Rural Michigan embraces telemedicine

Virtual visits with doctors and medical professionals have become the new norm for many residents in rural Michigan, thanks to the Covid-19 pandemic.

And healthcare providers are advocating for continued use of telemedicine as a way to cut costs and increase access to medical care, especially in rural areas. 

“We’ve definitely seen benefits,” says Chelsea Szafranski, who is executive director for telemedicine at Munson Healthcare in Traverse City. Hers is a new position created in February 2020, just weeks before the pandemic created the immediate need for patients to safely access medical care without risking exposure to the virus.

In the past two years, Szafranski has seen a surge in telemedicine and virtual visits across the board -- with a 50 percent spike during peak outbreaks of the virus and 10 percent to 20 percent rise at other times.

Some specialties, such as behavioral health, endocrinology and nephrology, lend themselves so well to virtual visits that those have remained high even as virus threats fluctuate, she says.

The rise in telemedicine is common across the state.

In Sandusky, for example, virtual telehealth visits with primary care providers and after-hours clinics swelled from about 6 percent in 2019 to nearly 11 percent in 2020, says 
Billi Jo Hennika, CO at McKenzie Health System.

With 33,000 visits per year, “that’s definitely a pretty big increase,” she says.

Residents in Sanilac County, where Sandusky is located, were among those surveyed by the non-profit group Connected Nation Michigan, in partnership with the Michigan Public Service Commission. In February2020 and again in December 2021, respondents in the rural Michigan counties of Gladwin, Sanilac, Roscommon, Osceola, and Dickinson were asked about telehealth trends and perceptions in rural telemedicine.

The study found that people are not only embracing virtual health visits, but they’re hoping telemedicine options continue after the pandemic. 

Telemedicine is not so new

Years before the Covid-19 pandemic, electronic records transmission and virtual consultations with specialists had already been embraced by small, rural health systems as a way to expand the services they can offer rural patients.

The electronic exchange of medical information from one site to another can be especially critical in life or death situations where services are far flung and every minute can count.

For instance, rural stroke victims were once sped by ambulance, clock ticking, from small rural ERs to a larger medical center with a neurologist on staff who could determine the proper treatment while there might still be time to avoid permanent brain damage. 

Telemedicine’s Telestroke system, adopted by many rural hospitals years ago, allows emergency physicians to connect the patient virtually with the neurology department of a neighboring urban hospital for diagnosis, and to then be treated under the neurologists' guidance by doctors at the rural hospital. 

This access to specialists from larger hospitals “has really saved our butt out here in the country in many ways,” says Jim Connell, retired veterinarian and secretary of the board of trustees at Ascension Borgess Allegan in Allegan County.

An explosion of no-contact services

But until the Covid-19 public health emergency in March 2020, the use of those technologies — and insurance payment for them— was only approved for select situations. When those restrictions were lifted nationwide by emergency order, the effect was swift.

Health systems geared up to help patients connect to their doctors virtually. Patients quickly realized the conveniences telemedicine offered in addressing day-to-day medical needs.

“We have some patients that travel far distances, patients traveling all over northern Michigan, so if we can reduce a few hours of drive time— that’s a big benefit,” Szafranski says. “Northern Michigan has harsh winters, and if we see a bad weather day, a practice’s registration staff can call or text the day before, even the day of”  to offer a virtual visit, she adds.

That’s true on the other side of the state as well, Hennika says. “I think that (Covid) encouraged our providers to become more diligent at offering televisits as well as encouraged patients (to consider the virtual option),” she says. “They said ‘sure, if I can stay home and stay safe, let’s figure out how to make me connect via telehealth.’”

In Allegan, Connell himself has seen things from the patient’s view. “I see my primary care provider every three months, my kidney doc twice a year, my oncologist at least once or twice a year,” Connell says. “All those appointments became FaceTime appointments.”

Some types of visits lend themselves to virtual consultations better than others. For instance, Hennika says, doctors can take a look at digital photos of a patient’s rash, listen to the patient’s self-reported symptoms, and make an assessment online. On the other hand, she says, “If I need to listen to your lungs, or get an accurate blood pressure… that can certainly be challenging.”

 “(Telemedicine) is not the absolute answer to everything,” Connell says, “but giving the patient the option, (as) an adjunct— it’s sure nicer to see your doctor on an ice storm day by telephone, rather than having to reschedule.”

And it’s not just patients that travel long distances. Providers spared travel to remote clinics can see more patients, or partner with other health systems as needed. In a survey of its members, The American Academy of Family Physicians found that more than 80 percent of family physicians began offering virtual visits during COVID-19 and nearly 70 percent would like to provide more virtual care in the future. 

No wonder, then, that as of July 2021, nationwide telehealth usage had grown by an estimated 3003 percent over pre-pandemic rates among Medicare users alone.

Is it here to stay?

Now that patients and providers have experienced the option of telemedicine to deliver such a variety of services, what will happen when society opens back up and the need for strict social distancing declines?

Munson Health System, Ascension, and other rural Michigan health systems are among the more than 300 telehealth stakeholders signing off on a plea to Congress last month to extend Medicare telehealth flexibilities beyond the current public health emergency.

 “A return to pre-COVID telehealth policies would … squander the time and resources that physicians have invested integrating telehealth within their practices,” according to the AAFP website. 

Obstacles remain
Even if the policy changes become permanent, many rural residents still lack adequate internet service to handle video conferencing. 

Connell is among them, and the issue is “E-normous,” he says.

Though he lives on the edge of the county seat, his internet provider offers only dialup services. The slow speeds have resulted in dropped calls, out of sync audio and video, and other connectivity issues. Sometimes visits that begin virtually online turn into mere telephone calls.

Another problem — lack of technical knowledge among patients.

U.S. Rep. Brenda Lawrence, D-Mich., is proposing that the government create a new federal interagency commission to improve digital literacy nationwide so that less tech-savvy residents aren’t left behind as the world becomes more virtually connected. 

“Especially for rural Americans and low-income communities who can't easily access a hospital and rely on telehealth, digital literacy can make all the difference between life and death,” Lawrence says.

The Digital Literacy and Equity Commission will be helmed by the secretary of Education, or a delegate from the secretary, and have members from across federal agencies, according to the bill Lawrence introduced in December.

Lawrence says the Digital Literacy and Equity Commission Act  will promote digital literacy, streamline these services, and create a whole-of-government approach to narrow the digital divide. 

“The pandemic forced most of our everyday life to move online, including seeing the doctor, “ Lawrence says. “ As reliable internet access has been an obstacle for too many Americans, knowing how to use and navigate these online programs has also become an issue. The overcomplication of our online systems is frustrating the American people, and it’s blocking them from accessing these essential services, like telehealth and telemedicine.”

Rosemary Parker has worked as a writer and editor for more than 40 years, most of that time in Southwest Michigan.

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