It’s challenging times for Vermont’s health providers. In response to COVID-19, the University of Vermont Health Network and Washington County Mental Health Services have ramped up telehealth services to increase their capacity to serve patients remotely.

The daily patient count at the Visiting Nurse Association & Hospice of the Southwest Region has increased by 80 patients in less than three weeks, while some physician practices have seen a marked decrease in business.

“Prior to a couple of weeks ago we had 25 clinical sites offering telehealth conferencing to their patients. Right now we are in the process of enabling about 70 additional clinical areas. This includes speciality clinics, surgical clinics and therapies,” said Sarah Chistolini, senior tele-health program strategist for UVMHN.

UVMHN is a six-hospital and home health and hospice system in Vermont and northern New York, which includes the University of Vermont Medical Center in Burlington, Central Vermont Medical Center in Barre, Porter Medical Center in Middlebury and UVM Health Network Home Health & Hospice (formerly the VNA of Chittenden and Grand Isle Counties).

“Telehealth is imperative to being able to continue to care for our patients amidst the COVID-19 outbreak. Being able to offer care and connection remotely during the time of physical separation supports continuity of care and relationships,” Chistolini said.

Telehealth refers broadly to electronic and telecommunications technologies and services used to provide care and services remotely.

All 10 Medicare-certified home care agencies in the state use telemonitors to remotely assess the vital signs of some of their patients. COVID-19 has affirmed the value of monitors.

Derek Kouwenhoven, director of clinical services for Central Vermont Home Health and Hospice, said the agency determines, on a case-by-case basis, which patients should use a home monitor.

“If it makes clinical sense, we can use a telemonitor. Our telemonitors are equipped with full vital-sign transmission capability and video functionality. They also allow a clinician to listen to a person’s heart and lung sounds remotely. With the governor’s Stay Home, Stay Safe order, a telemonitor can be a useful tool to help us care for individuals living with chronic conditions like heart or lung disease and who are at risk of hospitalization. For other patients, we are utilizing platforms like Zoom and to conduct video visits, which allow us to stay engaged with our patients and to provide care remotely,” Kouwenhoven said.

“We are looking at using phone and video visits to keep some of our clients, especially those with Personal Care Attendant or homemaker services in place, stay connected. For many of our clients with PCA services, the social component of care is so important, and we would like to keep this up,” he said.

Washington County Mental Health has seen a dramatic increase in its use of telehealth in response to COVID-19.

“We’ve been headed in the direction of employing technology in delivering telehealth services for some time. With the global COVID-19 pandemic, the time frame has just moved up to delivering it now,” said Mary Moulton, WCMHS’ executive director.

According to Moulton, in the last 10 days WCMHS has conducted nearly 600 meetings and counseling sessions remotely for a total of nearly 80,000 minutes, and that doesn’t include the numerous hours spent on the phone with clients.

Many physicians are also meeting remotely with some of their patients.

“Depending on the type of practice, specialty care or primary care, we have seen physician practices make a number of changes in response to COVID-19, ranging from separating well visits from sick visits, postponing preventive services or moving visits to remote, phone or telehealth visits,” said Jessa Barnard, executive director of the Vermont Medical Society. VMS represents approximately 2,400 physicians, physician assistants and medical students.

On March 17, Blue Cross Blue Shield started paying for physicians services provided by telephone.

“We purposefully pursued the telephone visit option before expanding traditional telemedicine to ensure that our local providers, many of whom are not equipped to perform audio-visual telemedicine, remain the primary source for members to seek and receive care. These telephone visits are reimbursed at the same rate as an office visit to minimize cash flow disruption,” said Sara Teachout, director of government and media relations for Blue Cross and Blue Shield of Vermont.

According to Teachout, Blue Cross is committed to paying for services provided by telephone for the duration of the COVID-19 pandemic and will determine later if payment for telephone visits will continue.

On Wednesday, the Vermont House, with 76 of 150 legislators in attendance, passed emergency COVID-19 legislation that includes a section geared toward increasing access to telehealth services. The legislation mandates that all health insurance plans in this state provide coverage for telemedicine and the reimbursement rates for the services be at par with an in-office visit.

Ron Cioffi, the director of the Visiting Nurse Association & Hospice of the Southwest Region, which serves Rutland and Bennington counties, said one result of the Coronavirus pandemic has been a significant increase in business for the home care agency. Two weeks ago the average daily patient census was 410 patients. On Thursday, the patient count was 490 patients, nearly a 20% increase. Cioffi attributes the increase to the fact that the hospitals in his service area are gearing up for a rush of patients by making sure beds are available.

At the same time as VNAHSR has seen a sizable increase in business, some physicians have seen a marked decline in their business.

“Many physician practices have experienced declines in revenue. We are working with the state and our federal delegation to secure financial resources to help ensure that practices can continue to operate and serve patients across Vermont,” Barnard said.

Nick McCardle, division director for the Rutland office of Bayada, a statewide home care and hospice service, said an increasing number of Bayada’s clients, especially those in the Choices for Care program who are fearful of contacting the coronavirus, have called asking that their caregiver not make a home visit. Choices for Care is a Medicaid program that provides a package of long-term services such as meal preparation, food shopping and bathing for those needing nursing home level of care but who are living in their own homes.

“When that happens we call them and try to assess whether crucial needs are being met,” McCardle said, adding the biggest issue is food insecurity. “We try to make sure they have enough food to eat, if we don’t think they do we strongly encourage them to let our staff help them.”

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