REUTERS/Andrew Kelly
Hospital workers are seen near a tent erected to test for the coronavirus disease (COVID-19) at the Brooklyn Hospital Center in Brooklyn, New York City, U.S., March 19, 2020.
- Almost overnight, the way Americans get their healthcare turned on its head.
- As efforts inside hospitals ramped up to take care of patients with the novel coronavirus, efforts to keep people out of the hospital through virtual visits surged as well.
- Business Insider spoke to three of the biggest companies in telehealth. They told us they're facing long wait times in virtual waiting rooms, and big unknowns about what's going to happen next.
- Visit Business Insider's homepage for more stories.
Roy Schoenberg, would've appreciated a heads-up that the nation would be moving from in-person to online doctor's visits in the course of three days at such an overwhelming pace.
Schoenberg's the CEO of American Well, a privately held telemedicine company that works with health systems and health plans to provide virtual healthcare services for patients. In a matter of days, starting around March 13, the company's doctors started seeing 27 times the volume of patients they had just a few days earlier.
Over the past week, telemedicine has caught hold in the US healthcare system, pushing some of the biggest telehealth companies like American Well, Teladoc Health, and Doctor On Demand to their limits as the country confronts the coronavirus pandemic. Insurers have become more open to paying for care done virtually, as has the federal Centers for Medicare and Medicaid Services.
And as part of President Donald Trump's address calling the coronavirus pandemic a national emergency, Trump called telehealth services "a fairly new and incredible thing."
"I have to admit, I didn't think we were going to hear so much discussion at a White House press briefing about virtual care," Jason Gorevic, the CEO of publicly-traded Teladoc, told Business Insider.
Hospitals are being pushed to their limits by cases of the novel coronavirus, which causes the disease known as COVID-19. Some are running out of protective gear and many are canceling elective procedures. By some estimates, millions of Americans sickened by coronavirus might need to stay in the hospital.
To help in the response, telemedicine has emerged as a viable way to keep patients - both those concerned they might have the coronavirus, and those who need routine care - at home.
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Taking on an unprecedented amount of visits
During the week ending March 13, Teladoc completed 100,000 virtual visits, an increase of 50% over the prior week. Teladoc works with health plans and employers to provide video visits with doctors in Teladoc's network.
This past week, Teladoc has been setting up virtual "COVID clinics" for 25 health systems.
"Within the span of yesterday, today and tomorrow, these three days, we will stand up a half a dozen of those," Gorevic said on Thursday. Typically, the process would've taken 60-90 days.
With that increase comes longer wait times, however.
American Well, which operates under the name Amwell, soon realized it had to tweak an algorithm it had in place that was sending people from one virtual waiting room to another with the hopes of getting them in front of a doctor faster. But when each waiting room had about 40 patients waiting, that wasn't all that effective.
Because Amwell works with doctors doing both in-person and online visits, the waits would be so long that doctors would need to go see in-person patients while patients online were still waiting.
"These are the realities," Schoenberg said.
For the most part, Gorevic said, patients have been understanding of the longer wait times and volume that doctors on the telemedicine platforms are seeing.
"Consumers understand these aren't normal times," Gorevic said.
For Dr. Kristin Dean, the associate medical director for Doctor On Demand, a telemedicine service that works with health plans and employers, and markets directly to consumers as well, the biggest issue she's run into while seeing patients is how to get them testing for the coronavirus.
Most patients Dean's seeing have mild symptoms, and ideally the hope would be to keep them out of the emergency room by managing their symptoms at home. Navigating where to send patients for testing isn't easy, but as more drive-through testing centers and at-home options come online, the hope is to direct patients there.
The organization realized at the end of February that the pandemic was going to hit the US and put more work in the hands of doctors working online. Doctor on Demand, she said, has been working overtime to make sure it can handle the volume of patients, which she expects to keep growing.
"We are at the beginning of this," Dean said.
Augmenting hospitals
Ideally, virtual networks of doctors could help out within hospitals as well.
It's a strategy health systems like Intermountain Healthcare, based in Utah, have had in place for years. Intermountain uses telemedicine to broaden the reach of its infectious disease experts to rural hospitals in its network.
Dr. Todd Vento, the medical director for telehealth infectious disease for Intermountain, uses the system to consult with local doctors about infectious disease cases they're seeing. While working in Liberia during the Ebola outbreak, he used the technology to meet with patients without having to go into the room with them, limiting exposure to the virus.
Teladoc, which in January acquired telemedicine company InTouch, is hoping to put similar technology in use to see patients without exposing healthcare workers.
Beyond offering an alternative to in-person visits, Schoenberg said he also sees telehealth services helping to balance out the need for doctors in hotspots where the virus is spreading quickly.
For instance, if a hospital has a number of patients on ventilators because of the virus, telehealth companies could patch in experts who are well-versed in handling the equipment to help those on the front lines.
Right now, Schoenberg said he's most worried about not having enough doctors to power the online systems.
"I fear that without that we're going to be inefficient at using the technology to do a lot of good," Schoenberg said.
What comes next
Still, so much is changing day-to-day as the US picks up more cases of coronavirus.
"What nobody knows is where the puck is going to be in 5 days" Schoenberg said. "It's hard to prepare for such an unknown."
But from where Gorevic sits, the pandemic has sped ip the move to adopt telehealth in the US by years.
"I think the role of the healthcare system has changed forever," Gorevic said.
- Read more:
- Primary care doctors are delivering toilet paper, testing patients in their cars, and going online to combat the coronavirus epidemic
- The Trump administration is working with the healthcare startup founded by Jared Kushner's brother to power a coronavirus tool
- 'We're underprepared:' Urgent care centers find themselves on the front lines of a pandemic, but few have tests to treat the crowds coming in
- Here's why experts are worried we won't have enough hospital beds to handle a surge of coronavirus patients
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