During the COVID-19 pandemic, the use of telemedicine services has skyrocketed in Vermont. The services are being used to help protect the health and safety of both patients and health care providers.
And while Dr. Anna Hankins was initially skeptical of telemedicine, she’s now an enthusiastic supporter.
She recently checked in with the mother of a 2-year-old who suddenly developed a nasty rash on his hands:
Hankins: “Hi! I just wanted to check in and see how Chase is doing. How is that rash from yesterday?”
Mother: “His rash is doing much better. He has no longer the bumps on his fingers.”
Hankins: “Good, so no more waking up in the middle of the night with a crazy itchy finger?”
Mother: “Nope, not at all.”
Hankins: “Thank heavens, because that sounds miserable.”
Hankins has been a pediatrician in central Vermont for the past 16 years, and until the coronavirus pandemic hit in Vermont in early March, she had never conducted a session with a patient using video technology.
"So we started rolling out these video visits and telephone visits, and I thought it was just a terrible idea, but the best we could do in a crisis,” Hankins said. “And I was approaching it as, ‘Well, l do my best, it's not ideal, I can't wait to get things back to normal,’ and at that time I was thinking, ‘in a few weeks.’”
But early in the pandemic, Hankins had a change of heart. She says she became more comfortable with the video technology, and she realized that telemedicine could be a very effective way to diagnose and treat certain ailments, like her young patient's rash.
“I left that visit kind of a in a really good mood, because I had gotten to seen a patient in a non-crisis kind of way, but I also realized, ‘Wow, that that was a really good visit,’” Hankins said. “I was able to address the problem of the rash, but I was also able to check in in a way that, up until that in my career, I've only ever done in person.”
Hankins wasn't the only one skeptical about using telemedicine. So was Holly, the mother of the young patient, Chase.
“At first I was a little nervous, because I thought, ‘How is she going to be able to see the rash?’” Holly said. “And I really didn't want to have to bring him into the office, so when they offered me to do a video chat, I was a little nervous, wondering, but really it worked out well."
Holly says there's no question that she would happily use telemedicine services again in the future.
"I definitely think it's been a positive thing rather than to bring him in the office,” she said. “And like I said, it is definitely something that if there was an option or a need to do it again, I would be on board with that.”
“And I really didn't want to have to bring him into the office, so when they offered me to do a video chat, I was a little nervous, wondering, but really it worked out well." — Holly, mother of pediatric patient
Blue Cross and Blue Shield of Vermont President Don George says the insurer encouraged health care providers to use telemedicine services because so many patients were canceling their visits to the doctor's office.
It was a situation that George felt threatened the financial stability of the state's health care system.
Patients and providers responded with enormous enthusiasm: In the first five months of 2019, Blue Cross processed just under 2,000 telemedicine claims. This year, that number jumped to almost 84,000.
In addition, a year ago, 200 providers participated in telemedicine. This year, almost 4,000 have.
George says Blue Cross made a critical decision to help expand the use of telemedicine.
“We did that by reimbursing providers the same rate for telehealth as they were receiving from Blue Cross for in-person visits,” he said. “And by doing that, we were best able to maintain their cash flow while also providing members with access to care."
More from VPR: Regional Hospitals Explore Telehealth Options To Improve Health Care Access
Most of the Blue Cross telemedicine claims are for medical visits and mental health visits. But roughly 3% are for the services of a physical therapist.
Dr. Emelia Brogna has been a licensed physical therapist for the past 13 years. She owns the Wayfinder Wellness and Physical Therapy Clinic in Burlington.
She admits that many people did a double take when she suggested offering her services using the telemedicine approach.
“I have to say that a lot of physical therapists were scratching their heads when this all started as well: ‘How do we deliver high-quality care that historically has been delivered in person?’” Brogna said. “We think of physical therapy as being a ‘hands on’ profession."
But Brogna found it was fairly easy to teach her patients their recovery techniques. And then, she says, something quite unexpected happened: Many of her telemedicine patients took more responsibility for their own recovery, and as a result, healed faster.
“People are starting to really develop and foster a lot more independence in their self-treatment and their self-care techniques, that will ultimately, I think, benefit them more in the long run than having to depend on coming into my clinic for somebody else to apply a treatment to them,” Brogna said.
"People are starting to really develop and foster a lot more independence in their self-treatment and their self-care techniques, that will ultimately, I think, benefit them more in the long run." — Emelia Brogna, physical therapist
What's the future for telemedicine services in Vermont? Dr. Anna Hankins thinks it offers positive benefits in certain circumstances.
"There are going to be some visits that I have learned are just better by video,” she said. “And maybe they're better because the medium really just supports it better, but maybe they're better because that family really struggles with transportation, and I can see them more frequently if I can just get them in on video.”
Blue Cross President Don George thinks there's a growing market for telemedicine in Vermont. But he also says it's important for patients to have the option of having an "in-person" visit with their doctors.
“We want people to engage with their health care providers, and if telehealth better enables them to do that, then I think we want to support that choice that they make,” George said. “But if patients want to see their health care providers face to face about their particular health care need, then we need to ensure that that choice is preserved, too.”
The Blue Cross reimbursement policies will be in effect through the end of the year. The company plans to evaluate its approach to telemedicine this fall and might consider ways to expand the services.
Update 4:20 p.m. 7/6/2020: This story has been updated to include Dr. Emelia Brogna's professional title.
