As people in the Pittsburgh area are seeking advice about COVID-19 without exposing or being exposed to the virus, local hospitals have been seeing the number of patients seeking urgent care by video chat skyrocket in recent days, according to UPMC and Allegheny Health Network. Conversely, the number of patients seeking urgent care in person has fallen.
The number of virtual patients jumped from about 75 to 100 on a typical day, to more than 400 patients on Saturday, according to Dr. Sundeep Ekbote, the director of UPMC Anywhere Care’s virtual urgent care.
The Allegheny Health Network [AHN] on Saturday expanded its telemedicine service to 24 hours from ordinary business hours, and it’s seen the number of patients increase from about 90 patients per month to more than 100 every 24 hours since, most asking about coronavirus, according to Dr. Amy Crawford-Faucher, the vice-chair for the department of family medicine at AHN. Volunteer medical providers are being paid to staff it during their off hours.
The Trump administration announced expanded telehealth benefits for Medicare users on Tuesday. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus," Centers for Medicare & Medicaid Services Administrator Seema Verma said.
UPMC is encouraging some patients to switch their appointments to virtual appointments. In a message sent to pregnant patients Wednesday the largest health provider in Western Pennsylvania wrote that ”to decrease potential spread of the novel coronavirus (COVID-19) and to limit traffic throughout our facilities, we are looking at visit types that may be eligible for conversion from in-office visits to MyUPMC Video Visits.”
Ekbote of UPMC said he has had to scramble in recent days to find additional doctors, physician assistants and nurse practitioners to see patients through video-conferencing, as the wait times increased from roughly five minutes to 30 minutes. The number of patients in the virtual “waiting rooms” grew from about two people per provider to about nine or 10. "Typically we use only nurse practitioners,” he said but "under warlike conditions” he increased his recruitment to doctors and physician assistants.
Ekbote said the wait times are now falling again, as he increased the number of health specialists seeing patients from two to 10.
"We were able to ramp up volume management very, very quickly,” Ekbote said. "...I was able to add multiple providers and give them multiple rooms to see their patients. Everyone is in their own home, using telemedicine to interact with them.”
Ekbote said the ability to scale up the telemedicine would’ve been impossible in a traditional setting because there wouldn’t be enough beds and rooms for patients or even space in the waiting room. But, in this case, he just had to find medical providers who were either off that day or doing extra work at the end of their normal day, and some were able to do the work from their homes. Some other providers video-conferenced with patients from their traditional offices because the number of patients seeking urgent care in person has fallen, he said.
UPMC sent out an email on March 13 notifying customers that until June 15 they are waiving all member cost-sharing expenses, including deductibles or copayments, for in-network virtual healthcare visits.
Crawford-Faucher said the cost of telemedicine at AHN varies widely depending on people’s insurance. “The greatest benefit is ease for the patients, they can get the information they need and be safely at home to be evaluated,” she said. “And, of course, that is better for everybody in the office because we can minimize exposure. So it’s safer for everybody.”
Ekbote said providers refer patients who think they need to be tested for coronavirus to the UPMC Wolff Center for Quality, Safety and Innovation on Baum Boulevard, where providers make the final call about whether a patient is currently eligible for testing. So far, tests have been limited except for patients who meet the current requirements for being tested.
But on Tuesday, UPMC released a statement saying it will begin directing patients with symptoms consistent with COVID-19, who have a physician's referral, to a specimen collection site in Pittsburgh’s South Side neighborhood. The site is not open to the general public.
Crawford-Faucher said AHN is setting up drive-by testing centers for later in the week, so patients who are recommended for testing can go straight from their homes to getting tested without additional exposure.
“We’ve been screening everyone for flu-like symptoms including fever and cough,” an AHN spokesperson said in an email. “Then we ask about domestic or international travel to endemic areas and/or known or suspected contacts. If they screen positive for both of these conditions, we screen first for flu and if flu is negative, we send COVID-19 testing.”
AHN patients access the care through their secure MyChart app and UPMC patients can access it online or through a UPMC Anywhere Care app.
Telemedicine is helping to decrease the burden of ordinary diseases on the healthcare system right now as it prepares to take on an increasing load of coronavirus cases, Crawford-Faucher said.
“A lot of it is people are calling who don’t meet testing criteria, so we are doing triage: We can set you up for a flu test or, or if your symptoms are mild, maybe the best bet is to stay home and we can say, “Here are some things you can do to treat your symptoms,’” she said.
If there are any elderly patients who are not comfortable using a computer or smartphone, Ekbote said, family members can help them register for their own account and guide them through a few simple steps to get started.
Oliver Morrison is PublicSource’s environment and health reporter. He can be reached at email@example.com or on Twitter @ORMorrison.
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