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Telehealth model showing its value through pandemic

  • Dr. Luc Shippee, medical director of Monadnock Health Partners, conducts a telehealth visit with editor Tim Goodwin. Staff photo by Tim Goodwin—

  • Dr. Luc Shippee, medical director of Monadnock Health Partners, conducts a telehealth visit with editor Tim Goodwin. Staff photo by Tim Goodwin—

  • Dr. Luc Shippee, medical director of Monadnock Health Partners, conducts a telehealth visit with editor Tim Goodwin. Staff photo by Tim Goodwin—

  • Dr. Luc Shippee, medical director of Monadnock Health Partners, conducts a telehealth visit with editor Tim Goodwin. Staff photo by Tim Goodwin

Monadnock Ledger-Transcript
Published: 8/3/2020 3:43:40 PM

When you’re sick or injured, the next step has always been to call the doctor, describe your symptoms or pain and if necessary, schedule an appointment to be seen.

If you need help working through a bout of depression or anxiety, setting up a visit to talk with a psychologist has always been just a phone call away. The same can be said for those finally looking to get their nutritional habits on the right path.

But when the coronavirus changed just about every aspect of life in March, the way that people sought medical treatment or therapy could not be done in the same way as before. It had to adapt and evolve too. Hospitals all around the country, including Monadnock Community Hospital in Peterborough, shut down non-essential in-person services, which meant finding a way to see patients in a safe manner.

Enter telehealth visits.

While not the norm in this area by any stretch of the imagination, the quick switch to the virtual model allowed for continuing or acute care to happen when sitting down in an office for a conversation just wasn’t safe.

And those types of meetings between patients and providers happening through webcams from the comforts of home has been the way of the world for the last few months.

Telehealth then and now

Luc Shippee, medical director of Monadnock Health Partners, said discussions among those at the hospital and potential outside facilitators around telehealth began 18 to 24 months prior to COVID-19, but nothing was put in place before the onset of the first global pandemic in more than 100 years.

“Zero,” Shippee said when how many telehealth visits he conducted prior to coronavirus. “All of us had ample opportunity to pick up the phone and talk to people, but not perform an actual visit.”

So they had to quickly adapt.

“We just had to start,” said Shawn Harrington, president of medical staff at MCH. “We built it from ground zero and it was quite a lot. It is impressive.”

Michael Weil, a clinical psychologist based in Peterborough, said he had done a couple telehealth appointments prior to COVID-19, but since March 11 that’s the only way he’s been able to meet with clients. Weil said he uses three different platforms that are all HIPAA compliant and that it wasn’t hard to get set up, considering his wife is an IT professional. And it’s allowed him to continue to meet with people who need his services.

“The continuity of care is important and this really enabled that,” Weil said.

Tiffany Calcutt, owner of Harvest Nutrition & Wellness in Peterborough, said she never did telehealth visits before COVID because it wasn’t covered by insurance, but made the switch the third week of March as soon as the Governor ordered insurance to reimburse for virtual nutrition counseling.

“I have done two in-person visits since things shut down in March – one was outside 70 Main St., six feet apart at a picnic table and the other was just Wednesday p.m. indoors at a large conference room table specially distanced. This last one was in person at the request of a 9 yerr old who told her mother she wanted to come back to see me in person,” Calcutt said.

Harrington estimated that 30 to 40 percent of patient visits at the hospital are held through telehealth, despite the fact that MCH began reopening many of its services in June.

“It’s different,” Harrington said. “Because you don’t have that interpersonal type of care, but you adjust pretty quickly.”

Challenges

Meeting with someone remotely presents a certain set of challenges. Shippee said the first visit is always the most difficult, as there is inevitably time spent troubleshooting technical difficulties. But as he’s seen patients during followup appointments, also virtually, Shippee said the process has been much smoother.

And like most things, change is hard.

“There’s a lot of resistance on anything new,” Harrington said.

“Our staff does a lot of leg work to sell it,” Shippee said. “And you can get a lot of valuable information doing it this way.”

For Calcutt, she has seen some hardships, especially when it comes to her pediatric clients.

“Virtual counseling is not conducive to new food trials, recipe prep or other hands-on games and experiences with food. So I would often ask a parent to help out in this role but that’s not as easy for them to do,” she said.

Finding a way

While different than anything they learned in medical training, Shippee and Harrington both said that the benefits of telehealth are hard to ignore. For one, it allows for a conversation to take place in a safe manner, given all the uncertainty surrounding coronavirus these days.

“We were forced into this and for some patients it’s a whole lot safer,” Shippee said.

Despite not seeing a patient in person, they can ask all the same questions and conduct a similar conversation, discuss lab or imaging results as if they were in the office and make the decision if the person does need to be seen, especially if the patient wants to meet in person.

“If they’re persistent, we’ll see them in the office,” Shippee said.

And for patients, the convenience makes meeting with a provider so much easier.

Harrington said it eliminates the need for patients to drive to the office, check in and sit in the waiting room. He’s met with people via telehealth on their breaks at work or from their car.

What Calcutt has found is that sessions don’t run all that differently from before.

“What may get a little lost, however, is some of that special energy and feel-good chemistry that can happen in a space when folks are working together towards a common goal.” she said.

And it has allowed her to change some of her ways.

“A silver lining of COVID and remote counseling has been a de-emphasis on the scale as a way of measuring progress with healthy habits,” she said. “Pre-COVID, I would often include a weigh-in as part of follow-ups. Throughout virtual counseling, I was pushed to explore non-weight-victories for folks seeking weight loss, such as greater energy, more fruits and veggies in their diet, clothes fitting differently. I now have greater confidence using these alternative means of measurement, which ultimately reflect healthier habits far better than a number.”

And through it all, telehealth has allowed her to stay connected when physical distance is a barrier.

“For several clients, I sensed I was one of few non-family members a client was “seeing” throughout this pandemic. That continuity and connection is a positive thing for sure,” Calcutt said. “Additionally, I sensed a shared “humanity” and “we’re all in this together” feeling when seeing clients in their own home spaces and likewise them seeing me – it’s like a little window into their personal lives that I otherwise would not have, which may lend insight to certain comments and/or struggles and similarly for them to experience my surroundings.”

Returning to normal

While Weil prefers to meet in his office, right now that is not a safe way to provide care.

“I think my preference and most of my colleagues preference is face to face meeting, but having said that, it has been effective,” Weil said.

Weil said if he was to resume appointments in his office, he would require facemasks for both himself and clients.

“But what would be lost in that is facial expressions, other signs of non-verbal behavior,” he said.

And he’s not sure when he will resume in-person visits.

“I’m thinking about safety, first and foremost,” Weil said. And so far, he hasn’t had anyone ask to go back to meeting in the office, and when it does happen, he plans to keep telehealth appointments as an option.

Through the switch, Weil said he has added clients from the Lakes Region and Seacoast that likely wouldn’t have sought his help if appointments were strictly in-person.

“It’s enabled me to establish a therapeutic relationship where there’s geographical differences,” Weil said.

He attributes his addition of clients to both the telehealth model and people seeking to deal with the new anxiety brought on by the pandemic. It’s allowed to talk about normalizing anxiety.

So far it hasn’t streamlined visits, but with more time it could allow for providers to see more patients throughout a day and sooner, Harrington said.

“It’s not perfect, but it gets easy access to your clinician,” Harrington said. “Where in the past you might have had to wait longer to see your doctor.”

But for something that had to be quickly put together, it has worked rather well given the circumstances the two MCH physicians said.

The future

On July 21, Governor Chris Sununu, signed a bill that makes permanent some parts of the expanded telehealth system put in place for COVID-19. The bill requires equal insurance coverage for medical visits done remotely and in person, including for Medicaid users. It also added parameters for telehealth to state law, including spelling out where and how treatment can be given and received.

Calcutt said if her services continue to be covered by insurance she plans to offer the model – as long as it remains a budget-friendly option for her clients.

The hospital has been dovetailing the telehealth model with its mobile integrated health system, which is where a local emergency medical services provider, like a paramedic, visits patients in their homes.

“So now I’ve got eyes and ears in the home,” Shippee said. He said they’re looking at and hoping for funding to increase the technology to make it a more usable model.

Both Harrington and Shippee said that a lot of people at MCH worked to get the telehealth format up and running and that’s why it has been able to work.

During those meetings investigating the idea of telehealth, Shippee said projections forecasted that by 2024 telehealth visits would outweigh in-person visits. And with many providers switching to the model out of necessity, that tip of the scales may happen sooner.

“There’s still a need to connect face to face with people. There’s an important value of that,” Shippee said. “But (telehealth) is not going away.”


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