Video telemedicine got underway earlier this year when the coronavirus interrupted personal doctor visits. Earl Egner missed that trend.
The 84-year-old diabetes and cancer survivor does not have a computer or mobile phone. Instead, he relies on some form of communication older than himself – the phone – to talk to doctors while remaining at his home in Somerset, Virginia.
“We don’t even let people come home because I have underlying conditions,” Egner said. “If this bug came my way every time, I’m a dead man and I’ll try to be as careful as possible.”
The pandemic prompted the U.S. healthcare system to embrace video visits, with health insurers waiving telemedicine fees, doctors moving their practices online, and the federal government expanding access. But a portion of the U.S. population continues to rely on audio-only calls for care, even as doctors’ practices reopen.
Doctors say they provide telephone care more than ever, and higher reimbursements for these appointments make it feasible for them. But doctors also see phone calls as a last resort, and some nonprofits are trying to get more video-compatible smartphones or tablets from patients who need them.
“Telephone visits are better than no visits,” said Egner’s physician, Dr. William Fox. “But a lot of useful information can be obtained by looking at the patient, even if it is done through a computer monitor.”
The doctor in Charlottesville, Virginia, said he had about two audio-only telephone appointments with patients at the height of the pandemic every day.
Smartphones, tablets or computers in combination with a fast internet connection are essential for a good video connection with a doctor. Researchers and doctors say older and poorer patients often lack this technology, although it is difficult to pinpoint exact figures.
The Federal Communications Commission estimates that about 21 million people do not have broadband internet access, but experts have said that this figure is likely to be underpowered.
The Pew Research Center discovered last year that about eight in ten American adults have a smartphone. But the figure drops to about five in ten for people over age 65.
Such metrics make advocates fearful that people will miss crucial care because they don’t have the equipment or connectivity. After the new coronavirus started to spread earlier this year, the federal government’s Medicare program increased payment for audio-only visits with doctors to be on par with personal visits. That increased the payback range from about $ 14 to $ 41 per visit to $ 46 to $ 110.
These calls can last 20 or 25 minutes, said Dr. Robert McLean, a Connecticut-based specialist in internal medicine and former president of the American College of Physicians. Although he cannot visually examine patients, he can ask how they are, how they get food, and whether they wear a mask when they go out.
“We now provide real care, not just lab results and short conversations,” he said.
Egner has started tracking vital signs like his temperature, blood sugar and heart rate twice a day, so he has information to inform doctors by phone. He said a recent telephone check with Fox went well, in part because he has known him for at least ten years.
But he is concerned that a doctor cannot see him and may discover a health problem unknown to Egner.
Some entities are trying to fill the technology gap.
CareOregon, a non-profit insurer that provides Medicaid and Medicare coverage to approximately 375,000 people, has started offering smartphones to help customers connect with doctors.
A group of high school and college students founded a nonprofit company, TeleHealth Access for Seniors, to do the same. Yale University student Hannah Verma said that she and her brother, Arjun, decided to help after hearing from their parents, both doctors, that many older patients were unable to have video chats.
They started giving old iPhones they had back home to their parents back in March. Then they asked friends and family for unused devices and continued to expand their push.
Their non-profit organization has now collected 775 devices to distribute to patients through doctor’s offices and clinics, including 16 Veterans Affairs hospitals. They clean the devices and then pass them on with instructions, which they offer in five languages.
They also provide directions for finding free internet connections. A tip: park at the doctor’s office to use their WiFi for a video chat.
“We are definitely trying to do this in the long run, because now, and probably next year, there will be a medical need for telemedicine,” said Hannah Verma.
Health care providers say that video medicine can help reduce health inequalities long after the pandemic has subsided. The practice offers a deeper level of care than an audio-only conversation. It also makes it easier for people to keep appointments because there is no need to take time off work or find money for a ride to the doctor’s office.
South Dakota-based Avera Health expanded telemedicine during the pandemic at a clinic operating on an Indian reservation in the Great Plains. Traditionally, nearly half of the clinic’s behavioral appointments are no-shows, but that dropped to 26% when patients were allowed to check in remotely.
“I recently made a virtual (video) visit to a patient of mine, and when I came in contact with him, he was fishing on the Missouri River between two reservations in South Dakota,” said Dr. Jason Knutson, a family medicine specialist at Avera.
AP Technology Writer Tali Arbel contributed to this report.
Copyright 2020 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or distributed without permission.