Escalating gasoline prices, doggedly lingering pandemic safety concerns, rugged, rural roads (that sometimes join ones charging toll fees), and other factors may add headaches (figurative or literal) to more pressing health concerns for a sizeable segment of West Virginia residents.
To alleviate some of those fiscal and physical challenges, CAMC has expanded its range of telemedicine services. A major part includes opening regional offices -- or hubs -- to permit patients to forgo long drives and the subsequent travel expenses to "see" their specialists.
"The pandemic forced us to really engage with telemedicine," said Dr. Michael Robie, CAMC's Associate Chief Medical Officer, Ambulatory and Physician Services, "but about six or 12 months before it happened, we had made the decision to make telemedicine part of our future.
"West Virginia is kind of isolated in areas. Some are difficult to get to -- as the crow flies, it may only be five miles away, but it takes an hour to get there. But we were fortunate that before COVID-19 started, we already had a platform and a system in place."
CAMC was able to get the system running quickly, particularly during the early months of the COVID-19 shutdowns and restrictions. "We found that we could kind of hold our own taking care of patients remotely," Robie said.
Telemedicine hubs
While telemedicine capabilities have streamlined or supplanted many of the traditional doctor-patient interactions in recent years, Robie said more needs to be done to make them more effective for all parties.
"The lack of infrastructure in West Virginia continues to make it challenging getting from the doctor's office to the patient's home," he said. "Despite what everyone seems to think, not every household has cell phones or iPads, which makes the ability to do audiovisual telemarketing difficult. Our senators talk all the time about improving the state's infrastructure, but audiovisual telemedicine only wasn't something we wanted to focus on.
"Instead, we wanted to focus -- and kind of pivot -- our expectations of where telemedicine occurs," Robie said.
To that end, he said, CAMC has begun establishing partnerships with local clinics throughout the state.
"We've developed telemedicine hubs," he explained. "For instance, our most successful hub is at the Robert C. Byrd Clinic in Lewisburg. Basically, we lease space from them to place one of our telemedicine hubs in the location."
Robie described the hub as a miniature doctor's office, complete with a small waiting room, two examination rooms, a doctor's office, and a standard-size patient examination room. "It has a big TV on the wall and has peripherals we can hook up there, such as a stethoscope.
"We can still see the patient in their community. Lewisburg is about two hours and two toll booths away from Charleston, but they can see one of our specialists, stay in the community and receive the same level of care they'd see here."
He said telemedicine techniques have also been successful for administering patients' post-procedural care. "Let's say a patient received a heart cath in Charleston. When we want to check up on them, they don't necessarily have to drive all the way back to Charleston for that.
"We've all had success in establishing new patients at these hubs. Now, obviously, if someone needs a procedure or a more extensive physical exam, they might have to come in, but we staff all of these hubs with registered nurses who can provide neurological exams and other procedures.
"We're really excited what the future of that looks like. Our mission is to continue to add these hubs throughout West Virginia. We've been in Southern West Virginia, the Lewisburg/Princeton area, the Summersville area, and Jackson County.
"What we've looked at is where the patients are coming from. We're trying to connect with patients who already drive from Princeton to Charleston to see a specialist. We can save them three or four trips a year -- they only have to come to Charleston once a year.
"We particularly want to expand the specialty care out there. These areas have wonderful primary care providers, but they can be kind out on an island where they are, and we're able to give them that kind of specialty care," Robie said.
CAMC Ambulatory Services Associate Administrator Rebecca Harless has been instrumental in advocating for and implementing telemedicine services not only at CAMC but throughout the state. These efforts include a telestroke program enabling virtual consultations between stroke patients and their physicians. Launched at Boone Memorial Hospital, the telestroke program has expanded to other state health care providers.
Harless also helped develop direct-to-consumer visits on an around-the-clock platform called 24/7 Care for CAMC, through a license agreement with Teladoc Health. Started in July 2019, the platform is staffed by CAMC physicians who are buoyed by a national network of medical practitioners "on call" when the CAMC staff members may be unavailable.
According to Becker's Hospital Review, nearly 13,000 people registered for 24/7 Care within its first year of operation.
Two years ago, the Federal Communications Commission's Wireline Competition Bureau approved CAMC's application for approximately $782,000 to obtain remote monitoring devices, a remote patient monitoring platform, network upgrades and a new platform to improve the outpatient telehealth platform. The outlay came from a segment of $200 million Congress allocated nationally through the CARES Act in the wake of the pandemic.
"We were poised and ready to invest in it before COVID hit," Harless said, "so it was really beneficial for the community and for us. Mostly, it was to quell the fears of people who were rushing to the ER in the beginning phases of the pandemic. Now we're in the neighborhood of 10% of our ambulatory visits being done by telemedicine.
"We try to meet the patient where they are wherever possible. Some things you can't do via telemedicine, of course, but we've found patients are much more willing to use it if their next or subsequent visits can be done from home or a hub if they don't have access to internet. It's not just urgent care anymore; we do a lot of doctor visits through telemedicine," Harless said.
CAMC is continuing conversations with communities and other entities to create new hubs. "I think hubs work best when you have the partnership. That's where I think health care is going, to these partnerships," she said.
"On the business side of this, the hub is non-threatening to other facilities. If they have a cardiologist, for example, they don't have to use our cardiology services.
"I speak on a national level, and I've found we're kind of unique in doing this. A lot of my peers around the country aren't really doing the hub method. I liken it to going to the AT&T store, where people in line are all getting specific tech help. In the rural areas, patients are able to access our telemedicine services for those kinds of things," Harless said.
"I use telemedicine pretty much any way I can," Dr. Nathan Hale of CAMC's Urology Department said. "It just enhances our ability to reach our patients. The vast majority of patients here in West Virginia have to travel several hours to get to a large-enough facility to receive specialized care like urology." "Through the telemedicine apps, I can just as effectively make sure you're doing well over your lunch break or something like that. ... It's done a lot of good in broadening access to care and making it more convenient for people," CAMC Primary Care physician Zachary Wiley said. Among those who have provided patient testimonials to CAMC's telemedicine services are Debra Fogus of White Sulphur Springs. “I usually have to drive two hours to my doctor’s appointment, two hours home, and I have to take a full day off work," Fogus said on CAMC's website. "At the CAMC Telemedicine Center in Lewisburg, I certainly feel that I was given the same attention and quality care as if I was in my doctor’s office. My doctor was very attentive and spent 35 to 45 minutes talking with me, asking questions and giving helpful recommendations. The nurse at the center also showed me how she can check my ears and listen to my heart in the telemedicine office and the doctor can hear my heartbeat in Charleston. This is simply amazing.”
More information about CAMC's telemedicine services can be found at www.camc.org/telemedicine.
Telemedicine growth
According to an article posted on McKinsey & Company's website earlier this month, telemedicine use for office visits and outpatient care surged to a rate 78 times higher from February 2020 to April 2020, due princiapply to the pandemic. The article from the global management consulting firm added that number has since stabilized to levels 38 times higher than before the pandemic.
The report projects that models are likely to evolve to optimize hybrid virtual and in-person care.
From a financial standpoint, McKinsey analysts stated venture capitalist investment in virtual care and digital health rose tripled from 2017 to 2020. In May 2021, they posited that up to $250 billion spent on American health care could be shifted to virtual or virtually enabled care in the immediate future. However, the analysts tempered the estimate in a follow-up article this month by noting that quarter-of-a-trillion-dollar forecast would depend on factors such as sustained consumer and clinician adoption and an accelerated redesign of virtual-care pathways for telemedicine.
To alleviate some of those fiscal and physical challenges, CAMC has expanded its range of telemedicine services. A major part includes opening regional offices -- or hubs -- to permit patients to forgo long drives and the subsequent travel expenses to "see" their specialists.
"The pandemic forced us to really engage with telemedicine," said Dr. Michael Robie, CAMC's Associate Chief Medical Officer, Ambulatory and Physician Services, "but about six or 12 months before it happened, we had made the decision to make telemedicine part of our future.
"West Virginia is kind of isolated in areas. Some are difficult to get to -- as the crow flies, it may only be five miles away, but it takes an hour to get there. But we were fortunate that before COVID-19 started, we already had a platform and a system in place."
CAMC was able to get the system running quickly, particularly during the early months of the COVID-19 shutdowns and restrictions. "We found that we could kind of hold our own taking care of patients remotely," Robie said.
Telemedicine hubs
While telemedicine capabilities have streamlined or supplanted many of the traditional doctor-patient interactions in recent years, Robie said more needs to be done to make them more effective for all parties.
"The lack of infrastructure in West Virginia continues to make it challenging getting from the doctor's office to the patient's home," he said. "Despite what everyone seems to think, not every household has cell phones or iPads, which makes the ability to do audiovisual telemarketing difficult. Our senators talk all the time about improving the state's infrastructure, but audiovisual telemedicine only wasn't something we wanted to focus on.
"Instead, we wanted to focus -- and kind of pivot -- our expectations of where telemedicine occurs," Robie said.
To that end, he said, CAMC has begun establishing partnerships with local clinics throughout the state.
"We've developed telemedicine hubs," he explained. "For instance, our most successful hub is at the Robert C. Byrd Clinic in Lewisburg. Basically, we lease space from them to place one of our telemedicine hubs in the location."
Robie described the hub as a miniature doctor's office, complete with a small waiting room, two examination rooms, a doctor's office, and a standard-size patient examination room. "It has a big TV on the wall and has peripherals we can hook up there, such as a stethoscope.
"We can still see the patient in their community. Lewisburg is about two hours and two toll booths away from Charleston, but they can see one of our specialists, stay in the community and receive the same level of care they'd see here."
He said telemedicine techniques have also been successful for administering patients' post-procedural care. "Let's say a patient received a heart cath in Charleston. When we want to check up on them, they don't necessarily have to drive all the way back to Charleston for that.
"We've all had success in establishing new patients at these hubs. Now, obviously, if someone needs a procedure or a more extensive physical exam, they might have to come in, but we staff all of these hubs with registered nurses who can provide neurological exams and other procedures.
"We're really excited what the future of that looks like. Our mission is to continue to add these hubs throughout West Virginia. We've been in Southern West Virginia, the Lewisburg/Princeton area, the Summersville area, and Jackson County.
"What we've looked at is where the patients are coming from. We're trying to connect with patients who already drive from Princeton to Charleston to see a specialist. We can save them three or four trips a year -- they only have to come to Charleston once a year.
"We particularly want to expand the specialty care out there. These areas have wonderful primary care providers, but they can be kind out on an island where they are, and we're able to give them that kind of specialty care," Robie said.
CAMC Ambulatory Services Associate Administrator Rebecca Harless has been instrumental in advocating for and implementing telemedicine services not only at CAMC but throughout the state. These efforts include a telestroke program enabling virtual consultations between stroke patients and their physicians. Launched at Boone Memorial Hospital, the telestroke program has expanded to other state health care providers.
Harless also helped develop direct-to-consumer visits on an around-the-clock platform called 24/7 Care for CAMC, through a license agreement with Teladoc Health. Started in July 2019, the platform is staffed by CAMC physicians who are buoyed by a national network of medical practitioners "on call" when the CAMC staff members may be unavailable.
According to Becker's Hospital Review, nearly 13,000 people registered for 24/7 Care within its first year of operation.
Two years ago, the Federal Communications Commission's Wireline Competition Bureau approved CAMC's application for approximately $782,000 to obtain remote monitoring devices, a remote patient monitoring platform, network upgrades and a new platform to improve the outpatient telehealth platform. The outlay came from a segment of $200 million Congress allocated nationally through the CARES Act in the wake of the pandemic.
"We were poised and ready to invest in it before COVID hit," Harless said, "so it was really beneficial for the community and for us. Mostly, it was to quell the fears of people who were rushing to the ER in the beginning phases of the pandemic. Now we're in the neighborhood of 10% of our ambulatory visits being done by telemedicine.
"We try to meet the patient where they are wherever possible. Some things you can't do via telemedicine, of course, but we've found patients are much more willing to use it if their next or subsequent visits can be done from home or a hub if they don't have access to internet. It's not just urgent care anymore; we do a lot of doctor visits through telemedicine," Harless said.
CAMC is continuing conversations with communities and other entities to create new hubs. "I think hubs work best when you have the partnership. That's where I think health care is going, to these partnerships," she said.
"On the business side of this, the hub is non-threatening to other facilities. If they have a cardiologist, for example, they don't have to use our cardiology services.
"I speak on a national level, and I've found we're kind of unique in doing this. A lot of my peers around the country aren't really doing the hub method. I liken it to going to the AT&T store, where people in line are all getting specific tech help. In the rural areas, patients are able to access our telemedicine services for those kinds of things," Harless said.
"I use telemedicine pretty much any way I can," Dr. Nathan Hale of CAMC's Urology Department said. "It just enhances our ability to reach our patients. The vast majority of patients here in West Virginia have to travel several hours to get to a large-enough facility to receive specialized care like urology." "Through the telemedicine apps, I can just as effectively make sure you're doing well over your lunch break or something like that. ... It's done a lot of good in broadening access to care and making it more convenient for people," CAMC Primary Care physician Zachary Wiley said. Among those who have provided patient testimonials to CAMC's telemedicine services are Debra Fogus of White Sulphur Springs. “I usually have to drive two hours to my doctor’s appointment, two hours home, and I have to take a full day off work," Fogus said on CAMC's website. "At the CAMC Telemedicine Center in Lewisburg, I certainly feel that I was given the same attention and quality care as if I was in my doctor’s office. My doctor was very attentive and spent 35 to 45 minutes talking with me, asking questions and giving helpful recommendations. The nurse at the center also showed me how she can check my ears and listen to my heart in the telemedicine office and the doctor can hear my heartbeat in Charleston. This is simply amazing.”
More information about CAMC's telemedicine services can be found at www.camc.org/telemedicine.
Telemedicine growth
According to an article posted on McKinsey & Company's website earlier this month, telemedicine use for office visits and outpatient care surged to a rate 78 times higher from February 2020 to April 2020, due princiapply to the pandemic. The article from the global management consulting firm added that number has since stabilized to levels 38 times higher than before the pandemic.
The report projects that models are likely to evolve to optimize hybrid virtual and in-person care.
From a financial standpoint, McKinsey analysts stated venture capitalist investment in virtual care and digital health rose tripled from 2017 to 2020. In May 2021, they posited that up to $250 billion spent on American health care could be shifted to virtual or virtually enabled care in the immediate future. However, the analysts tempered the estimate in a follow-up article this month by noting that quarter-of-a-trillion-dollar forecast would depend on factors such as sustained consumer and clinician adoption and an accelerated redesign of virtual-care pathways for telemedicine.
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