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Telemedicine keeps patients safe, medical practices going in the age of Covid-19

Dave Obrochta decided to ease his Covid-19 cabin fever five weeks ago with a walk through the woods.

He fell down a creekside ravine and almost broke his left shoulder.

In normal times, he would have gone to an emergency room or urgent care center to size up his injury.

These aren’t normal times.

He called a specialist and connected virtually instead.

“It’s the first time I ever did a telemedicine visit, so it was strange,” said Obrochta, 51, who owns a specialty pharmaceutical company in the Southtowns.

Dr. Michael Rauh – a shoulder and knee surgeon with UBMD Orthopaedics & Sports Medicine – conducted an exam by smartphone. He looked at Obrochta’s bare chest, arm and back as Obrochta moved his shoulder blade and his wife, Beth, moved his iPhone at the doctor’s direction.

“He accomplished more than I thought he would,” Obrochta said. “I would prefer to go in and see my doctor but under these circumstances, I was very pleased.”

Hospitals, primary care providers and specialty practices across the region are conducting similar visits much more often since the novel coronavirus pandemic began.

BlueCross BlueShield of Western New York reimbursed health care providers for 135 telehealth visits in March 2019, compared to 20,000 last month.

It expects to cover the costs of 30,000 such visits this month, said Dr. Thomas Schenk, senior vice president and chief medical officer of the region’s largest health insurer.

“When we started to see coronavirus become a pandemic, we saw a really sweeping change in people’s behavior. They didn’t want to come into the office,” said Schenk, who still picks up weekend shifts once a month with Delaware Pediatric Associates, where he worked full time before joining BlueCross BlueShield six years ago.

Those shifts now exclusively involve telehealth.

New York State since 2016 has required insurers to cover such visits in most cases as if they were office visits. The state Department of Financial Services last month also directed insurers to waive copays and unpaid deductibles – no matter how large – for virtual visits, as well as cover doctor-patient phone consults.

Technical support

A college freshman helped get UBMD Ortho up and running with telehealth last month.

Rauh’s daughter, Hannah, a biology major home from Duquesne University in Pittsburgh, suggested the practice try a computer app to connect with patients while promoting social distancing and limiting the potential spread of the new coronavirus to patients and staff in their office settings.

“When she came home,” Rauh said, “I asked her, ‘How are you still doing all of your classes? How can you relate to your professors?’ She said, ‘Dad, it’s easy. It’s called Zoom.’”

This and similar applications use passwords and other strategies to preserve privacy, easily schedule appointments, and connect patients and providers with the click of a computer mouse or tap on a tablet or smartphone.

The new approach also has helped teaching doctors, including Rauh, to take virtual rounds with University at Buffalo medical residents working in hospitals and nursing homes. Coupled with a new consultation line (906-5951) anyone with an orthopedic concern can call free, telehealth “has probably saved hundreds if not more patients from going to emergency departments,” he said.

Broad applications

Dr. Renata Anand, with Buffalo Medical Group, visits with patient Wayne Herr during an annual annual physical exam before the novel coronavirus pandemic. The practice is now handling one-third of its current patient load through telemedicine. (Robert Kirkham/News file photo)

Most people who struggle with musculoskeletal injuries don’t need surgery, Rauh said. They can be helped with physical therapy and other interventions.

During his 15-minute visit with Obrochta, he was able to determine his patient’s shoulder wasn’t broken. Rauh arranged for an X-ray and MRI two days later. He suspected – and later learned – that Obrochta had a torn ligament.

Rauh told him during a follow-up telehealth visit he’d need to wait several weeks for surgery because, despite the injury, it was considered an elective procedure. He also ran through several personal training exercises Obrochta could do in the interim. He checked back Wednesday to see how things were going and offer encouragement.

Despite lingering pain he’s treating with Tylenol, and that fact that he lives only two miles from Rauh’s office, the still busy business owner said he appreciated the reassurance – and not having to sit masked in a potentially busy office waiting for appointments that instead started right on time.

Virtual visits have bolstered medical practices that have struggled during the Covid-19 paradigm, including with layoffs as elective surgeries and many office visits have been postponed.

Furloughs, pay cuts come as Covid-19 batters health care industry

Buffalo Medical Group is seeing about one-third of the typical volume of patients it sees face to face, said Dr. John C. Notaro, its medical director.

Of the primary and specialty care patients who aren’t coming into their doctor’s office, one-third of them have shifted to appointments handled over video or phone calls, he said.

Patients are showing an openness to telehealth that he and other group officials believe will continue to grow after the Covid-19 pandemic eases.

“We are slowly but surely as an organization moving in that direction,” said CEO Dan Scully, noting that 200,000 people use the practice’s patient portal for online health records.

Notaro said he is surprised at what can be done through a video call. He was able to virtually diagnose diverticulitis, an intestinal inflammation, in one of his elderly patients. The patient’s history played a role in guiding him to the right diagnosis, he said, but it’s an example of where medicine is headed.

“That’s a totally new paradigm,” said Notaro, who also pointed to the example of a urologist who coached a patient through a kidney stone without requiring an emergency room visit.

Mental health matters

As seen on a Sussex Directories Inc site

Distance is nothing new for Monica Farrar, a licensed mental health counselor who launched her telehealth business five years ago with encouragement from doctor friends.

Her virtual patients have included nurses in New York City and college students, many with ties to Western New York who attend school elsewhere.

Farrar also is an adjunct professor who teaches online courses in crisis intervention for Purdue University in Indiana and addiction recovery and sociology at two colleges in Colorado.

Last month, she moved her Introduction to Psychology course at Niagara County Community College from the classroom to the internet.

Farrar has an office in Williamsville. She started working exclusive online, from home, early last month.

“I usually see people with anxiety, depression and grief,” she said, “and in my opinion, that’s what we’re going to continue to see. People are fearful for the future.”

Univera Healthcare reported before the pandemic that 40% of those who used its related telehealth services did so for mental health reasons.

Roughly one in three such visits BlueCross BlueShield has reimbursed in recent weeks involved mental health, Schenk said.

Farrar and other counselors and life coaches are encouraging clients to focus on the here and now, practice healthy behaviors and use guidance they provide to buttress hope and perspective.

Virtual visits often give counselors a better sense about how some of her patients are living during the pandemic.

“I can’t tell you how many people are in bed when it’s time for the session,” Farrar said. “I can see the headboard. I’m not denying that it’s hard to get up, but structure is super important right now.”

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Hospitals also have gotten into telehealth. Kaleida Health and Erie County Medical Center have established platforms to provide virtual emergency room visits and consults.

The need remains for many patients to continue making office and emergency room visits, Schenk said, including children who need to stay on vaccination schedules and people who need hands-in treatment for illness. Medical offices are practicing the same precautions as hospitals and ERs, he said.

Going forward, Schenk hopes telehealth will provide another avenue for all to preserve and protect their well-being.

“During the time we’re all very focused on Covid-19, people still have diabetes and asthma and congestive heart disease and a variety of other things,” he said. “We wanted to make sure that people could access their doctors.”

Insurers will help members by phone or online seek services through a primary care provider, or find one for people without one.

Most of those practitioners are comparing notes when it comes to telehealth and trying approaches in many cases that are new to them.

“Going forward,” Schenk said, “I think providers are anticipating that things will be different.”

News Staff Reporter Stephen T. Watson contributed to this story.

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