By Ivelisse Velázquez Negrón, MD

Telehealth:

The Silver Lining of the Pandemic

By Ivelisse Velázquez Negrón, MD

t the beginning of the COVID-19 pandemic, adjusting to virtual interactions was one of the most frustrating limitations that many of us encountered. This frustration was shared among most of my peers, that after months of being confined to our houses and finishing medical school through virtual didactics, were craving a more personal connection. However, safety has always been the number one priority. Within time, we all adapted to this new form of practicing medicine. We learned and made it work for us and for our patients. More than a transitional period, this was going to be a new era, and medicine was going to change before and after COVID-19. Telehealth was here to stay.

In the blink of an eye, I was starting my second year of psychiatric residency. I was at Geriatrics printing out my schedule and to my surprise, had a fair share of virtual visits. The average age of the clinic was 76 years old, so I mistakenly thought that my patients would not be “on board” with doing virtual visits. As I reviewed their charts, I noted that most of them were vaccinated, so I wondered why they preferred a “MyChart video visit” rather than coming to the clinic they had been coming to for years. I was determined to find out the reason behind this.

Certainly, during my intern year I experienced all the struggles you can imagine with technology. One example was not knowing how a

ACOW (computer on wheels – it took me a while to figure that one out too) connects to the internet; I admit that I was not fond of technology, especially in an acute psychiatric setting. However, it seems that the experience was different for most of my patients, and surprisingly, even more so for the elderly. “Good morning, I’m Dr. Velazquez, can you hear me?” Audio is connecting. “Hi, Dr. Velazquez, can you hear us?” “Yes, I can, can you see me?” I asked. “Yes, I can, can you see us?” they asked me. I started my first assessment with a new patient. She told me that she had not seen a doctor for a while since she lived in a town 90 miles away from San Antonio, and at least 60 minutes away from the nearest medical facility. Her family lived on a ranch, and they had not been out for a long time since their adult daughter had a severe neurodevelopmental disorder and was almost fully dependent on her. She confided that it was a lot of work and said she appreciated the fact that she was able to get care through a video call. A similar story was told by another patient who was relieved that Medicaid was covering video visits since she did not drive anymore. She explained to me that her husband was physically unable to drive her to San Antonio for her medical appointments. At the end of the day, I realized that what started as a solution for a Public Health Emer-

gency was a feasible solution to ease the burden of care for so many patients. We needed it to stay.

Our patients can safely access needed mental health services during the COVID-19 pandemic through telehealth. Congress and the Administration acted to lift many of Medicare's telehealth restrictions, but at the end of the Public Health Emergency, Medicare will require that individuals seeking mental health treatment need to meet in person with a clinician within six months of the first telehealth visit. This restriction could impede access to care for patients seeking mental health services, especially elderly patients that depend on Medicare to be able to afford health care.

Our geriatric population is approximately 16.5% of the American population and is expected to reach 22% by 2050. As per a CDC telehealth and telemedicine publication, “Telehealth is a promising public health tool because of its 1) potentially significant impact on medically underserved populations through increased access, 2) increasing prevalence as a recognized standard of care, 3) influence on the provider-patient relationship, and 4) potential to save billions of dollars in healthcare expenditures.”

Similar access restrictions are not required for patients seeking services for substance use disorders or co-occurring mental health conditions.

The Tele-Mental Health Care Access Act (S.2061) could remove the six month in-person barrier to accessing mental health treatment for Medicare patients. This bill could potentially help patients access mental health care, avoid worse outcomes and likely avoid higher-level crisis interventions that are more expensive to our state, our patients and Medicare. In my opinion, although telehealth visits will never be superior to in-person visits, this could be a superior solution to no visits at all. All of us have a privileged position where our voices can be heard, and it only takes a couple of minutes to help our elderly and/or incapacitated population.

Ivelisse Velázquez Negrón, MD is a resident in the Department of Psychiatry at the UT Health Long School of Medicine. She is a resident member of the Bexar County Medical Society.

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