Sarasota-Manatee healthcare providers and patients have scrambled to adjust to the technology, which can be challenging to access for those without access to devices or assistance.
A few months ago, when news was breaking about the spread of the coronavirus in the United States, Dr. Stephen Nicholas recognized the threat.
“I thought, ‘This could be big,’” said Nicholas, chief medical officer at CenterPlace Health, Sarasota County’s primary health resource for all patients, regardless of their ability to pay.
He huddled with colleagues and devised a plan to start providing telehealth to some patients. The advantages of “virtual visits,” like seeing the doctor online through Zoom or FaceTime, are many, starting with the convenience of staying home.
Medical offices can book appointments within shorter time frames, as doctors spend less time moving from one patient to another if things go smoothly. And neither patient nor doctor risk spreading the virus to the other.
The hassles that come with telehealth are temporary. Patients and providers say there are inevitable growing pains with change. Some, including older adults and those with asset-limited incomes, will have a harder time gaining access to or utilizing the technology.
Telehealth was already in use before COVID-19, but advocates were frustrated by its slow progress.
A 2019 report by J.D. Power concluded that “telehealth technology is maturing, but engagement is very low, barely in double digits in the most engaged demographics.”
The Florida Legislature in 2019 paved the way for out-of-state physicians and a broad range of other health care providers to care for patients in Florida by telehealth, which included virtual visits, but not by telephone only or email.
The Legislature enhanced the aid in its 2020 budget, requiring insurance companies to cover telehealth services during the pandemic. Just how long that will last is uncertain, said Rep. Travis Cummings, R-Jacksonville.
“It’s a shame it took a pandemic to bring residents this wonderful technology,” Cummings said.
As death counts spiked from the coronavirus, offices scrambled to set up the needed software. CenterPlace made telehealth possible for its pediatric, obstetric and gynecological practices, and saw its first patient less than two weeks later, Nicholas said.
The pandemic prompted MCR Health (formerly Manatee County Rural Health Services) to train staff on evenings and weekends in telehealth services. The clinic has since conducted more than 8,000 telehealth visits with patients in Manatee, Sarasota and DeSoto counties, president and chief executive officer Patrick Carnegie said.
“About 10% of our patients seeking telehealth visits have experienced connectivity issues for various reasons,” Carnegie said. MCR has added temporary “tent triage” locations where patients can receive care while operating more than 30 clinic offices, all of which have remained open.
Adjusting to the technology hasn’t always been easy, for both providers and patients.
Joe Patera, a retired cabinet maker and electrician with pancreatic cancer, has finally gotten his camera and sound to work. Patera, 66, sees a physician at Friendship Centers in Sarasota, which also went largely virtual.
“My fingers tend to be like hams,” Patera said. “I’m watching somebody’s lips moving, but I can’t hear, and it’s because I turned the sound off. And suddenly I think they’ve disappeared and they haven’t. I’ve just turned the camera around.”
Dr. Meghen Bueler, a family practitioner in Venice who also practices at Sarasota Memorial Hospital, saw telehealth patients in March jump from zero to about half of her patients.
“I never did any telehealth before the coronavirus,” Bueler said. “I don’t even like to FaceTime my friends.”
Consultations about lab tests can be done virtually, she said, as can mental health counseling.
“Mental health has been really big with the COVID-19 pandemic,” Bueler said. “People are stressed, they’re anxious.”
Dr. Lana Nusbaum, who sees patients at Senior Friendship Centers, estimated that 40% of the homeless clients she sees don’t have cellphones. Others own subsidized phones for low-income residents, which don’t have video capability.
The same clients are more likely to struggle with a telehealth visit. “A lot of them can’t get through the unfamiliar technology,” Nusbaum said.
In April, the Federal Communications Commission pitched in with its Keep America Connected program, which funneled $200 million to support telehealth services to clients who couldn’t otherwise afford it. That help extends to devices such as phones to help people reach doctors.
Cable companies are also offering assistance. Comcast’s Internet Essentials program, initiated during the pandemic, offers two free months of service to new customers and a monthly bill capped at $9.95. Eligible customers must qualify for public assistance such as the National School Lunch Program, Medicaid, SSI or others. The program includes online computer tutorials. The company recently moved the application deadline from June 30 to Dec. 31.
“When we announced this, we were just inundated with calls and applications,” Comcast spokeswoman Cynthia Arco said. “Suddenly, families need Internet so kids can do schoolwork.”
Many patients in the Newtown area also depend on Internet access for their health, said Dr. Lisa Merritt. She practices physical medicine called physiatry at the Multicultural Health Institute she founded and directs.
Residents know “Dr. Lisa” as an engaged advocate who visits the homeless and leads meetings at the Goodwill Job Connection Complex.
“Our focus now is on contact tracing and linking to care,” Merritt said. She worries that smaller providers lose out in grant funding to larger players. She also wants to see patients have more access to doctors virtually.
“We have a list of providers, and I’m trying to help support them to find out who is doing telehealth so we can get that updated,” she said.
Psychologist Nancy Schlossberg, who leads a discussion group at Senior Friendship Centers, believes COVID-19 has illuminated long-standing socioeconomic disparities.
“It’s difficult to generalize because some older people are very sophisticated,” said Schlossberg. “Others don’t know how to access a computer or (computer) gurus. I think the pandemic has highlighted that our worlds are so different, and that haves and the have-nots are going further and further apart.”
This story comes from Aspirations Journalism, an initiative of The Patterson Foundation and the Sarasota Herald-Tribune to inform, inspire and engage the community to take action on issues related to digital access.