Tucson patients, families who use telemedicine are worried it might disappear

Getting a doctor’s advice or a therapist’s help without risking infection from a face-to-face visit to a medical office has been essential for many Tucson residents during the pandemic.

Now, with Arizona’s rate of infection still rising and no vaccine in sight, many are wondering how long insurance providers will keep covering the video visits and telephone calls commonly referred to as telemedicine or telehealth.

The uncertainty is troubling for Tucson mothers like Sara Nixon-Kirschner and Dianne Westfall, whose young children have challenges that require medical care and therapies while also making them especially vulnerable to viruses and infection.

Nor is it comforting for Tucson residents like Melinda Parris, whose immune system has been weakened by cancer treatments. She needs pain medication but can’t renew her 30-day prescription without an in-person visit, which is especially frustrating after being able to use video appointments for pain medications in April.

“My nephrologist and my pulmonologist are still available by telehealth, my primary care is not offering it, nor is my oncologist,” she said. “So, it’s hit or miss, and I’m taking what I can get.”

On Friday, Parris saw a notice on an insurance form that telemedicine might not be covered anymore, so she started investigating.

“My doctor says call Medicare, who said to call Humana, who said as far as they can tell it’s covered,” she said Friday. “When I pressed for a coverage date, the person I spoke to said she doesn’t see any date so she assumes it’s Dec. 31, 2020.”

That date is better than what people were hearing earlier this month, when many were bracing for telemedicine visits to end at the end of June or sometime in July.

But as of last week, with the coronavirus continuing to make people afraid to keep in-person appointments, many providers announced telemedicine will continue until the end of September.

“Cigna has no plans to end coverage for telehealth,” said Mark Slitt, public relations senior advisor for the company. “In fact, we have been expanding telehealth coverage to include behavioral health and dental care, and we have been collaborating with a variety of virtual providers nationally and in specific states.”

Aetna and United Healthcare, two more examples, have extended their coverage of telemedicine appointments through the end of September.

“Right there at my fingertips”

Continuing coverage is good news for Tucsonan Amy Burke, who has counted on telemedicine to help her with the post-traumatic stress she developed while working as respiratory therapist in Brooklyn for the first two months of the pandemic. Burke now has daily panic attacks.

Burke said she can text her therapist at any time and also has an hourlong phone or video session each week.

“I love that I can have therapy whenever I need it,” she said. “It’s right there at my fingertips.”

Typically, payment for a telemedicine visit is lower than an in-person visit and was not offered as readily because of regulations imposed by the Centers for Medicare & Medicaid Services, or CMS. That’s changed to equal coverage for both in-person and video appointments due to the pandemic.

“I would argue it should continue in perpetuity,” said Dr. Jeff Couchman, a local pediatrician. “As for private insurers, CMS payment policies don’t necessarily translate over to private insurers — they can essentially pay however they want, but they usually follow CMS.”

Around the country, there have been a variety of challenges related to telemedicine, said Dr. Jacqueline W. Fincher, president of the American College of Physicians. Some elderly patients, for example, are not very tech savvy and may not have the iPad or computer they need.

“In the rural areas, broadband is a major issue,” Fincher said. “So even if patients do have a smartphone and can receive the telemedicine platform link, when they hit the link, there’s not enough bandwidth to download the link.”

And while many of the private insurers offer payment parity for telemedicine, it’s limited to video visits and not necessarily telephone only — which is what some elderly patients want.

“The ACP is pushing both CMS and AHIP, or America’s Health Insurance Plans, to continue paying physicians to do telemedicine and telephone visits with their patients appropriately based on the patients’ needs and delivering patient care whatever way the patient and the physician think is best,” Fincher said. “That should not be determined by geography, especially when transportation can be an enormous barrier to getting the care needed face to face.”

The option has also been helpful for physicians who collect a fee for service, as it’s enabled them to stay open and still see patients despite the pandemic.

Fincher’s organization is pushing for continued pay parity for telemedicine and face-to-face visits until at least the end of 2021.

“That’s because the COVID-19 virus will continue to have major impact on patients and physicians ability to have face-to-face visits as the virus waxes and wanes over the next 18 months,” she said.

“Until we have an effective vaccine that is widely distributed and taken by the public and effective treatment if one gets COVID, then we will still be stuck with social distancing, masks and limited face-to-face visits, especially for routine, chronic or preventive visits.”

“Not as efficient”

Tucson providers like Dr. Jane Hartline of El Sol Family Medicine, 2260 N Rosemont Blvd., have been using telemedicine since shortly after the pandemic started.

“My patients really appreciate that they don’t have to leave their homes, to be able to meet with their physician and not have to take the risk,” she said.

She encourages people who want to see this choice continue to reach out to insurers and make that known.

Couchman said since the pandemic began anyone who calls in sick to Mesquite Pediatrics, 2350 N. Kibler Place, No. 1, can start with a telemedicine appointment and then, if it’s needed, comes into the office.

Theoretically, it costs less, he said, since there are no gloves, paper, nursing or staff time.

On the other hand, appointments take about twice as much time because there can be connectivity issues, illnesses can take longer to diagnose and then there are patients who have to come into the office anyway .

“Telemedicine is not as efficient,” he said. “I can’t schedule as many patients in a day.”

Intermountain Centers for Human Development are now using telemedicine for about 80% to 85% of its appointments, said Paul O’Rourke, a spokesman.

“If our (COVID-19) numbers are like they are now, there’s no reason for them not to continue these services,” he said of providers. “People will be afraid to come to a health center.”

For Intermountain’s low-income patients, using up a lot of phone data can be tough, said Jessica Reese, chief clinical officer for Intermountain. To help, the centers are trying to utilize grants to provide phone cards.

“We do have a lot of individuals living below the poverty line and we really need to be thinking about equal access to care,” she said. “We are getting innovative about how to provide this to our members.”

For mothers Westfall and Nixon-Kirschner, telemedicine means keeping their children both safe and cared for during the pandemic.

Westfall’s 3-year-old daughter, Maddie, has a rare chromosomal disorder called Cri du Chat Syndrome that made them nervous about infection even before COVID-19. “We’ve always acted like flu season was a pandemic,” she said. “We self-isolate and wear masks every year.”

For Nixon-Kirschner, continuing to get speech therapy for 4-year-old daughter Rosie has been critical as they help her with a genetic disorder called Koolen-de Vries syndrome.

“We would love to be in the same room as our therapist and Rosie loves the stimulation of being together,” she said of her daughter’s speech therapist at Tucson’s Mealtime Connections, 1601 N. Tucson Blvd. But since that’s not possible, she said, she is very grateful for telehealth.

“If they were to turn it off,” she said, “I don’t know what we would do.”