Albert Chan, Sutter Health’s Chief of Digital Patient Experience, which runs 24 hospitals across Northern California, says that he “cannot imagine scaling a response to an epidemic like Covid-19” without technology. Sutter Health uses video visits as well as an app called Ada, whose AI chatbot asks users a string of questions in order to direct them to the right resources. Chan says these tools have helped Sutter Health officials scale up their response to coronavirus worries and reach patients more quickly and safely than it ever could before.
“Telehealth is widely recognized as a tool in this public health emergency,” says Lori Uscher-Pines, a researcher at the Rand Corporation who studies health care. But, she says, while telehealth could do a lot to ease the burden on hospitals, regulations and reimbursement models have stunted telehealth’s growth. Medicare has traditionally only reimbursed telehealth visits for patients in rural areas. And ironically, these patients can’t always access the service at home. Sometimes they have to go into the clinic in order to have a virtual conference with a doctor located in another city. In those situations, there’s still a danger of spreading a disease to the outside world, because the patient has to leave home and share space with other people.
Additionally, since doctors have to be licensed in the state where their patients are, it makes it harder for independent telehealth companies who want to expand across state lines. Uscher-Pines says these funding and licensing barriers mean that current systems aren’t able to handle a widespread outbreak. “Most health systems and telehealth companies don’t have the capacity to suddenly serve hundreds of thousands patients via telehealth,” she says.
On Thursday, the Senate approved a new funding package to help the Centers for Disease Control, the National Institutes of Health, and Medicare handle the novel coronavirus. In addition to pumping millions of dollars into vaccine research and public education outreach, the package would also allow the Department of Health and Human Services to ease some Medicare restrictions on reimbursements for telemedicine visits.
Another reason doctors hope that people with mild or no symptoms will stay home is that some medical supplies are already limited, and the threat of a global face mask shortage is looming. Doctors can’t distinguish between influenza and the novel coronavirus without a test, but with none commercially available, and with test kits running low at the CDC and state health agencies, many hospitals are trying to conserve the tests they do have.
“Right now, we have what we need to care for our patients,” says Megan Farnsworth, medical director of Providence Medical Group, which runs over 50 hospitals in states including Texas, California, Oregon, and Washington, where Covid-19 cases have been confirmed. Farnsworth says Providence is also developing guidelines that will help conserve masks and other protective gear should supplies start to run low.
At Montefiore hospital, where doctors have tested a few potential Covid-19 patients but haven’t turned up any positive results yet, Rabrich says there are restrictions on when staff can use protective gear like gloves, gowns, and masks, “conserving them for appropriate use so we’re not having wastage or excess use.”
Urgent care clinics that aren’t attached to hospitals are also getting ready to handle novel coronavirus cases, but they don’t have the same resources as hospitals. “Currently, we have signage on our clinics’ front doors stating that if someone believes they have been exposed to Covid-19, or has had exposure to a person who has traveled from China, Italy, Iran, Japan, or South Korea in the past two weeks, to remain outside and call the clinic so a team member can bring them a mask before they enter,” writes a representative for FastMed, one of the country’s largest urgent care chains. While clinics like Fastmed can help identify patients who might need testing and alert local public health departments, they aren’t licensed to run tests and they don’t have the facilities to quarantine patients.