so at least some staff-patient interactions can take place without in-person contact. In addition to limiting the potential for exposure, such approaches also can help preserve supplies of N95 respirators and other personal protective equipment.
Health systems are leveraging virtual triage techniques, too, and some are developing automated chat boxes in which patients can report their symptoms and receive general advice on how to proceed. The idea behind the chat option is to help ease the concerns of the “worried well” so they do not present unnecessarily to EDs or other settings that are dealing with large caseloads.
Some health systems with robust telemedicine infrastructures are trying to convert scheduled in-person visits into video visits, when possible. This approach has received added impetus of late as the Centers for Medicare & Medicaid Services (CMS) has significantly eased restrictions on the use of telemedicine services in the care of senior patients. The move enables seniors to visit their physicians via phone or videoconference, even using platforms such as FaceTime or Skype to do so.
Further, CMS pledges penalties will not be imposed on providers who use telehealth in ways that are not compliant with HIPAA requirements. Clinicians can bill for telemedicine visits with reimbursement rates on par with in-person visits.
Such moves should be beneficial for patients who are immunosuppressed or live with other underlying conditions that put them at higher risk of complications from the virus. In a statement, the American Medical Association (AMA) applauded CMS for its actions.
“The use of telemedicine and remote care services are critical to the management of COVID-19, while also ensuring uninterrupted care for 100 million Americans with chronic conditions,” the group said. “The AMA encourages any private payers that are not already covering telehealth services to remove those limitations now.”
Additionally, the American College of Emergency Physicians reports that in response to its advocacy, CMS will be revising its Emergency Medical Treatment & Labor Act guidance to allow medical screening exams to be delivered via telehealth, too.
The AMA has been vocal on this issue. It unveiled a "quick guide to telemedicine practice," a resource that includes implementation advice and other tips to help providers start in this area. The guide provides links to other resources that can assist providers who are ramping up their telemedicine capabilities to respond to the virus and minimize exposures.
Other public health agencies are encouraging the use of telemedicine wherever possible. For instance, the CDC is directing health systems to consider virtual techniques to guide patients to the right setting for care. Further, lawmakers have signaled strong support for efforts to fully leverage telemedicine during the outbreak. In March, Congress passed legislation that includes $500 million in emergency funds for telemedicine services.
Facilities are using technology to maintain safe distances between workers and patients to reduce the spread of COVID-19.
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