Telehealth is a service which has been offered by many health care providers for years, but there has been a sharp increase in demand and utilization since the onset of the coronavirus pandemic. Many visits that would have traditionally been conducted in-person, but could be administered remotely, have transitioned to a virtual setting, so long as adequate internet connectivity is available.
With the demand for these services on the rise, the Federal Communications Commission awarded funding to health care providers across the country through its COVID-19 Telehealth Program. Among these were SSM Health and Barnes Jewish Hospital in St. Louis, as well as Burrell Behavioral Health with locations in central and southwest Missouri and northwest Arkansas.
Additionally, at the onset of the pandemic, the Centers for Medicare and Medicaid Services loosened some restrictions regarding which services can be provided and covered under its health insurance plans. This allowed over 80 new types of services to be offered, and it relaxed rules regarding the technology that could be used to conduct telehealth visits.
A startup surges
One area of telehealth that has experienced increased business since the onset of the pandemic is teledentistry. The TeleDentists, a Kansas City-based startup, has seen its business grow substantially.
“We’ve grown thousandfold,” president and co-founder Maria Kunstadler said. “From March to the end of April, we had thousands of calls come in.”
The TeleDentists began as a service offered to hospitals, as patients often respond to dental problems by visiting hospital emergency rooms, where there are no dentists on staff to assist them. Many times, patients leave with only an antibiotic and no referral to a dentist who could address the root of the problem.
“I was sitting with a lot of physicians that were currently doing telemedicine and it just washed over me,” Kunstader said of the idea for her startup. “What we really need is a virtual dentist, a teledentist, to be able to be in all the wrong places people go for dental problems — emergency rooms, pharmacies, walk in clinics, urgent cares.”
Once the risk of contracting COVID-19 began to cause people to limit their trips outside the home, many people turned to teledentistry as a way to continue their dental consultations. While there are many dental services that cannot be performed virtually, many concerns can be addressed in a remote setting.
The TeleDentists is also able to connect patients with providers if they need in-person services. The company partners with over 300 dentists across the U.S.
The increased use teledentistry services throughout the pandemic has introduced patients to the option of receiving care from home. Kunstader is confident that the newfound interest will continue.
“The genie is out of the bottle for people,” Kunstader said. “I think that we’ve touched the tip of the iceberg because now people are aware of the services that are available.”
Rural patients, providers connect
The expansion of new telehealth services is particularly beneficial to patients in rural areas, who often have to commute long distances to visit medical specialists in larger cities.
Jennifer Wilson and her daughter have utilized these services for a routine checkup with her daughter’s neurologist. They would have typically gone to this type of appointment in person before the pandemic.
“We live 30 to 40 minutes from the hospital, so it was nice,” Wilson said. “We didn’t have to take off work or take time for the drive.”
After using telehealth for a doctor visit, Wilson said she could imagine using the technology again in the future.
“It would depend on the issue, of course, but maybe for a routine follow-up where you’re checking in with your provider and you don’t have any new issues or, you know, maybe you need to just have your medications renewed, I would use it for that,” Wilson said.
Telehealth is not just being utilized by patients from home, but also from patients in rural hospitals who seek the services of specialists without having to be transferred to urban hospitals.
At Golden Valley Memorial Healthcare, one of the most utilized telehealth services is teleneonatology. The Clinton hospital has paired with both Children’s Mercy Kansas City and HCA Midwest to provide patients access through telehealth to neonatal intensive care specialists. In August, Golden Valley’s foundation announced a $59,000 gift to purchase a new teleneonatology robot for the hospital’s birthing center.
“Teleneonatology is used on a case-by-case basis depending on the level of care the infant may need,” said Lea Studer, director of marketing and communication at Golden Valley. “If a birth proves difficult or the infant is in distress, teleneonatology may provide life-saving measures to critically ill patients. It can be used from the moment a baby is born up until discharge for patients who may need a higher level of care.”
One local woman utilized the teleneonatology services during the birth of her second child, just prior to the onset of the pandemic. Shelby Daugherty experienced complications while delivering her daughter, Sofia, who was born five weeks premature with underdeveloped lungs.
Included in the teleneonatology technology is a function that allows specialists to listen to a patient’s lungs as if they were there in person using a stethoscope. Through this technology, specialists in Kansas City were able to listen to the infant’s breathing from almost 80 miles away and devise a plan of care to improve her breathing.
“We were really grateful, not only that we were able to stay at (Golden Valley), but that we felt comfortable staying there,” Daugherty said. “It was really reassuring that everything was okay – she was just early, and her lungs needed more time to develop. We also have a toddler, so if we would have been required to go to a hospital in the city with Sofia, it would have been incredibly difficult for our family.”
The onset of the pandemic spurred Golden Valley to begin offering virtual access to services that were traditionally delivered in person.
“Due to the COVID-19 pandemic, Golden Valley Memorial Healthcare implemented virtual visits through our patient portal,” Studer said. “This allowed patients to consult with their primary care provider through a virtual visit using a smartphone or computer.”
According to Studer, the telehealth services offered have been met with positive reactions. As a rural hospital, Golden Valley caters to many patients who do not live in Clinton and must commute to their in-person visits.
“Telehealth gives patients living in rural areas access to more providers, which leads to reduced readmission rates, effective management of chronic diseases and increased patient satisfaction,” Studer said. “It also allows patients to receive care in their own communities, instead of traveling long distances.”
Infrastructure challenges remain
There are obstacles that prevent patients in some rural communities from receiving care via telehealth services. The quality of internet service is a big impediment in some parts of the state.
According to the Missouri Department of Economic Development, there are roughly 300,000 households in the state that lack internet connectivity.
In July, Gov. Mike Parson extended the Missouri Broadband Grant program through 2027. This program works to bring high-speed broadband to people across the state, with a focus on providing service to rural areas.
In addition, Parson allocated $50 million in CARES Act funding to improve high-speed internet service across the state in the interest of increasing access to telehealth and remote learning.
From that initiative, $5.25 million is to be used exclusively to improve telehealth, obtaining more than 12,500 internet hotspots to be used by Federally Qualified Health Centers and Community Mental Health Centers.