Always looking for a COVID silver lining, here’s a hopeful story from KARE 11 about how telehealth is helping a young girl…
From her home in Hancock, Minnesota, four-year-old Freya is learning to walk with the help of a physical therapist at Children’s Minnesota.
The family lives nearly three hours away from the Twin Cities but Freya is still able to receive weekly physical therapy sessions thanks to virtual care.
“Since doing telehealth, she’s made so much progress… I’m still in awe about how good she’s doing right now,” said Jessica Bossuot, Freya’s mother.
And how telehealth is likely to continue even after the pandemic…
While the future of telehealth is uncertain, Tanner is hopeful those services have a place in our future.
“I think there are some kids out there right now that are getting rehab services because they can do it virtually that wouldn’t be doing it at all if it wasn’t available,” Tanner said.
Freya fits into that category. Prior to the virtual physical therapy sessions, Freya would scoot everywhere. Now she’s standing up and walking on her own.
Bossuot said, “The fact that she’s trying to do this and she’s taking the initiative to do it on her own is amazing.”
The University of Minnesota’s Minnesota Daily Podcast, looks at…
the Boynton Mental Health Clinic’s coronavirus response and patients’ reactions, speaking to providers at Boynton and students who have experienced virtual therapy.
The experience sounds much more mixed than I would have anticipated. They spoke with students and health care providers. Healthcare, especially mental health care, went online in early March due to COVID, as soon as the campuses closed. In March, they saw a sudden drop in mental health appointments, often based often on policies of a students home state as well as because need for therapy may have changed as students went home. But eventually that number went back up.
As I listened I try to track the pros and cons of remote telehealth:
Complaints about telehealth:
- It doesn’t capture body language.
- It would be difficult to build a rapport if you had never met in person.
- Difficult without broadband.
- Difficult when home isn’t a safe place.
- Availability depends on students home state when they go home.
- Digital skills are required
- It is more convenient.
- Can do it from a distance.
- Students can keep connected from home.
- Able to see students who are sick or in quarantine.
- Reaching students who were hesitant to come into the office in the past due to stigma.
- Online doesn’t require masks, in person does. Hard to read a face behind a mask.
Love it, hate it or site somewhere in between, telehealth is here to stay – even in a post-COVID world. Despite the shortcomings, it is a way to encourage new patients, to maintain continuity for a transient population and it keeps people safe.
Thanks to Teri Fritsma at Office of Rural Health & Primary Care for sharing their MN Health Care Provider COVID Survey. I’ve pulled out the stats that I thought seemed most broadband related. You can see that broadband has made telehealth easier in ways and COVID has accelerated adoption.
About the survey…
With the onset of the COVID-19 pandemic, MDH designed a brief survey to learn more about the changes Minnesota’s health care providers are facing at work as they respond to the pandemic. The COVID Health Provider survey focuses on a handful of COVID-specific topics, including providers’ concerns, time spent working, use of telemedicine, and related topics.
▪ Approximately 15 percent of providers reported that their primary work location was some sort of remote site (such as their home), where they consulted with patients via telemedicine. However, this varied greatly by profession, with mental health professionals far more likely than others to be working in a remote setting away from patients or clients. An estimated 57 percent of licensed professional counselors (including LPCs and LPCCs); 54 percent of social workers; and 58 percent of psychologists reported that they were working remotely.
▪ More than half of all providers reported that at least some of the care they provided was remote—either via telephone, email, or dedicated telemedicine equipment (or all three). Again, this varied greatly by profession, with mental health providers most likely to be providing care via telemedicine or telephone.
▪ More than 85 percent of all respondents who were using telemedicine said they thought they would continue to provide at least some care via telemedicine after the pandemic ended.
▪ Nearly two-thirds of all respondents reported that their work had changed in some way because of COVID-19—for example, taking on new responsibilities at work, backfilling for other employees, and/or managing patients’ and clients’ COVID-19-related concerns. ▪ An estimated 23 percent reported that their worksite had been “totally prepared” to respond to the pandemic.
licensed marriage and family therapists renew their licenses in the fall and therefore would not have had the opportunity to take the survey
Comments on telemedicine…
- “Telemedicine can be very challenging for patients who need an interpreter.”
- “Should be allowed going forward. It’s very helpful for elderly patients who have a difficult time getting to appointments.”
- “I work in mental health and I think it works well. We have fewer no-shows, and clients generally like it. A lot of people are uncomfortable coming in to the office even without a pandemic.”
- “It’s okay for follow-up or non-acute care, but it doesn’t work for evaluating new, acute problems.”
- “It’s been a great tool for some patients, but some (non-tech savvy) don’t have the ability to use it.”
- “Exacerbates existing inequities in health care.”
- “Telemedicine works well for me for people who struggle with transportation issues in rural areas.”
- “It works in the sense that I can still provide much-needed client care. But it doesn’t work in the sense that there’s inequality in clients being to access telemedicine.”
- “We need to do more of it. It improves patients’ care and our professional lives.”
- “Telemedicine has been integral in providing services to vulnerable and oppressed populations that face transportation issues, scheduling concerns, unforgiving work schedules, family demands, and poor organization due to a variety of factors. It behooves us as social workers to fight for this service to remain a widely-available platform for services that have typically been gatekept for those with flexible business hours, reliable transportation, and available childcare.”
- “I have found telemedicine a great way to provide care especially for established patients with whom I am familiar. It is a bit more difficult for complex medical issues and for multiple concerns but I think my patients really appreciate the option. There are some things that we still need to see patients for.” “The CMS rules going forward are unclear.” “Works great.”
Craig Settles is on a campaign to help communities see that telehealth is key to economic development and you can’t do telehealth without broadband. Next Centruy Cities higlihgts his reasoning…
Telehealth is more than video chat with your doctor. It means using intranets and Internet networks to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care so that residents can heal and stay healthy.
Telehealth increases broadband’s economic development impact, and can add revenue streams for the network and/or the community. For example, 26% of economic development professionals in a national survey felt using telehealth to attract doctors and medical specialists would have a definitive impact on local economies.
Another important benefit…
Broadband and telehealth can draw other healthcare professionals to your community. For example, “We have less than half of the psychiatric providers needed to meet the U.S. mental health demand,” says Encounter Telehealth CEO Jennifer Amis. “In the rural areas we may have less than 20% of the providers needed.”
And a list of telehealth benefits…
In addition to attracting medical professionals, telehealth’s economic benefits include (more details here about here [https://tinyurl.com/yxmevaq9])
Slowing or reversing hospital closings
Reducing unnecessary visits to the ER
Attracting medical research grants
More mental healthcare services staying local
Keeping seniors living at home longer
I wanted to share this because I think the increase in tele-mental-health for everyone is so important but especially for kids figuring our college and living in a pandemic. Lakeland PBS reports…
Bemidji State University and Northwest Technical College are partnering to expand mental health services available to students and have received $120,000 in funding from the Minnesota State Multi-campus Collaboration Grant program. The funding will support the hiring of a new case manager, as well as provide increased support for student psychiatric care and equipment needed for secure Telehealth services.
A 2018 health survey of Minnesota college students found that more than 40% of those surveyed reported mental health issues, and 55% indicated that mental health issues impacted their academic performance.
The program “Expanding Reach: Mental Health for All” will support initiatives that strengthen BSU and NTC’s ability to accommodate student needs amidst the COVID-19 outbreak.
Following more than a year of collaboration and planning, Allina Health and Blue Cross and Blue Shield of Minnesota (Blue Cross) today announced a six-year, value-based payment agreement between the two organizations, which collectively serve a significant percentage of Minnesotans. Allina Health performs more than 6 million patient visits per year, while approximately one in three residents in the state have coverage through Blue Cross. The agreement is designed to provide enhanced value for Blue Cross members while fostering even more high-quality care and healthy outcomes that Allina Health is well-known for across the state.
This is something the started before the pandemic, but COIVD escalated the need.
Impact on patient…
The rewards placed on additional preventive and coordinated care were designed to maximize the time available for building doctor-patient relationships, streamlining the care delivery experience and simplifying administrative requirements. Both organizations believe that such an emphasis is necessary to foster more proactive and preventive care, and catalyze work to reduce the unacceptably high rates of health disparities across our community.
Impact on health care facilities…
An increasingly popular alternative in health care contracts, value-based agreements can maintain the historic levels of revenue for a health care system, but with larger payment portions for optimal patient outcomes and quality of care. By de-emphasizing the reliance on payments for each health care service delivered, providers can be protected from loss of revenue during periods of reduced volume – such as the recent pause on scheduled procedures during the pandemic – while still maintaining access to care for the broader community through long-term health initiatives.
Impact on telehealth…
The pandemic rapidly increased the adoption of telehealth, as in-person care options were curtailed for the safety of providers and patients. Part of succeeding in value-based models is the ability to provide care at the most appropriate time and place. Providers and patients are increasingly comfortable with expanded options for giving and receiving care, and this agreement will allow the expansion of these options to continue in a sustainable way.
Alexandria Echo Press reports on a recent survey of healthcare during the pandemic…
Minnesotans experienced adverse health outcomes due to delays in care, the use of telehealth has surged, the bottom lines of physician practices in Minnesota were hurt significantly during the first months of the COVD-19 pandemic, and doctors fear the next wave of the virus.
These are a few of the key findings of a recent study commissioned by the Minnesota Medical Association (MMA) on the impact of the pandemic on physician practices.
The study, “Minnesota Physicians Respond to COVID-19,” is based on responses to two surveys – one sent to Minnesota physicians (the 641 responses represent a +/- 4 percent margin of error at 95 percent confidence interval) and one sent to medical practice administrators (92 responses). Surveys were completed between June 16 and July 13, 2020.
They outline the impact of telehealth…
Not surprisingly, the use of technology increased dramatically during the pandemic, the study found. In 2019, practice administrators reported that approximately 3 percent of patient encounters were conducted via telehealth including e-visits, phone, and video visits. Since March 2020, that number has increased to 28 percent, an increase of 833 percent.
Eighty-four percent of physicians reported that patients were satisfied or very satisfied with telehealth visits. A similar proportion of physicians (83 percent) said telehealth is meeting the care needs of their patients. “Telehealth is a lot like doing house calls,” commented one respondent. “I am a guest in their home and the patient is much more comfortable. I hear the sounds of their life.”
Nearly three-quarters of physicians said they think it is important to retain telehealth as a care delivery method, but changes are needed for that to continue. Seventy-eight percent reported uncertainty around ongoing reimbursement by insurers as a barrier to broader telehealth adoption and use.
Another critical barrier to telehealth adoption is on the patient side – 73 percent of physician respondents noted that patient access to technology and patient access to broadband (60 percent) were moderate to significant barriers to broader telehealth use.
“We’re glad to see the expanded use of telehealth,” Stelter says. “However, not all patients can currently access it. Many Minnesotans don’t have access to broadband. Variation in technology platforms can also drive patient comfort and use. For telehealth to be truly helpful, everyone needs to have the ability to use it effectively. This is yet another example of the health care disparities that exist in Minnesota.”
The emphasis above is mine. They also discuss the financial situation for healthcare facilities, which is down. Some of that may be due to people accessing less care. But it may also be a reason to look at cost and reimbursement for telehealth. Maybe the start is to quit looking at cost and start looking at value! What is it worth to keep patients out of the healthcare facilities and hospitals? What is it worth to have a house call over driving to the nearest hospital? What is the cost versus value of having healthcare access in your community? We may need to change the equation?
Earlier this week Bernadine Joselyn, Mary Magnuson and I had a conversation with Kristian Braeken at Region 9 about their telehealth plans and programs (supported with Blandin Foundation funding). It’s interesting to hear about what they are doing and the impact they are having but a key point is how they are using this to ensure that they have a healthy workforce, which makes this as economic development issue as well as community development and health. (Also worth nothing that the project started late in 2019.)
Region 9 serves the following counties: Blue Earth, Brown, Faribault, Le Sueur, Martin, Nicollet, Sibley, Waseca and Wantonwan. They have created a portal that provides referrals and access to mental health services. Actually better than that – they didn’t create anything, they found a solution with Direct Assessments and Counseling. It’s been a great way to reach community members who can be geographically out of reach. And it’s been a great way to connect those people (and others) to providers and counselors who do not necessarily live in the area.
Being able to access counselors outside Region 9 has been a coup because there’s a shortage in the area. The push to move everything online (due to COVID) has opened up everyone’s interest in doing more things online. Zoom was a niche word a year ago; now everyone is doing it so there’s a growing comfort level.
Some regulations have been loosened making it easier to use accessible technology. And with the stress of a pandemic, job loss and change, students doing everything differently and with seniors experiencing more acute seclusion the need is greater. Also, Region 9 works with people who require court mandated assessments and services.
People have found that they like it. Within a month, the portal was operating to capacity. People with court mandated assessments appreciate the convenience. Many other experience the privacy of services from home. They found that before the online option people might drive a couple hours to get service or forego services altogether. And going online has opened the door to more diverse clients, especially immigrant groups.
By all accounts it’s been a success. It’s easy to see that much of this will continue to serve a purpose even after the stringent rules aroudn COVID are relaxed.
Craig Settles is an original thinker. I recently saw him talk about a project to get barbers and beauticians involved in telehealth. Being honest I first thought of the Medieval Barber from SNL, and then I remembered how everyone – male and female, all walks and ways of the world – were so happy when the salons opened after quarantine. And I realized it was a pretty genius idea.
MHealth Intelligence wrote about his idea back in January…
An innovative project in Ohio is using barbershops, hair salons and telehealth to screen people for hypertension.
Three Cleveland-area barbershops in urban neighborhoods are currently working with the Cleveland Clinc to screen patrons with mHealth-enabled blood pressure cuffs. Once the readings are taken and entered into a connected health platform developed by VSee, those patrons can then work with care providers to manage their blood pressure.
For some, the experience was life-saving.
“Ninety percent or more (of our) customers discover the first time they’re screen they have high blood pressure,” Waverley Willis, owner of the Urban Kutz barbershop, said in a story prepared by the Benton Institute for Broadband & Society. “Several customers’ blood pressure was so high they went straight to the ER, and a good number were well on their way to a stroke or a heart attack.”
The program is the brainchild of Craig Settles, a telehealth and broadband business planner, who wanted to find some way to improve care management for the African-American community – 40 percent of which are living with hypertension.
Craig is looking for some more cities to try this out. As he recently posted in a public discussion list..
I’ve got five cities ID’d for my barbershop/hair salon telehealth pilot program (Cleveland, Wilson County, NC, Chicago, Denver-area and possibly Topeka). I need five more, and I’m thinking some cities don’t have a broadband project lined up because they have to get the money spent by Christmas. This pilot addresses the time constraint.
I spoke with Craig and he’s interested in some rural areas too. If you’re interested, I encourage you get contact Craig for more info.
I just happened to hear an interview with Audrey Tang, the Taiwan government’s digital minister on Public radio about all of the ways Taiwan is using technology to curb coronavirus. Technology supports quarantining for people crossing a border into Taiwan…
Anyone returning to Taiwan has two choices. Either they go to a quarantine hotel for 14 days, in which case they’re physically barred from leaving; or, if they live in a place with their own bathroom and with no vulnerable group of people, they can also choose to digitally quarantine, placing their phone into the digital fence. In that case, the nearby cellphone tower will measure the signal strength, as they always do, and send out an SMS whenever the phone runs out of battery or breaks out of the 50-meter or so radius. So, the idea is that during those 14 days, we pay each person in quarantine about $33 a day as a stipend. But if they break out of the quarantine, then they pay us back a thousand times that. So, very few people break the quarantine.
Technology to provide mask inventory to the public…
There was a person named Howard Wu in Tainan city who developed a map so that people could see the nearby places and exactly how many masks there are in stock. So, we very quickly supplied them, every 30 seconds, the real-time mask levels of all the pharmacies, and later on convenience stores, so that people who queue in line can keep this system accountable.
And they make sure everyone has broadband
And the second thing is about equality. In Taiwan, broadband is a human right. Even on the tip of Taiwan, which is almost 4,000 meters high, people still have 10 megabits per second at just $16 per month. No additional cost, unlimited data. Otherwise, it’s my fault. And so, we will not systemically exclude people who don’t have broadband.
I know it’s not Minnesota, but I also know Taiwan (population 23+ million) has been in single digits for COVID cases since April 12 and Minnesota (population 5.6 million) had 730 cases on Aug 14 alone.
Angela Davis (MPR News) hosted a whole show on telemedicine this week with three guests:
- Joel Beiswenger is the president and CEO of Tri-County Health Care in Wadena, Minn.
- Joshua Stein is a child adolescent psychiatrist and the clinical director of the Prairie Care’s Brooklyn Park medical office.
- Annie Ideker is a family medicine physician at the HealthPartners Clinic in Arden Hills, Minn., and helped train more than 2,000 clinicians on telemedicine.
They start with a brief history of what has been happening in Minnesota (especially rural MN) in terms of telehealth. For those of us who have been involved with health and broadband – I will repeat the shout out that Joel Beiswenger gave to Maureen Ideker for her work in the field.
Telehealth is a balance of medicine, technology, practice and policy. So many things go into the mix. But especially in rural Minnesota, getting that to work out will save time and money for patients and often healthcare facilities as well.
Dr Joshua brings up the increased comfort level, especially for kids, in moving mental health issues online. Kids, this will surprise no parents, are pretty comfortable talking via technology. There are some exceptions but on the whole the kids are very comfortable.
Amazing to hear how quickly people could transition to telehealth during the pandemic. Turns out that for many visits, Dr Ideker points out, patients have been interested in continuting telehealth visits even after their healthcare facilitity has opened.
They report that 30 percent of office visits have shifted online post-quarantine; 70-80 percent of mental health visits remain online even after offices have opened.
You can listen to the whole show. There were some interesting topics
- the impact of telehealth on people with limited English language skills.
- The access is only as good as the broadband
- Dealing with online-meeting overload
- Needing to be alone for in-person meetings
Red Lake Nation News reports…
Today, the Minnesota Department of Health announced that Sexually Transmitted Infection (STI) rates continue to increase. Notably, the data shows a 23 percent increase in syphilis from 2018-19. Planned Parenthood has launched at-home STI testing kits to respond to this urgent public health need.
Combined with telehealth consultation, at-home STI testing kits allow patients to safely and conveniently test themselves from the privacy and safety of their home. After a patient consults with a provider via telehealth, the patient is mailed a testing kit, complete with directions for sample collection and return shipping supplies. Patients have 30 days to mail their sample to the testing lab. If there is a positive test, or if follow-up care is needed, patients are contacted by the Planned Parenthood care team for treatment options.
Telehealth consultations and follow-up, combined with at-home STI testing, can help mitigate the significant barriers to care posed by COVID-19 and help slow the anticipated growth of STIs through the pandemic and beyond.
Beyond the convenience factor here (so important during a pandemic) I think the potential for anonymity will encourage people to get tested. and treated and hopefully will curb the increases in cases.
From the Minnesota Rural Health Association…
Each year at the MN Rural Health Conference MRHA Awards a deserving student the Emerging Rural Health Leader award. Unfortunately this year’s conference has been cancelled. However, the opportunity to acknowledge an up-and-coming rural health leader is not.
MRHA will be presenting this year’s award in conjunction with National Rural Health Day on November 19, 2020. Please consider nominating someone today.
With the growing reliance of telehealth, it feels like this belongs in a broadband blog as well as any health resource out there. Deadline is Oct 23, 2020.
High Plains Journal reports on a recent webinar on rural telehealth…
A July 15 webinar on those issues was hosted by Kevin Oliver, lead relationship manager at CoBank, part of the Farm Credit System that supports key initiatives in both rural broadband and healthcare. Titled “COVID-19 Impacts On Rural Healthcare and Broadband,” it is the fourth in the “From the Farmgate” series of webinars sponsored by CoBank. The speakers were Rick Breuer, CEO of Community Memorial Hospital, located in a rural area of Minnesota just west of Duluth; and Catherine Moyer, CEO of Pioneer Communications, which provides connectivity services in western Kansas via coaxial cable, copper wire, fiber and wireless.
I was especially interested in the bottom line impact to the broadband providers versus the healthcare facilities (the tele vs the health)…
Oliver noted that the cost dynamic was different for health care facilities and communications. Health care facilities saw a simultaneous increase in costs and decreases in revenue. On the other hand, communications companies have added customers and grown more quickly than they might have otherwise. While some payments are in arrears, “most of those arrears will be collectible,” said Moyer—whether from customers, or by laws like the Critical Connections Act that reimburses communications companies. Moyer said Pioneer had “donated” about $500,000 worth of connection services that may or may not be reimbursed.
Breuer said he doesn’t expect revenues at the hospital to return to anything like their full levels for at least a year. The hospital has managed to avoid layoffs or furloughs, “but we’re getting [through] by the skin of our teeth.” Whatever happens with COVID, he said, “telehealth will definitely be part of our future. Home and hospital connections are equally important, since telehealth often happens from home.”
Breuer noted that until recently, he had to drive his kids into town to access hot spots so they could do their homework. One hospital sectioned off part of its parking lot for customer parking to use its hot spot, whether for medical tele-visits or other reasons. He also noted the vulnerability of rural networks, with little or no redundancy. He said one gnawing squirrel recently took down connectivity for a 50-square-mile area.
His hospital could not have kept its doors open without help from 10 separate funding organizations, said Breuer—but that in turn created a lot of documentation paperwork. He said independent clinics have been the worst-hit by the COVID crisis, especially those that service mostly rural populations but that don’t technically qualify as rural health clinics for one reason or another. Breuer supports changing those designations to allow more clinics to be helped.
Moyer supports what she calls contribution reform. Bill surcharges are based on an outdated model of long-distance service, now that texting has taken the place of phone calls for many. Fortunately, “the COVID crisis has focused the attention of many in Congress. I’ve been talking about all these connectivity issues for 20 years,” she said. “The silver lining is a lot of other people are focused on this issue now too.”
For so many years, the providers have invested (often with public support) in the networks that have made millions for private industry without reaping the same benefit. (A couple years ago, I looked at the community ROI of public investment in rural broadband – the community sees the return much more quickly than the provider.) It will be interesting to see what happens with healthcare and telecom/broadband. Many broadband providers are being generous with free/low cost connection right now and hopefully that will be an investment in a future paying customer. While the hospitals are in a different situation – the article points out that “163 rural hospitals have closed and about 600 more are vulnerable, or a third of all rural hospitals in the United States.“