How do get telemedicine during COVID-19

Actions by the private and government officials will make it easier than ever to use telemedicine — both to evaluate a potential case of COVID-19 and other ailments.

The moves come as state and health officials stress a minimum of in-person contact is critical to slowing the spread of the novel coronavirus, which as of Monday was known to have infected nearly 3,000 people in New Jersey. State officials expect that number to keep growing, and quickly.

Screenings done via telemedicine can indicate a patient should be tested for the virus at one of several facilities that have opened in the last few weeks. Most require screenings and appointments in advance, and none will presently test individuals without symptoms.

In its simplest form, patients of telemedicine or telehealth programs are connected via laptop, smart phone or tablets with doctors. Patients see a doctor face to video-captured face, and can receive prescriptions based on their conditions without going to doctors' offices and risking exposure to themselves or others.

Thomas Bader, vice president of medical quality at Hackensack Meridian Health, said use of the Convenient Care NOW mobile app has "spiked dramatically" in the past few weeks due to effort promoting telemedicine as a way to get a diagnosis.

"People have figured out this is a good way of getting health care without having to go to a doctor's office and sit in an exam room with other people who might be infected," Bader said.

"It started out as one option for patients who thought it would be more convenient for them to do his virtually rather than coming in," following discharge from the hospital, Bader said.

Bader said Meridian Health found that the vast majority of people who use this service are able to have their problem diagnosed without having to come into a doctor's office.

"Our normal practice had been that 99% of all encounters were in person, and I think even if we were designing the perfect system for two or three years down the road, we might still have a circumstance where 60 or 70 percent of all encounters are in person," Bader said.

Bader said to use Meridian's system, a patient downloads the Convenient Care NOW app onto his or her device, and then selects an option to be evaluated using telemedicine.

"Depending on the volume the clinician will either get back to you in several minutes or sometimes it stretches much longer than that at peak demand times," Bader said.

When a physician is ready, the patient is notified via the app and the interaction begins with questions like those that might come up in an in-person visit — about age. medical condition and symptoms.

"Then they might ask you specific questions honing down on the specific problem" before making a recommendation and answering questions, Bader said.

The telemedicine program offered via Horizon Blue Cross Blue Shield, New Jersey's largest insurer, allows an insured patient to use a HIPAA-compliant video or audio interaction specifically with his or her family doctor, according to Don Liss, chief medical officer of Horizon Blue Cross Blue Shield.

No special equipment is needed by a patient. However, prior to the COVID-19 outbreak, participating doctors were required to use special software to ensure conversations were private and information was protected, according to Liss.

"Just in the last week the government has relaxed those standards so doctors are now able to use some of the very common devices available to all of us like FacetTme and Skype to provide that service," Liss said.

"The coronavirus outbreak has come on so quickly that many physician practices are scrambling to figure out how to serve their patients especially older and sicker patients for whom traveling in the community and sitting in their waiting rooms poses potentially an exposure risk," Liss said.

The COVID-19 outbreak has acted as a way to move telemedicine from an informal interaction to a more formal, structured visit, he said.

"Physician offices are quickly having to figure out how to provide care in very creative ways and our hope is they'll use the capability when appropriate to provide care especially for those for whom a visit to the doctor may pose more risk than benefit," Bader said.

The state has loosened up other regulations in the wake of the COVID-19 pandemic.

The state Division of Consumer Affairs waived a number of regulatory requirements last week, allowingr healthcare professionals licensed in other jurisdictions to serve New Jersey residents, including through telemedicine services.

Gov. Murphy announced on Sunday several moves that would expand access to both telehealth and tele-mental health services during the COVID-19 public health emergency including Medicaid reimbursement, allowing insurance customers to use out-of-network telemedicine providers at no extra cost, and to continue providing 24/7 Access to Horizon Nurse Line over the phone at no cost to members.

“As we continue to strengthen our health care system to meet the medical demands of the COVID-19 pandemic, access to telehealth and tele-mental health services for New Jerseyans will be more important than ever before,” Murphy said. “These actions will ensure that our most vulnerable residents have flexible access to vital health care services from the comfort and safety of their homes.”

The Aetna Teladoc program says it connects a patient with a doctor in minutes by phone, video or mobile app. The insurer has agreed to waive co-pays for all diagnostic testing related to coronavirus, and to offer zero co-pay telemedicine visits for any reason for the next few months.

Horizon Blue Cross Blue Shield announced earlier this month it would waive member-sharing cost obligations for telemedicine from in-network doctors through its platforms. BHBCBS said the waiver would apply to qualified telemedicine visits "for any covered purpose including diagnosis or treatment of COVID-19, routine care, or mental health care."

The changes include those covered through Medicaid, Medicare, Individual and Small Group policies. The State Health Benefits and School Employees Health Benefits Programs have also agreed to waive cost-sharing for their members for these services, BHBCBS said.

Medicare said last week, under direction from the Trump administration, it would immediately expand coverage for telemedicine nationwide to help seniors with health problems stay home to avoid the coronavirus as well. Current telehealth coverage under traditional Medicare is limited. It's available in rural areas, and patients need to go to specially-designated sites for their visits. Since last year Medicare has also been paying for brief “virtual check-ins.” Last week's announcement goes beyond that, allowing clinicians and hospitals to bill Medicare for visits via telemedicine that previously had to take place in person, at a medical office or facility.

Material from the Associated Press was used in this report