Sunday, September 27, 2020

Virus prompts spike in telehealth demand, services

Daily Inter Lake | May 10, 2020 1:00 AM

When it came time for Alan Gianoli to meet with his doctor at the Woodland Clinic in Kalispell, he first hesitated, and then eventually canceled his appointment. At 72 years old, he figured the risks associated with an in-person visit were too great.

The Columbia Falls resident said concerns surrounding the novel coronavirus outbreak were accelerating around the same time he was supposed to go over the results of some blood work. But soon after Gianoli canceled, he received a call from staff at the clinic who said a doctor could instead meet with him virtually through a secure online platform.

“They helped me get everything set up and made sure I understood how to use the technology on my end,” Gianoli said. “The experience was very pleasant overall. I mean, what a great option to have, especially right now during a time like this when there is so much uncertainty.”

For about 20 minutes Gianoli met with Dr. Sarah Robinson, an internal medicine physician at Kalispell Regional Healthcare’s Woodland Clinic. She not only discussed the results of Gianoli’s blood tests, but also checked in on his general well-being, which he said was both surprising and welcomed.

“I think there is a lot of anxiety out there right now surrounding the virus, so I like to make sure we’re getting to the basics,” Robinson said. “Are you getting outside when the days are nice? Are you exercising? Are you limiting your TV time?”

Gianoli is part of a rapidly growing population of patients who have recently opted to meet with their health-care providers virtually instead of in-person. While Kalispell Regional has offered various telehealth and telemedicine services for a number of years, the demand for these services has skyrocketed since the COVID-10 outbreak reached Montana and stay-at-home orders were implemented.

According to Nichole Perisho, virtual health manager for Kalispell Regional, the organization performed about 2,000 telehealth visits during the 2019 calendar year, but since March this year, providers have booked more than 9,000 visits. Perisho said there are about 150 providers throughout the organization who are collectively completing between 400 and 500 telehealth visits per day.

“This has really been one of the first times where we have been able to witness how important telehealth services are, especially in a rural state and especially during a time like this,” Perisho said. “We’ve wanted our patients to know that even though we may not be able to see them in person, we can still be there for them and provide services.”

PERISHO ATTRIBUTES this dramatic increase in telehealth demand and usage to several factors.

Among other reasons, she said the outbreak has prompted a shift in the type of patients looking to utilize telehealth services, which, in turn, has led to a shift in the type of provider needed to perform telehealth visits.

The organization’s telehealth system was built years ago with the primary mission to bring the expertise of special-care providers to areas where specialty services are typically unavailable. With that goal in mind, telehealth systems were established in clinics in areas such as Polson, Eureka, Ronan, Shelby and Cut Bank. And for years special-care physicians based in Kalispell have been able to teleconference into those clinics to assist with medical issues ranging from strokes to neonatology, and more.

“So typically, a patient would arrive at one of our outreach clinics and would enter an exam room either with or without a physician, depending, and they would then virtually connect to their specialist here in Kalispell,” Perisho said. “Prior to March, primary-care physicians really had no reason to utilize the system.”

But when the coronavirus outbreak reached Montana and shelter-in-place orders went into effect, Perisho said many patients, including those who would typically be seen by a primary-care physician for minor issues, were turning to telehealth. So in early March, Kalispell Regional started moving quickly to find a way for all providers, both specialty and primary-care, to safely connect with patients in their homes for low-acute issues.

It was around this time also that the Centers for Medicare and Medicaid Services (CMS) began to roll out an array of temporary regulatory waivers and new rules in response to the pandemic. One of these rules allows all beneficiaries to receive Medicare telehealth and other communications technology-based services wherever they may be located. In addition, health-care providers are able to waive Medicare copayments for these telehealth and other non-face-to-face services.

“Before these adjustments were made, federal guidelines essentially said a patient needs to be in a federally qualified facility or clinic to receive these services, like in one of our outreach clinics,” Perisho said. “But around early March, they essentially said ‘no, a patient can be seen in their home.”

And once CMS loosened certain regulations, Kalispell Regional expanded its teleconferencing platform, Lifesize, to be able to do just that.

“We were able to come together and nail down different options that allowed us to connect more with patients that are unable to come to the hospital or are generally nervous to because of the pandemic,” Perisho said. “Now specialty-care and primary-care providers are jumping on and it’s been so successful it’s hard to imagine going back [to prior telehealth restrictions] once regulations are back in place.”

ROBINSON IS an example of one provider who hadn’t used the telehealth system much prior to the pandemic, but has started using it more since the outbreak. She said most of her patients at the Woodland Clinic fall into the Centers for Disease Control and Prevention’s high-risk category for coronavirus complications — something that has prevented many of them from making trips to the office for regular check-ups and other minor services.

“The majority of patients in our clinic are 65 and older. So when COVID reached Montana, we wanted to make sure the older adults that still need more simple services on a regular basis weren’t lost in the shuffle,” Robinson said.

She also said telehealth has allowed her to check in on her patients in assisted-living and nursing-home facilities who are feeling particularly isolated due to the tight and ongoing shelter-in-place restrictions at locations that cater to elderly populations.

“When you’ve known a patient for years, seeing them through telehealth can still give you a good sense on how they are doing and help us make the decision on whether or not it is critical to schedule an in-person visit, send someone to the ER, or continue to manage their medical issues via telehealth in the setting of the pandemic,” Robinson said. Telehealth platforms allows her to help her patient “know more about the medical issues we were dealing with and ultimately decreased anxiety for the patient.”

And although the expansion of telehealth capabilities has allowed physicians like Robinson to treat and comfort their patients during uncertain times, she said it’s important to note that some still prefer in-person visits, even for low-acute needs.

“Telehealth isn’t for everyone and there are obviously barriers, too, like what kind of internet access someone has or what type of device they will be using. All of these factors are taken into consideration prior to virtual appointments,” Robinson said. “But for those who prefer face-to-face contact with their physician, we want them to know we are here for that as well and will find a way to do that even during this outbreak.”

Reporter Kianna Gardner can be reached at 758-4407 or