The push towards virtual medical visits has been happening in Alaska for years. But it has been accelerated in-state and nationwide by the novel coronavirus, which has complicated in-person medical visits.
“In Alaska, telehealth has been vital for some time, but the coronavirus pandemic has created a new normal and certainly fueled that need,” said U.S. Sen. Lisa Murkowski, R-Alaska, in a statement last week.
She was responding to an executive order President Trump had just signed, intended to expand access to telehealth services, especially in rural parts of the country — even after the current public emergency ends.
Murkowski said in the statement that she looks forward to reviewing the plans that result from the order, which directs the U.S. Department of Health and Human Services secretary to develop a new payment model that will make it easier for rural health providers to offer and receive reimbursement for telehealth care, and makes permanent some of the earlier telehealth expansions the administration had put in place at the start of the pandemic.
In Alaska, even before the pandemic began, more than 250 providers were licensed to practice virtually using telemedicine, which is defined by division of public health in Alaska as “the practice of caring for a patient when the patient and provider are not physically together...using technology such as video conferencing and smartphones without the need for an in-person visit.”
Telemedicine refers specifically to remote clinical services, whereas telehealth is a broader term for the practice of health-related care that uses technology.
“The biggest benefits of telehealth are being able to provide services that aren’t usually available in a rural community,” said Tricia Franklin, state director for the Alaska Office of Rural Health. “And being able to monitor a situation from afar without having to go into the office.”
But some providers and public health officials told the Daily News that while telehealth can be helpful, virtual doctor’s visits are often no substitute for in-person care. One key issue in Alaska is broadband access. It remains extremely limited throughout much of the state — which can complicate access to telehealth in rural areas, Franklin said.
“Saving people the trip of trying to get to the doctor’s office, of course that’s very helpful,” said Franklin. “But does the patient have computer or smartphone technology? And do they have enough broadband access to actually do that?”
Older, poorer men in rural areas, and those with disabilities, have experienced the most challenges to accessing care via telehealth, according to a recent study by the University of California in San Francisco.
Researchers there also found that a third of Americans above the age of 65 experienced difficulty with accessing telehealth services, either from lack of internet access or technical skills needed to manage the appointments. Hearing, visual or cognitive problems also made remote care challenging for these participants.
This study rings true for Dr. Carl Brown, a physician’s assistant at Cross Road Medical Center in Glennallen.
“I would estimate there’s about a 50 to 60 percent deficit of access to technology in order to participate in telehealth,” he said of his clinic’s patients.
In other cases, the complexity of patients’ medical conditions means in-person care is better.
“It’s difficult to get to a thorough exam through telehealth,” said Brown.
Another concern is that some people are no longer coming into the medical facility to receive care out of fear of contracting the coronavirus, said Jim Godin, a director at Copper River Native Association.
In many of those cases, “telehealth can’t usually substitute,” he said.
There are some bright spots. Behavioral health is the area where Godin and Brown say they have seen telehealth be the most helpful.
In East Anchorage in June, a new behavioral health clinic opened, offering mental health care for veterans and their families — entirely virtually.
Virtual mental health treatment has been “wonderful, in that it’s now allowing access to care for people who have not otherwise received it,” said Anthony Hassan, president & CEO of Cohen Veterans Network, which owns and operates the new clinic, along with more than a dozen others across the country.
Telehealth has helped with the stigma of seeking mental health treatment, Hassan said, because people are now able to access care without leaving their home. It also reduces “no shows,” because less effort is required to arrive at one’s appointment, he said.
He said that while his network of clinics pre-pandemic used to conduct about 18% of sessions virtually, now that’s up to 98% — or 2,000 sessions a week nationwide.
“I know (virtual care) isn’t a panacea; people do need to come in,” he said. “But our outcomes in-clinic and telehealth are equal.”
Usage has varied by zip code, he said. So far, more veterans dwelling in cities and urban areas use the network’s services than those in rural parts of the state.
“That was such a shock to me,” Hassan said. “Because I thought that telehealth would be the great equalizer, the one tool that would be able to give access to rural veterans. But what we know, though, is the broadband or the access isn’t always there.”
[Because of a high volume of comments requiring moderation, we are temporarily disabling comments on many of our articles so editors can focus on the coronavirus crisis and other coverage. We invite you to write a letter to the editor or reach out directly if you’d like to communicate with us about a particular article. Thanks.]