Staff file photo by Troy Stolt / Dr. Siobhan Duff scrolls through an app her practice uses for telemedicine calls inside of her office at Chattanooga Family Practice on Thursday, March 26, 2020 in East Ridge, Tenn. Chattanooga Family Practice made the decision to convert all patient-doctor interaction to telemedicine calls for at least 14 days or until the practice could guarantee the safety of staff members through a higher availability of Personal Protective Equipment and Testing, forcing both care givers and patients, especially those less technologically inclined to adjust in order to give and receive care.

While telemedicine, or providing health care services by phone or video conference, has been around for decades, the COVID-19 health crisis has shone a spotlight on the technology highlighting its value and convenience, local experts say.

Galen Medical Group began offering in March its Galen Remote Access Care program to provide health care to new and existing patients while maintaining social distance to prevent the spread of COVID-19. Existing patients can receive care remotely from their own doctor, and new patients are connected with a Galen physician who can remotely provide the type of care they need.

Galen does not restrict the types of services or providers patients can access remotely, but some visits are better suited for telehealth than others, said Charlie Lathram, Galen Medical Group administrator.

According to a 2016 study by the Agency for Healthcare and Research Quality, telehealth has produced positive outcomes when used for remote monitoring of chronic conditions such as cardiovascular and respiratory disease, as well as for behavioral health counseling. It has been shown to improve outcomes such as mortality, quality of life and reductions in hospital admissions.

Using telehealth for doctor visits that require testing or physical exams is more difficult, but not impossible. Medicare Advantage plans actually encourage annual wellness exams be done over a video-enabled telehealth platform, Lathram said.

About 80% of the information a doctor gets during a visit is what the patient tells them, said Dr. Harish Manyam, chief of cardiology at Erlanger. And that information doesn't change depending on whether the patient is in the office or communicating from home via an interactive video platform.

"Obviously we still need to draw blood at some point; we still need to be able to take vitals," said Lathram. "Instead of you coming in and sitting in the waiting room, or waiting in the exam room, what we can do is do the encounter over our telehealth platform, and then at your convenience stop by, have a lab only, and get your blood drawn and leave."

Lathram said the new service has been popular with patients.

"Quite frankly I think this COVID crisis has pushed along implementation of telehealth services both on the payer side and the provider side," said Lathram. "We've gotten to use this technology in a broader sense sooner."

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The U.S. Centers for Medicaid & Medicare Services expanded coverage in March for telehealth services during the COVID-19 crisis to include evaluation and management visits (common office visits), mental health counseling and preventive health screenings.

During the pandemic, many private health insurers are temporarily reimbursing telehealth visits in the same way they would face-to-face visits.

BlueCross BlueShield of Tennessee is covering telehealth visits with in-network providers who offer the service until at least June 30, 2020. This includes visits with primary care physicians; specialists; behavioral health providers; applied behavioral analysis providers; and physical, speech, and occupational therapists, said Alison Sexter, corporate communications specialist for BlueCross BlueShield of Tennessee.

The visits cost the same as a face-to-face visit with a provider, so any copayment or cost-share a member normally has to pay still applies. Visits to out-of-network providers are still covered, but the provider may bill the member for the difference between their visit charge and the payment they receive from BlueCross BlueShield, Sexter said.

From March 16 to April 14, BlueCross processed more than 71,000 telehealth claims. During the same period last year, the company managed only around 3,900 telehealth claims, according to Dr. Andrea Willis, chief medical director for BlueCross.

The eased restrictions under COVID-19 that allow patients to see their normal doctors are one factor behind the increased use of telehealth services, said Lathram.

"It has really kind of picked up steam since then as more and more patients realize that it's not a nameless, faceless physician somewhere out of state, but it's actually their primary care doctor who they normally see who knows all about them and has their medical record," he said. "Their acceptance of it, not to mention their fondness for it, has really increased."

The Tennessee House of Representatives recently approved a bill sponsored by state Rep. Robin Smith, R-Hixson, that would make it state law for insurers to reimburse telehealth visits at the same rate as in-person visits. The new law also would allow patients to receive remote care at their choice of location, such as home or their place of employment. State law does not now require insurance companies to reimburse physicians for telehealth visits at the same rate as face-to-face visits if the patient does not receive the teleheath services at a health care facility.

This would not only allow increased access to telehealth for patients, but allow Tennessee doctors to participate, Smith said. And seeing one's own doctor provides continuity of care and the best outcomes for patients, she said.

The law still needs to pass the Tennessee Senate, which is expected to reconvene in June.

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