Quarantine rules help spread telehealth options for rural moms-to-be in Bemidji

The Bemidji Pioneer reports

If there’s a silver lining to the COVID-19 pandemic, it may be how it sped up a change in prenatal care that could improve outcomes for rural mothers and babies.

Dr. Johnna Nynas, an OB/GYN physician at Sanford Health in Bemidji, discussed her hospital’s move to offering virtual visits during the past year.

“We started laying the groundwork a couple of years ago,” said Nynas. “We looked at implementing a virtual visit option that provided patients with some equipment to monitor their pregnancies at home, including a blood pressure cuff, and then a Doppler, so they can listen to their baby at home. But what really thrust us to the forefront and accelerated the timeline was the COVID pandemic.”

Technical and legal challenges involved the interface between patients at home and their medical records. But with the onset of the pandemic, Nynas said, “there were rapid changes in Congress that made it much easier for health care organizations to initiate telehealth.”

They need better broadband…

There are still barriers that need to be addressed, such as broadband and cellular access in rural areas and for lower-income families. And there are days when the technology doesn’t work as well as others, and doctors have to make do with voice-only telephone visits.

Still, Nynas said, virtual visits will likely continue even after COVID-19 fades from public awareness.

There is a need…

The disparity is real. Nynas quoted shocking statistics: 23 percent of American women live in rural areas, but only 6% of OB/GYNs practice in rural areas. “That’s the challenge that we’re up against,” she said.

The benefit of prenatal care is also real, even for women whose pregnancies are considered low-risk. “It’s better to connect with prenatal care and get that care when and however you can,” said Nynas, “because getting no prenatal care is definitely correlated with worse outcomes.”

At the same time, the costs of running a labor and delivery unit while performing fewer deliveries are widening the gap between rural patients and the care they need. “That’s where being able to offer services remotely can be a really helpful thing,” she said.

EVENT Jun 15: Rural Broadband & Telehealth Financing

Looks like an interesting session…

Rural Broadband & Telehealth Financing
Tuesday, June 15 at 2:00 PM Eastern —
The COVID-19 pandemic has caused many disruptions in our daily lives and highlighted disparities among communities. Schools have gone remote, healthcare providers have increased seeing patients virtually, and small businesses have shut their doors to in-store customers. These disruptions have particularly impacted rural communities where there is already a gap in accessing high-speed internet.

Join us for the CDFA // BNY Mellon Development Finance Webcast Series on Tuesday, June 15 at 2:00 PM Eastern to hear experts explain how rural communities can embrace the challenges of financing high-speed internet for the economic and societal gains provided by broadband.


  • James Young, Vice President, The Bank of New York Mellon, Moderator
  • Caitlin Cain, Vice President and Rural Director, Local Initiatives Support Corporation
  • Lindsay Miller, Of Counsel Attorney, Ice Miller LLP
  • Kenneth Neighbors, Partner, McGuireWoods LLP

To participate, register below. You will receive the login information on the day of the webcast. Registration is free and open to all interested parties.

Get Engaged! Contact Allison Rowland.

More white patients get COVID tested via telehealth; more black patients tested in ER

The UK Daily Mail reports…

White patients were more likely to be screened for Covid-19 during telehealth visits during the pandemic than their peers of other races, a new study suggests.

A research team led by members of the Hennepin Healthcare Research Institute analyzed health record data at Hennepin Healthcare, a safety net hospital in Minneapolis, Minnesota, to gauge when people were tested for COVID-19 based on a variety of demographic factors.

Researchers found that white patients were significantly more likely to receive a Covid-19 test than all other racial groups when they performed a doctors visit via telehealth, accounting for 64.5 percent of all tests.

Black patients received only nine percent of Covid-19 screenings performed by telehealth, while accounting for 45 percent of tests performed in an emergency department.

Black and white patients were around evenly likely to receive a Covid-19 screening in an in-patient setting, at 35.7 percent and 37.6 percent respectfully.

Researchers noted that patients who were receiving their tests in an emergency room or in-patient setting were more likely to need more intensive treatment, as their case of the virus was caught later than those who were screened via telehealth.

Non-English speakers were also tested less online (and off)…

Patients who speak English received a majority of the screenings no matter the setting, including a whopping 88 percent of screenings  performed via telehealth, and nearly 70 percent of tests overall.

They give some reasons…

Not all Americans have access to the stable internet connection necessary to access telehealth.

There is also a problem with insurers not knowing how to bill the visits properly, though many states, like Illinois, have passed laws regulating telehealth visits as normal doctor visits in terms of insurance and billing, preventing patients from being denied these visits by their insurance.

Researchers may have found another potential disparity in this study, though, as more research goes into the system that may be the future of medical care.

Health equity in Covid-19 testing was a problem early on in the pandemic as well, with the CDC reporting that ethnic minorities often faced barriers such as discrimination, transportation, lack of health care and more to not receiving same access as their white counterparts.

Many underserved, primarily minority, communities also were left without the needed supply of tests early on in the pandemic.

A Guide to help libraries build telehealth centers

Something for my librarian friends, a guide helps libraries build telehealth centers – Shhhhhh! The Doctor’s In. Guide to Connecting Library Patrons to Better Health

This guide lays out how to a) get to the heart of patrons’ healthcare needs, b) create something that’s never been done in your community before, and c) market your telehealth and broadband grant proposal. More than video chats, telehealth uses intranets and Internet networks to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care people receive when ill, injured, or wanting to stay well. I’ll take this definition one step further and differentiate between 1) real-time telehealth, 2) store-and-forward telehealth, and 3) “passive” telehealth.

A little more info…

This guide lays out a straightforward needs assessment process so you get a representative portrait of how telehealth can benefit the community. Libraries reach out and touch virtually everyone in their communities across the entire economic spectrum, so it’s quite exciting to imagine telehealth capabilities at work. Healthcare professionals weigh in on how to get the maximum impact from telehealth technology in your library. The guide also gives you tips and pointers on getting the best from your IT investment. Not only does it address access to broadband but also broadband and telehealth adoption and training. Ultimately, it takes funding to transform community dreams into reality. The guide offers insights into federal grant programs that fund libraries and telehealth: the FCC’s E-rate program, the Institute for Museums and Library Services (IMLS), and Health & Human Services (HHS), plus links to other valuable resources that help you.

2020 increases need for mental health services; telehealth helps meet the need

InForum reports that the events of 2020 have increased the need for great mental health services…

Common reasons people have sought therapy recently have been anxiety; depression; stress about the pandemic, parenting or job stability; loneliness; or increased substance use. Clabaugh said many clients are also grieving, whether it be the loss of friends or family to the pandemic or the loss of a job or stability in life. People also have been stressed about political events like the 2020 presidential election, or worry about various conspiracy theories online regarding politics and the pandemic.

To meet the increased demand, counseling centers have hired more clinicians in the last year, and some continue to add more therapists to take on new patients. Erickson said the appointment openings for new clinicians will fill within a week or two, and then will have a three- to four-week waiting list like the rest of the clinicians. Clabaugh said when she opened Insight Counseling almost four years ago, she planned to have two or three therapists, but now she has 20 because the demand has always been so high.

Telehealth has helped counselors reach more people…

At Arrowhead Psychological Clinic, psychologist Dave Plude sees clients from Sandstone to Ely, and from Brainerd to Grand Marais. For many clients, the use of video or phone sessions has been a more convenient option in many ways. Plude said once clients overcame the learning curve of the technology, many people would rather call in from home or their cars than drive up to four hours round-trip for an hourlong session.

“It’s been kind of fun,” he said. “It’s enjoyable to be able to offer good clinical care to people in smaller towns who might not have as much access to it historically.”

It looks like virtual is here to stay for a while…

While telehealth has been offered at many clinics for a while now, it’s never been used as much as it has been in the pandemic. At Arrowhead, Plude said last summer, 80% of their sessions were via video or phone, and they went to 100% virtual last fall during the surge of COVID-19 cases. While many are now returning to in-person sessions, Plude said quite a few are fine with staying virtual. Some will start sessions in person, then switch to telehealth after they get comfortable with their therapist.

A permanent change in policy would make it easier…

U.S. senators introduced a bill at the beginning of May to continue access to telehealth services with Medicare after the pandemic. CONNECT for Health is one of more than 20 bills introduced this Congress about the future of telehealth.

But regardless of the specifics of insurance coverage or other future rules related to telehealth therapy services, all three therapists said they plan to continue offering video sessions at their clinics.

Telehealth is here to stay in rural Minnesota

WCCO TV reports

WCCO found the successes and the future of the practice for some patients in outstate Minnesota.

A former firefighter and medic, it was a bad fall after retirement that put Bart Cedergren in a wheelchair.

He lives up north with his wife. The three doctor visits a month could take much of the day, but are now done in a fraction of the time because they’re all online.

“Telemedicine I think is the wave of the future,” Cedergren said. “The only thing we go in for these days are basically lab.”

Family Nurse Practitioner Janelle Terhaar now dedicates one full office day a week in Long Prairie to her telehealth patients.

“We went from maybe having one or two a month to now we’re maybe having steady patients every day,” Terhaar said.

From parents with a sick child, behavioral health, and an older population, Terhaar says patient profiles come from all over and that even web cams don’t lie.

Telehealth is one way to help mental health resources reach rural Minnesota

The Bemidji Pioneer reports on Mental Health month…

May marks Mental Health Awareness Month in the United States, and during the last year, the topic has been increasingly brought to the forefront due to the coronavirus pandemic.

They recognize the challenge of reaching rural areas and the advantage telehealth brings

Outside of hub communities in the state like Bemidji, though, mental health resources can be scarce. Mulvihill said getting treatment options into more rural areas has been an effort by the organization recently.

“It’s certainly something we acknowledge that we have to just do a lot better on,” Mulvihill said. “It is a lot harder to find a mental health provider in Greater Minnesota, it’s just the reality. I think there have been some movement around telehealth certainly during the pandemic and we have really been advocating to maintain the things that were kind of made temporary with telehealth.”

While Mulvihill acknowledged telehealth options aren’t a fix for everyone, Mulvihill said it does provide a solution for a segment of the population.

Mayo Clinic doctor says Digital Healthcare is Healthcare

KTTC Rochester reports…

Three Mayo Clinic health professionals spoke virtually Tuesday about the advantages of remote care and the future of the health care provider-patient relationship.

Telehealth has been growing…

At its height, the pandemic is blamed for an 80 to 90% drop of in-person health care appointments.

“Beyond the height of the pandemic, we have witnessed a decline in the use of digital health care but not back to the pre-pandemic levels,” Damaerschalk said.

A new law in Arizona is expanding the definition of telehealth to be more inclusive, meaning providers will be compensated for helping patients when they aren’t in-person or virtually face-to-face.

“From a reimbursement standpoint, both government and commercial payors are reimbursing telemedicine activities on the same basis as in-person activities,” Ommen said.

The trio of doctors hopes to see that law adopted in Minnesota and Florida as well.

The doctors were very supportive…

Damaerschalk also recounted his difficulty to tell the difference between telehealth and in-person practices from a provider standpoint.

“I was completing documentation on my patients, and I had actually forgotten in several instances whether I had seen that patient in person or if I had seen them by telemedicine,” Damaerschalk said. “I paused for a moment, because to me that resonated, as it should, that digital health care is health care.”

Mental Health Telehealth Visits increase by 2,515 percent during pandemic

Business Wire reports

Medica members accessing mental health care through telehealth technology has increased by 2,515 percent since the pandemic began in March 2020. Meanwhile, Medica’s network of providers offering mental health care via telehealth has increased more than sixfold in the same period.

More details…

In the first quarter of 2020, early in the pandemic, Medica processed approximately 650 telehealth claims for mental health. During a similar time stretch spanning late 2020 to early 2021, Medica had processed 17,000 claims.

An analysis of mental health telehealth claims provide some insight to the effect of the pandemic. The top three conditions treated by telehealth were anxiety, depression and trauma (which includes diagnoses for post-traumatic stress disorder, acute stress disorder, adjustment disorder and reactive attachment). For those conditions, approximately 70 percent of claims were telehealth visits.

A breakdown of mental health telehealth claims for all conditions shows that people ages 35 to 49 used this service the most when seeking mental health care, followed by those ages 27 to 34. For those claims, women outnumbered men by a 3:2 ratio.

In the first few months of the pandemic, the number of Medica’s in-network providers offering mental health services through telehealth increased from 5,500 to 39,800 nationally. In Minnesota, the number increased from 3,841 to 7,130.

Medica will continue to support telehealth…

Medica has placed a priority on ensuring its members have access to mental health care in the setting that is most comfortable for them. To ensure they have access to the highest quality providers, Medica will continue to reimburse these visits – office and telehealth – at the same rates.

Increased access to telehealth is patient-centered care in Aitkin County MN

Aitkin Age posts a letter from a reader (and healthcare worker) about extending rules that support and promote continued telehealth…

The arrival of COVID-19 in Minnesota in early 2020 presented a series of challenges for Minnesota’s hospitals, health systems and the communities we serve.

Our health care providers at Riverwood Healthcare Center were confronted with preparing for and responding to COVID-19 while also providing non-COVID-19 care. Our patients were faced with making decisions about accessing care – including whether care capacity was available and whether they felt safe seeking care.

Expanding the use of telehealth was a way for providers to see patients and preserve personal protective equipment and a way for patients to access care but feel safe from exposure to COVID-19. Its use in Minnesota grew significantly during the pandemic. Now we have the opportunity to increase access to telehealth for Minnesotans and make permanent some of the temporary advances that occurred during COVID-19 through bipartisan legislation, Senate File 1160 and House File 1412. The bills are sponsored by Republican Sen. Julie Rosen and DFL Rep. Kelly Morrison, one of two physicians in the Legislature.

While previous law required patients to go to a health care provider site to access telehealth, this bill would continue to allow providers to deliver telehealth services directly to a patient’s home setting via audio-only telephone calls, or via secure two-way audio-video services on a tablet or computer. The legislation would allow scheduled visits to be conducted by telephone when a patient does not have access to internet or the appropriate electronic device at their location. These care delivery practices are currently in effect due to COVID-19.

Increased access to telehealth is patient-centered care. Allowing patients to access telehealth from their own home setting without the need to travel removes a barrier to getting needed health care and enhances equity within our statewide system of care.

At Riverwood, we have seen the positive results of increased adoption of virtual visits. We serve a rural community where patients often need to drive significant distances of 20 to 30 miles or more to get care in person at one of our clinics. A virtual video visit for more routine care like discussing medications and how they’re working is a huge benefit when the patient can do this from home.

The pandemic accelerated the adoption and practice of telehealth in all aspects of care delivery, which has reduced barriers to health care access and made a difference for our patients and communities across the state. Please join me in contacting our local legislators so we can keep this expanded access to telehealth in our community.

Timothy Arnold, MD, Riverwood Healthcare Center

Minnesota Telehealth Act looks good in Legislature

Mankato Free Press reports…

Telehealth service expansion in Minnesota appears all but certain as state lawmakers approved telehealth proposals this week.

The Senate unanimously passed the so-called Minnesota Telehealth Act Tuesday while the House passed a health and human services omnibus package Monday that included a similar bill.

The bill would raise reimbursement rates for video or audio consultations between patients and medical professionals. It also expands the state’s definitions of telehealth to include more medical services, such as mental health or substance abuse treatment, as well as expand coverage for those services. It also codifies several pandemic-related telehealth measures into law.

It’s looking good for telehealth…

Telehealth is one of the few things that won’t need much discussion when lawmakers head into conference committees to negotiate budget bills next month. Rosen pointed out there are still a few concerns lawmakers may address — she successfully introduced an amendment for a study on how insurance plans and providers adapt to the telehealth changes — but the measure has almost unanimous support within the Legislature.

The Health Variant gives an up close look at telehealth in NW MN

Bemidji Pioneer shares a podcast that talks about telehealth from the frontlines of Northwest Minnesota…

In the fifth episode of NewsMD podcast “The Health Variant,” host and Health Correspondent Jeremy Fugleberg talks with Dr. Sarah Manney of Essentia Health about the expanding world of telehealth

Last year, almost overnight due to the COVID-19 pandemic, telehealth such as virtual visits and home monitoring became crucial and common. Manney of Duluth, Minnesota-based Essentia Health tells us what has changed, and what’s next, in telehealth.

It’s a practical and first person account of what it’s been like for staff and patients.

MN Legislature can pass telehealth bills to make permanent telehealth expansion experienced during the pandemic

Albert Lea Tribune reports on regulatory changes that supported successful expansion of telehealth during the pandemic and permanent changes required to make sure access and expansion continue…

A swift though lesser-remarked-on transformation happened as well in medical care. As lockdowns loomed, state and federal regulators eased restrictions on “telehealth.” That led to more virtual visits in Minnesota and elsewhere, with doctors and patients communicating via video or a phone call in lieu of a clinic appointment. A year later, there’s a timely debate at the Minnesota Capitol over whether to maintain telehealth expansion measures, which are set to expire 60 days after the end of the peacetime COVID emergency. The answer should be yes, let’s keep going. A dispute between two key health care stakeholders — providers and insurers — over payment levels for telehealth care shouldn’t derail the legislation to do so.

Telehealth changes during the pandemic have provided convenient new options for patients. Previously, Minnesota patients may have had to drive to a clinic or hospital to use their telemedicine facilities. Now, they can connect from home using a personal device. Including mental health practitioners also is an advance.

Legislation to extend telehealth changes is enthusiastically backed by respected medical providers and organizations, including the Minnesota Medical Association (MMA) and the Minnesota Hospital Association (MHA). If this yearlong experiment wasn’t going well, these organizations would be the first to sound the alarm.

Some details about the bills…

Rep. Kelly Morrison, DFL-Deephaven, and Sen. Julie Rosen, R-Fairmont are commendably leading the efforts to pass the telehealth bills (HF 1412 and SF 1160) this session. Morrison is a physician, and Rosen has an admirable record of forging compromise and muscling legislation through.

That latter experience will be crucial. The telehealth legislation faces some headwinds. A key challenge is resolving differences between large health care lobbies over payment. The dispute involves “payment parity,” meaning providers are paid the same for a telehealth visit as they are for one in a traditional clinic. Before the pandemic, Minnesota was one of six states requiring comprehensive telehealth parity, said Lucas Nesse, president and CEO of the Minnesota Council of Health Plans. Since the pandemic, 14 more states have established parity during the pandemic, with requirements often in effect only for the COVID emergency, he added, citing a National Conference of State Legislatures report.

And a compromise…

A February telemedicine report points out one potential compromise: “setting payment parity as the baseline while expressly allowing providers and plans to voluntarily negotiate alternate payment rates and depart from the baseline.” This solution, or other innovative approaches, are needed to ensure that Minnesota moves forward on telehealth, not backward.

Minneapolis Star Tribune promotes legislation to expand telehealth

The Minneapolis Star Tribune Editorial Board posts…

The COVID-19 pandemic forced sweeping changes in how we work, with many workers doing their jobs remotely for much of the past year.

A swift though lesser-remarked-on transformation happened as well in medical care. As lockdowns loomed, state and federal regulators eased restrictions on “telehealth.” That led to more virtual visits in Minnesota and elsewhere, with doctors and patients communicating via video or a phone call in lieu of a clinic appointment. A year later, there’s a timely debate at the Minnesota Capitol over whether to maintain telehealth expansion measures, which are set to expire 60 days after the end of the peacetime COVID emergency. The answer should be yes, let’s keep going. A dispute between two key health care stakeholders — providers and insurers — over payment levels for telehealth care shouldn’t derail the legislation to do so.

Telehealth changes during the pandemic have provided convenient new options for patients. Previously, Minnesota patients may have had to drive to a clinic or hospital to use their telemedicine facilities. Now, they can connect from home using a personal device. Including mental health practitioners also is an advance.

Legislation to extend telehealth changes is enthusiastically backed by respected medical providers and organizations, including the Minnesota Medical Association (MMA) and the Minnesota Hospital Association (MHA). If this yearlong experiment wasn’t going well, these organizations would be the first to sound the alarm.

Telehealth is becoming more common for good reasons…

In 2019, just 3% of patient visits used telehealth. In 2020, that rose to 28%, according to data released last August. In addition, 83% of physicians surveyed reported that telehealth met patients’ needs “acceptably, well or very well.”