How Permanente uses telehealth during the COVID-19 pandemic

Telemedicine is quickly becoming health care’s first line of defense against COVID-19. With the growing concern over the COVID-19 pandemic, The Permanente Medical Group (TPMG) has ramped up its telehealth services to minimize foot traffic in offices and to educate patients. Continued expansion of these telehealth services helps to avoid putting physicians and their teams at a greater risk for exposure and utilizing scarce personal protective equipment (PPE).

“At a high level, the country's response has been lagging. It seems that there's interdepartmental politics,” said Richard S. Isaacs, MD, co-chief executive officer of The Permanente Federation, and CEO and executive director for TPMG. “You've got the federal government; you've got the state governments and here in California we've got city councils and counties and there's a lack of alignment. So, it creates uncertainty.”

“Being in many counties in Northern California there's not a uniform approach and it's creating a lot of confusion at the care delivery side,” said Dr. Isaacs who is also president and CEO of Mid-Atlantic Permanente Medical Group (MAPMG). Both TPMG and MAPMG are among eight Permanente medical groups in the U.S. which, with the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, comprise Kaiser Permanente.

Together, TPMG and MAPMG have nearly 11,000 Permanente physicians and more than 40,000 nurses and staff delivering high quality care to 5.2 million Kaiser Permanente members in Northern California, Maryland, Virginia and the District of Columbia.

Here are five ways TPMG is using telehealth during the COVID-19 pandemic to improve patient care and protection.

During this COVID-19 pandemic, patients can be experiencing information overload, which can lead to added stress and anxiety. By using the patient portal, Permanente doctors can share pertinent information as it is made available.

“We have a very robust digital presence where we provide information about COVID-19 on a day-by-day basis for all of our patients, members and staff,” said Dr. Isaacs.

Telehealth services are an important part of the mitigation process. For example, if a patient has cold or flu symptoms, they can contact their physician for an appointment. The primary care doctor then evaluates the patient via a video visit or a phone call. This helps the physician support a patient’s symptoms without spreading disease to other patients or medical staff.

In response to advocacy by the AMA and other physician organizations, Medicare’s physician payment schedule and some other health plans now cover telehealth visits at the same payment rate as in-person office visits. TPMG has a lot of experience with this already because their revenues do not depend on receiving a payment for each office visit.

“With our integrated care and coverage, the incentives are aligned to do this because it's the right thing to do for patient care,” said Dr. Isaacs. “We can actually deliver the care in the most efficient, high quality and effective way using telehealth services that other organizations may struggle to do.”

Telehealth services allow the physician to link directly to their patients through video. “The mechanism is a “smart phone technology where we can have a video visit created just as easy as clicking one button and you’re connected via video,” said Dr. Isaacs. “The physician is able to evaluate you on a screen, which is superior than just a telephone call.”

Delivering care during the COVID-19 pandemic has been a concern for patients and their physicians, but telehealth is “lenient” because patients “don’t have to leave their home and they’re getting instantaneous support from the physician who they know and trust,” he said.

TPMG has been using telehealth for over 20 years, which means physicians and other members of the health care team are very comfortable because it has been a part of their workflow.

“We have the technology infrastructure that makes it easy to use, so when you click a button there’s instant connectivity via video with your doctor,” said Dr. Isaacs.

“During this time in particular—dependent on local government creating the rules around PPE—there’s a pretty high burn rate through masks, gowns and gloves,” he said, adding that it is “unnecessary when you can treat in an alternative way.”

“One of the things that we talk about in health care delivery is the supply chain,” said Dr. Isaacs, adding that protocols can lead to high burn rates of PPE equipment, but telehealth serves as an added protection for physicians.

“The telephone actually creates the PPE,” he said. “That’s a huge advantage in addition to the convenience” of telehealth.

When dealing with any infectious disease, there is “the consolidation of effort and then there’s the mitigation effort and telehealth is critically vital in both of those phases of management,” said Dr. Isaacs.

However, with the epidemiology of any infectious disease, the first phase is often containment. This was seen with New Rochelle, New York when they implemented a one-mile radius around the area, he said.

“Telehealth is a great tool for both containment and also mitigation,” said Dr. Isaacs.

The AMA quick guide to telemedicine in practice has been developed to help physicians swiftly ramp up their telemedicine capabilities. The AMA and the Centers for Disease Control and Prevention (CDC) are closely monitoring the COVID-19 global pandemic. Learn more at the AMA COVID-19 resource center and consult the AMA’s physician guide to COVID-19. 

The AMA is also working to secure better coverage of telephone services during the pandemic, as many seniors at highest risk from COVID-19 do not have access to two-way audiovisual communications in their homes, especially in rural areas.

Additionally, the AMA, Physicians Foundation, Florida Medical Association, Massachusetts Medical Society and Texas Medical Association launched The Telehealth Initiative, which helps physicians implement telehealth services. Find out more about the available telehealth resources.