A Backlog of Healthcare Needs as COVID-19 Pushes Medicine Online and Over the Phone

In six weeks, Yale New Haven Health has transitioned 25 percent of their daily appointments to video or phone calls. That’s 2,500 telehealth appointments each day compared with about zero at the beginning of March.

“Technology that supports telehealth has been around for years, but there have been barriers to insurance coverage before now, but in the context of a crisis we manage to find our way around those,” said Lisa Stump, senior vice president and chief information officer at Yale New Haven Health.

Those barriers have been lifted as insurance companies have moved to cover virtual medical care in response to limitations posed by social isolation measures taken to limit spread of the coronavirus.

Anthem has waived member co-pays for telehealth visits including mental health as well as physical, occupational and speech therapies until June 14.

“What we see coming out at the end of this, is evidence that telehealth truly does provide,” Stump said. “It really is an important means of connecting people with their care team for all sorts of conditions.”

Both Anthem and CIGNA have also waived co-pays for COVID-19 testing, office visits and telehealth screenings.

But while COVID-19 care and treatment have ramped up, healthcare providers across the state have postponed procedures and transitioned other appointments to online or by phone as much as possible.

“We had providers review their calendars and tell us if an appointment or procedure needed to be in-person or if it could be done via video or phone,” said Kim Moriarity, the Chief Strategy Officer for Yale Medicine. “Anything urgent that needs to be seen will be seen in-person.”

According to Stump and Moriarity, physicians themselves are making the call about what is deemed urgent and what isn’t. At Yale, cancer therapies, transplant patients and those with inflammatory conditions that need regular care are deemed urgent and are generally continuing. Other procedures have been delayed.

At Middlesex Health all integrative medicine appointments, which include acupuncture, massage and hypnotherapy, have been canceled, as well as fitness classes for cancer patients.

“If there is a long-term detriment if the appointment is delayed that is being considered,” Stump said.

People seeking MRIs or x-rays for potential tears or stress fractures are often waiting. Patients with gallstones or kidney stones are often waiting.

“We were trying to hold off on the new patient appointments initially, but now we know we can’t do that,” Moriarity said. “We put them on as a video visit just to get them seen and evaluated so the doctor can determine if they need additional testing.”

Stump added that Yale-New Haven Health is actively encouraging not to self-select out of seeking care.

“There is a lot that a physician can determine in a video visit, but they can’t do that unless they engage with the patient,” Stump said. “What we don’t want is people to wait to be seen.”

Telehealth is now more than just a conversation. Yale-New Haven Health is distributing digital stethoscopes and even equipment that would allow a patient to perform an EKG at home.

“Before the pandemic insurance payer and physician comfort held us back, but now we are beginning to see the benefits of telehealth,” Stump said.

Moriarity said telehealth has received very high patient satisfaction scores compared to spending time driving to appointments, finding parking or waiting in the hospital.

Another use for telehealth

Telehealth isn’t only being used on the outpatient side, it’s also become essential on the inpatient side.

“It allows healthcare providers to limit the need for PPE and contact-time for our providers by virtually connecting with patients even when they’re in the hospital,” Stump said. “It also allows us to spread the expertise of our ICU specialists across a much larger population of patients by allowing them to support their colleagues in other locations.”

Telehealth has not only come in handy for physician-patient interaction, it has also allowed for patients to maintain social connection with loved ones even though visitors are banned from hospitals.

“We are leveraging telehealth to connect patients with friends and family while in the hospital,” said Stump, who explained that Yale recently purchased hundreds of tablets specifically for this purpose. “Where social distancing is still important, simple things like Facetime and Zoom or other tools to allow people to see each other is part of care too. We haven’t figured out how to reach through and hold your loved ones hands, but this is the next best thing.”

A backlog

Although the COVID-19 pandemic has been a turning point for telehealth, and both Stump and Moriarity expect to see telehealth continue as a regular option for patients after the outbreak, hospitals, clinics and offices will eventually reopen and begin seeing non-critical patients in-person again.

When they do, there will be a significant backlog of patients.

“We are going to have to operate more than just five days per week to accommodate the need,” Moriarity said. “We are looking at expanding our clinics and procedural time to include the weekends.”