The Alternative to a Doctor’s Office Visit Gains in Popularity During Pandemic

Experts bring virtual care to a diverse range of patients in need.

9:29 AM

Authors | Jina Sawani | Kelly Malcom

When the COVID-19 pandemic hit, many people were concerned about their access to health care. But 15-year-old Elly LeCursi knew that visits with her doctor would be business as usual.

She was diagnosed with PCD, or primary ciliary dyskinesia, five years ago and has been a virtual patient at Michigan Medicine since then. The cilia throughout her respiratory system does not function properly, making it difficult for her to produce mucus. LeCursi is immunocompromised and regularly sees a pediatric pulmonologist.

"My doctor, Thomas Saba, is really good about communicating with me through email when I can't see him in person," says LeCursi. "And during the quarantine, I got sick and we emailed back and forth to figure out the best way for me to get better."

She adds that their email exchange eventually led to a video visit where Saba could determine the best path forward for her health.

"I've always liked using virtual care because it's easier to work around my school schedule and extracurricular activities. I can also be home when I need to be home—I've even had visits with Dr. Saba from our car," she says. "Also, it's a lot healthier given everything that's going on right now with the pandemic."

Saba, who is a pediatric pulmonologist at C.S. Mott Children's Hospital, notes that when COVID-19 cases ramped up in March, Michigan Medicine's doctors, nurses and other health care professionals were naturally focused on managing the disease.

Personal protective equipment and logistics regarding a potential field hospital were top of mind.

There was also an incredible amount of effort around maintaining sufficient access to care for the academic medical center's existing and future patients.

Like Podcasts? Add the Michigan Medicine News Break on iTunes, Google Podcast or anywhere you listen to podcasts.

"We had a commitment to our patients and wanted to continue providing them with the level of care that they were used to," says Saba. "That's why a massive amount of work went into training thousands and thousands of our employees in telemedicine, a platform that has existed for many years."

Video visits have been available to Michigan Medicine patients in a slowly increasing number of ambulatory clinics since 2016, and e-visits have been offered to primary care patients since 2017. But it took several key policy shifts at the federal level in response to the pandemic to enable the recent rapid surge of telehealth.

"The number one thing that made it possible was making people's homes as a site where patients can connect and receive telemedicine," says Chad Ellimoottil, M.D., M.S., assistant professor of urology and director of the U-M Institute for Healthcare Policy and Innovation's Telehealth Research Incubator.

Up until March 2020, the Medicare program didn't allow patients to connect using their smart phones from home. But as the pandemic began to unfold and shelter-in-place measures were instituted across the country, Medicare not only allowed patients to connect with clinicians from home, it allowed for the use of non-HIPAA-compliant equipment and the practice of medicine across state lines.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

Before these moves, providers couldn't be sure whether a patient would get stuck with a large bill for a telehealth visit, Ellimoottil says. Now, Medicare considers a video visit equivalent to an office visit.

With these barriers removed, providers were able to respond to the rapidly growing interest in telehealth visits by streamlining operations and quickly training more providers. To date, Michigan Medicine has conducted more than 350,000 video and phone visits since the pandemic started.

We had a commitment to our patients and wanted to continue providing them with the level of care that they were used to during the pandemic.

Thomas Saba, M.D.

For patients leaving the hospital that still need care, Karen Neeb, a nurse practitioner at Michigan Medicine, provides them with home monitoring kits. The readouts are automatically sent to a team that operates 24 hours a day, seven days a week.

"We treat people who have left the hospital but still need care, whether at a subacute rehab center or in their own homes," says Neeb. "We also go to several nursing homes in the surrounding area to care for Michigan Medicine patients."

Neeb adds that when the pandemic started, the patient monitoring at-home service was created to serve as a bridge for individuals who needed closer monitoring upon leaving the hospital.

"We give them a kit that contains a scale, blood pressure cuff, tablet, pulse oximetry machine, thermometer and blood glucose machine so that we can monitor them closely and track their health," she says. "Especially now, with people staying home to remain safe, we're able to help them feel connected to their health care teams in ways that simply wouldn't be possible otherwise."

SEE ALSO: Seeking Medical Care During COVID-19

Many patients are new to the video visit system, so Neeb and her team provide them with this extra level of care by tracking things like their vital signs and weight, which help inform their primary care providers and other relevant specialists.

Virtual care offerings currently in use at Michigan Medicine include:

  • E-visits, where a patient fills out a questionnaire and receives a written treatment plan.
  • E-consults, where a primary care provider and another provider, typically a specialist, consult regarding a specific patient/condition.
  • Tele-specialty consults, conducted between Michigan Medicine providers and affiliates/partners to coordinate patient care.
  • Video visits, involving two-way audiovisual communication between a patient and a Michigan Medicine provider.

The COVID-spurred move to telemedicine also provides an unexpected boost to ongoing research by Ellimoottil and his team to study the impact of telehealth on health outcomes, cost and quality of care.

"Not only is this pandemic period uncovering new knowledge gaps, it's giving us the ability to assess the existing knowledge gaps in a more robust way," says Ellimoottil.

Meanwhile, virtual care is offering patients peace of mind during a very challenging time.

"Sometimes when you're not feeling well and you're concerned about something, you would like to know what the doctor or the nurse has to say about your situation," says Pat Pooley, a Michigan Medicine patient. "And with my virtual visits, I feel free to talk to someone if I have questions. I'm very impressed by how easy the setup is, it's a great advance in client care and I feel very well cared for."

SEE ALSO: Keeping Our Patients Safe During COVID-19

More Articles About: lifestyle Community Health Health Care Delivery, Policy and Economics Children's Health CS Mott Children's Hospital Hospitals & Centers
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories Illustration of red blood cells and bacteria in the bloodstream
Health Lab
New device can treat injury from sepsis
The FDA approved the use of a therapeutic device invented and developed at the University of Michigan for use in children with acute kidney injury and sepsis or a septic condition requiring continuous kidney replacement therapy.
Illustration of prescription bottle with a refill notice
Health Lab
In drive to deprescribe, heartburn drug study teaches key lessons
An effort to reduce use of PPI heartburn drugs in veterans because of overuse, cost and potential risks succeeded, but provides lessons about deprescribing efforts.
Photo of a cluttered, messy garage
Health Lab
Chemicals stored in home garages linked to ALS risk
A Michigan Medicine study finds that storing chemicals in a garage at home may associate with an increased risk of ALS.
Exterior photograph of an urgent care clinic
Health Lab
Thinking outside the doctor’s office: How older adults use urgent care & in-store clinics
In the past two years, 60% of people age 50 to 80 have visited an urgent care clinic, or a clinic based in a retail store, workplace or vehicle, according to new findings from the University of Michigan National Poll on Healthy Aging.
Illustration of hand holding a smartphone with green background
Health Lab
Medicare pays for message-based e-visits. Are older adults using them?
Telehealth study of patient portal e-visits by Medicare participants shows few had an interaction for which their provider billed them.
Dinero is back to being an active toddler following a kidney transplant
Health Lab
Formula prescription helps 2-year-old receive kidney transplant
Dinero's pediatric nephrology team developed a tailored formula to address his mineral deficiencies due to his chronic kidney disease, maintain nutritional health and avoid dialysis.