In Maine, COVID-19 case counts have been relatively low compared with the rest of the country, though that number has been slowly climbing.

But when the pandemic began to unfold this spring, Central Maine Healthcare Chief Medical Information Officer Dr. Steven Martel said the system still worked to minimize risk to patients and team members while delivering the care people needed. 

"When we started to implement our restrictions, they were pretty much modeled after the CDC recommendations to limit elective procedures and elective types of care," said Martel.

However, he continued, "we did find that patients were hesitant to come in for any type of care because of perceived risk."

CMH, which serves more than 400,000 people in the state, saw a significant decline in in-office visit numbers, said Martel, as well as a drop in the number of those seeking care through the emergency department and hospital admissions.

Like other health systems around the country, CMH turned to telehealth in order to care for patients remotely. 

"We very quickly stood up the ability to do phone visits, and then partnered with Innovaccer to do our video platform, so we could transfer to audio-visual and provide that more intimate connection," said Martel.

Before COVID-19, Martel noted, CMH was not broadly relying on telehealth, apart from as-needed tele-interpretive services and, on some occasions, in the NICU and for stroke and neurologic services. 

"The primary reason for that was the economics didn't support wide-scale use of telehealth," said Martel. 

"Traditionally, telehealth visits are not reimbursed by private payers, or, when they are, it's at a fraction of the cost. So the driving factors that might encourage that type of platform weren't present to allow for it," he continued. 

Martel pointed to the temporary federal policy changes around telehealth as an instrumental part of CMH's ability to scale up the program. 

"Their ruling, which indicated that these services would be reimbursed on par with traditional office visits, was absolutely key in helping, not only our organization, but also all healthcare organizations, to quickly implement workflows to be able to deliver care using [telehealth] technology," he said. 

CMH's focus was to roll out telehealth in the primary care service line as quickly as possible, with specialties following suit. Martel noted that the system's bariatric surgery group was particularly excited: Many of their patients travel long distances for regular consultations and check-ins, some of which can be done remotely.

"Many of their patients have mobility challenges, and so allowing them to conduct these visits through telehealth has been very helpful," Martel added. The system is also exploring behavioral telehealth services, which can be advantageous in an environment where mental health care can be difficult to access.

From the beginning of March through July, Martel said, CMH has conducted more than 25,000 visits.

What the future holds at CMH will depend largely on how many of the temporary changes to telehealth policy the U.S. Department of Health and Human Services and the U.S. Centers for Medicare and Medicaid Services make permanent.

"We need to be able to maintain the ability to offer services that are reimbursed in appropriate ways that allow us to continue to expand our offerings to patients," said Martel.

If reimbursement regulations return to their pre-COVID models, he said CMH will likely continue using telehealth for patients with some conditions – such as congestive heart failure, diabetes or chronic lung disease – who are at a higher likelihood of being readmitted to the hospital within 30 days. 

On the other hand, he said, "If reimbursements stay where they're at, I think telehealth can become an alternative option for patients for routine types of care."

Martel also pointed to the importance of broadband access for rural patients, noting that a strong cell signal or Internet connection is vital for virtual care.

"The more that people can advocate within their states to extend high-speed Internet to rural areas, the more likely we are to be able to offer an alternative to driving hours to reach routine care," he said. 

"The rural health population can take advantage of this in a way that some of our urban patients may not recognize," he continued.

Ultimately, Martel said, "my own personal perspective on it is there's always going to be a place for telehealth."

"The real question is about whether the economics will drive [its] widespread use," he said.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.