Jackie Hendry: You've heard the term virtual visits, as this pandemic pushes us to make the most of video technology. But that tech is being used for much more than socializing these days. Dr. Jason Knutson is a Family Medicine Physician with Avera, and he joins us today to discuss the uptick in these virtual visits for healthcare, as well as how important it is to keep your own health needs top of mind these days. Dr Knutson, thanks so much for joining us on In The Moment today.
Dr. Jason Knutson: Hi, Jackie. Thanks for having me.
Jackie Hendry: So, I know Avera, I've done some reporting on telehealth and an E-health visits and things like this before this whole COVID-19 thing really made it very salient for most of us. Tell us a little bit how typical it was before all of this happened, to use E-visits for just general medical checkups.
Dr. Jason Knutson: You know, it's been interesting. The history, for our telehealth and our virtual visits platform is pretty neat. It started about 10 years ago, in something in variably called the Innovation Council. And we wanted healthcare at the palm of our hands. We wanted healthcare to be available on a smartphone, and an iPad, or a desktop computer. And we started looking at vendors a long time ago, but it just didn't make financial sense. Until just a couple of years ago, we decided that even though it doesn't make a whole lot of financial sense to do it, we knew it was going to be important in the near future, so we started doing it.
We have something called AveraNow, and that's been utilized fairly frequently. We have an AveraNow platform that people can call into basically on their phone or a laptop or an iPad, and have a virtual visit. And that's been going on for a few years now. We also had AveraNow clinics in in some of the High V stores in Sioux falls that people could either see a person in those stores, or do a visit with a kiosk, virtually. So we have been doing those, but it definitely has changed a lot in the last couple of months.
Jackie Hendry: Tell us a little bit about some of those changes. Is it just the number of visits that are happening through this medium over time, or what are some of those changes?
Dr. Jason Knutson: Right now, we're doing at least a 1000 to 1200 visits a day. Before, that was a fraction of that, maybe 1/10th or 1/15th of that. So, obviously they're ramped up a lot right now, and they will continue to ramp up, especially if the surge hits here in the next month or so. Right now the numbers are a little bit down with the COVID positives, which is great, but we think when we open up the state a little bit and maybe start trying to stimulate the economy, that we'll see a little bit of a resurgence. So, what we're doing now at Avera is something that is really, I think it's awesome. If you think you may have COVID, you call into the COVID Hotline, and we can see if you qualify for a test or not.
If you get tested and you find out that you're positive, then we can follow you with nursing staff 24/7. And at any time during that time after you're positive you feel like you are not doing well, you get a virtual visit. Those will be accessible to patients 24 hours a day. And, the effort, or the reason why we're doing that right now is to walk through the whole process with the patient, and get them the help they need when they need it. And, if they do need to go to the ER, we can tell them when they need to go to the ER. We can even give them a oxygen saturation monitor and a thermometer too, to watch things at home to make sure we send them in at the appropriate time, and we can keep them home when it is appropriate as well. It's good for the patient and good for the health system. We try to keep the unnecessary ER appointments at home, and send them when they need to go in.
If they need more care, we send them into our home Home Care virtual platform or pathway, whatever you want to call that. And, at that point, they get even more specialized care. They can get more frequent nursing attention, more frequent physician attention, and even take care of people at home through end of life issues if that's what the patient wishes for.
Jackie Hendry: This is clearly a really key resource right now, considering the pandemic and for folks who are COVID positive, as you just discussed. But I also want to touch on what this means for folks who are just going through maybe their yearly medical checkups. For instance, I just had my regular, what would have been my regular visit, going into the clinic or the office, and ended up doing an E-visit a week or so ago. How much, to start off, I wonder how much of an adjustment has this been for doctors who maybe haven't had as much experience using this eCare model?
Dr. Jason Knutson: Yeah, I think it's been, it's definitely an adjustment, but I think it's been a quick adjustment. And, that normally we would roll something like this out, or a few months and get used to it and play with it and train everybody up, but this training happened very quickly. And I think almost all of the Avera providers, especially in primary care, are getting pretty well adapt, or adept, at doing the virtual visits. I think a lot of them like it, too, and I know a lot of patients enjoy them as well. There are a lot of things in medicine that you do need to go see a doctor for, and you need to be seeing them in person. But, historically, we've done a lot of care in the clinics that could have been taken care of at home. And I think that... I hope that will continue to change. The financial reimbursement has been the big roadblock to this, previously. But, with the insurance carriers covering virtual visits, just like they would an in-clinic visit, that's opened the doors for us, and that's something we've been waiting for, for a long time.
Jackie Hendry: Interesting. Yeah, that's a piece I hadn't thought of before. So, hat was that adjustment with insurance brought on by the pandemic?
Dr. Jason Knutson: Yes. Yep. I think it was a Federal mandate that basically said that any... It wasn't quite a Federal mandate, but it was highly recommended I believe from the government that we start covering virtual visits. Because, what we didn't want to do is bring patients who had COVID into clinics, and then we create clinics that are a little bit, well, a lot dirty, probably, with COVID. And then the people who needed to come in for emergent things or like lacerations or broken bones or whatever, then they had a high risk of contracting COVID, just from the clinic. So, we really tried to keep the people who were ill with respiratory problems out, and convert everything that could be to a virtual visit. We also delayed or pushed back all of our physicals, things that need to be done in person. We pushed those back for at least a couple of months, just trying to get everything done virtually that we can.
Jackie Hendry: Since the pandemic really, as you said, launched everybody into this maybe faster than we would have in the past, what are any technical challenges that have had to be overcome in quick order?
Dr. Jason Knutson: Well, there are a lot of technical issues. So far, things have been going okay. Bandwidth is an issue, sometimes. So the bandwidth we have in our clinics and in the hospital is quite good. We really don't have any problems with that. But some people who are doing a virtual visit at home may have bandwidth issues, and sometimes the technology can freeze, and sometimes it doesn't work at all, based on the bandwidth. But, most of the programs that we use, they allow people to test their computer or test their device beforehand, to make sure that they have the capability of doing it. And, that's helpful, but when people are streaming Netflix movies, and doing other computer things at home and they try to do this, sometimes it becomes difficult with the bandwidth issue.
We have probably about three or four different platforms that we're using, just in case. We have a Plan A, a Plan B, and a Plan C. Yeah, a Plan C if the first two don't work well. So, so far we've been able to do almost everybody virtually, but sometimes with those bandwidth issues, we have to switch to just a telephone visit, as well.
Jackie Hendry: And so of course for some of these regular checkups or things like this, it in a lot of ways makes sense to be able to move that online. But, tell us a bit how you're handling patients that are high risk for maybe things like breast cancer, who need regular mammograms, or other high-risk patients. How is that working out right now?
Dr. Jason Knutson: I think right now, we have delayed quite a few things. But things like that, we have started doing again. People still need to get immunizations, they still need to get mammograms. They still need to get a lot of different things. I believe Governor Noem is making an announcement today. And I don't know exactly what that's going to entail, but there may be something to do with opening up more procedures, like elective surgeries or screening colonoscopies. So, that will be helpful in that aspect. But at the same time, we have to remember that when we do that, we do increase our risk of spreading COVID a little bit more. But we have to find the balance in the whole system that allows people to get the care they need, and protect themselves as well. But we've learned a lot in the last two months, about how to do things. And hopefully we can do them the right way. And I think we have a better supply of PPE now. Hopefully, we've got enough to keep patients and staff safe when they do come in for procedures and diagnostic tests.
Jackie Hendry: Right. Exactly, because the benefit of virtual visits, you're not necessarily running through your PPE at the same rate that you would. It's a tricky balance to strike as those things dial back. In our few remaining minutes, I wonder if you can talk to us a little more generally for folks who are, it seems like they've got bigger things to worry about, they might think than their checkup with their doctor for a prescription refill. Or, asking about the rash, or whatever their issue might be. Talk a little bit about how important it is for folks to not only work on preventing contracting or spreading COVID-19, but also just to take care of themselves full stop?
Dr. Jason Knutson: Sure. So, virtual will be a huge way to deal with a lot of that. So that's where I think the virtual gains that we've made, especially with payment over the last couple of months, have been huge. So, post-op visits that a person would go in for previously, a lot of those will be done virtually, and I think that's fantastic. And granted, a lot of times that's probably the way it should be. People aren't feeling well, they're at home, and maybe they just need to get their incision checked, and have a quick visit. Maybe they drive 100 miles to do that, so that can be something that's done at home.
As far as going into the clinics, I think that will open up quite a bit. But, we do have... We've developed a priority respiratory clinic at Avera as well. So, what that does is it takes people with any respiratory symptoms who we feel need to be seen that go to that clinic, instead of the regular clinics. And, the reason why we're doing that, is that we're trying to keep the clinics free of COVID, basically. We want to protect the staff there, we want to protect the people coming in as well. So, if you do have something that needs to be seen in person, right now, we feel pretty good about having people go into our clinics if they need to be. They may contact their doctor beforehand, or even have to call from the parking lot to talk to the doctor before they go in, just to make sure that we can't do it virtually. We want to make sure that when people do come in, they need to be coming in.
Jackie Hendry: And finally, Dr. Knutson, I hate to ask you to predict the future, but I'm going to ask you to make your best guess maybe, about how this pandemic and the use of virtual visits, when all of this is said and done, how do you suppose that impact will echo into the future, as far as E-visits are concerned?
Dr. Jason Knutson: Well, I think it has been something that's long overdue. And this definitely is one of the positive things that's come out of the Coronavirus outbreak or pandemic. The issue will be payment, basically. To predict the future, my prediction is that I don't think we'll go back to the way we used to be. I think we will be hopefully able to do a lot more virtual visits. I think it's good for the patients, and I think it's good for the hospital systems, as well. So hopefully, my prediction is that it's here to stay and it's going to be something that can be enjoyed both ways, both by patients and providers.
And I think it can provide very good care and decrease travel for those folks who live in rural communities, and decrease the risk of traveling in, and decrease the risk of spreading more coronavirus. This probably isn't going away for quite a while, so we will have to be smart about the way we travel, and isolate, and things like that. But, to predict the future, I think it's here to stay, and I hope I'm right.
Jackie Hendry: My guest has been Dr. Jason Knutson with Avera Health, talking about virtual visits and guarding all aspects of your health during these uncertain times. Dr. Knutson, thanks so much for joining us today. Really helpful information, I appreciate it.
Dr. Jason Knutson: You're very welcome, thank you.