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In 2020, COVID 19 quickly fueled an expansion of telehealth services that has transformed how millions of Americans access medical care. It is a trend many providers predicted the public was already eager to embrace.
"Even before the pandemic, that transition was starting to take place. Very, very slowly but you could already see the groundwork being laid by different medical systems and the pandemic just steroid shot it into the stratosphere," said Jonathan Chao, PA-C, a physician assistant with University of Utah Health.
Chao's experience with virtual urgent care began in 2016 when he was asked to offer the service through the U of U Westridge Health Center in West Valley City. Patients responded positively to the virtual visits. "I feel like the public was ready, but it was the medical community that was more apprehensive as it is a large investment and a significant change in how we learned to practice medicine," Chao said.
The initial investment included providing video and audio equipment for health care providers to use during telehealth appointments. In addition, Chao suggested that "We (U of U Health) take patient data security and confidentiality very seriously. So, having a stable system was one of the initial hurdles we needed to clear."
Some still worry about preserving the quality of the care offered. Those who work with low-income patients and within communities of color know their access to technology might be more limited. They do not want to see the digital health care revolution leave these patients behind. Chao agrees that every patient who needs or wants face-to-face care should continue to have access to office visits with doctors and PA-Cs.
The personal interaction with patients is what originally brought many like Chao into the medical profession. So, the transition to virtual care initially took him and others out of their traditional comfort zones.
"In school, medical school, a big emphasis is placed on physical exams and vitals. That is why we give it the name vitals because they are so important. Then suddenly, we are asked to make medical decisions without using what has been drilled into our heads for years and years. It is somewhat daunting," Chao said.
Over the course of the pandemic, patients not only adjusted to virtual visits for urgent and normal health care needs, but they also told surveyors they "liked it" or "loved it." In a nationwide poll conducted by health care professionals at Harvard Medical School in 2021, 86% of those who reported using telehealth said they were satisfied with the services they received and willing to continue using it in the future.
The numbers are not surprising to Chao. He said he believes the convenience of getting an assessment, diagnosis, and treatment plan on a laptop or smartphone is one of the strongest selling points for virtual care. He offered an example that illustrates the ease of a virtual visit.
"Your toddler wakes up with red goopy eyes. Instead of needing to get the whole family ready, or worrying about child-care for other kids, or worrying about how busy the waiting room is, a mom can have a face-to-face conversation with a certified clinician in the comfort of her home. If medications are needed, we can send it to their neighborhood pharmacy. If patients have a good connection, we can take care of them. I've seen patients in their homes, parked cars, on lunch breaks at work, and even a resourceful fellow on the slopes of Brighton ski resort."
Those who have studied the promise and the pitfalls of virtual care see more potential for positive transformation in the delivery of health services. Patients living in rural areas can get exams and prescriptions refilled without lengthy travel requirements. Virtual consults with a scarce number of specialists who have long in-person waiting lists can provide assessments more quickly.
Chao said it often comes down to the provider's ability to make a connection, whether it is in-person or virtual. "Can you as a provider instill trust and confidence in your patient in that brief 10 to 15 minutes when you are talking? Just trying to listen and be as clear and accurate with our patients is still the best way to provide care. The more that I have done this, the more that I feel I can still reach across and connect with my patients."
In-person visits have rebounded from pandemic lows, but it is the cost of virtual care that will have the most impact on its future. Physicians' groups like the American Medical Association are pushing for Medicare and private insurers to maintain equal reimbursement for telehealth and in-person visits. Chao thinks insurers must be experiencing cost savings with virtual care since large healthcare providers like U of U Health are being encouraged to promote and provide the service.
It is clear, many Americans are ready to address more and more of their health care needs over the virtual platform. However, it is important to remember that there are still medical issues where professionals like Chao need those vitals and a physical exam to make important decisions about treatment.
"We want to give our patients the best care we can offer, so if a provider feels like an exam with vitals is needed, we may still ask you to come into the clinic," Chao said. Striking the right balance between expectations and current realities is something providers and their patients will continue to work on as they navigate the brave new world of virtual health care.
