Before the pandemic started, Adult Care of Austin on Menchaca Road didn't offer telemedicine appointments.
Now, the private practice conducts almost all of its visits virtually, either over the phone or on HIPAA-compliant video platforms.
Dr. Steven Dobberfuhl, an internal medicine physician, said telemedicine saved his practice—and has been a boon to his patients, around 75% of whom are 65 years or older and at high risk of contracting COVID-19.
"I didn't believe it would work as well as it has," he said.
Dobberfuhl is not alone.
With policy changes enacted at the state and federal level earlier this year, including requirements that insurance companies reimburse doctors for telemedicine appointments, the technology finally made financial sense for many local physicians.
"Sadly, if it's not getting paid for, it's not getting done," Dobberfuhl said.
Telemedicine—which includes live videoconferencing, recorded videos, remote patient monitoring and mobile health, such as texts—offers convenience and limits doctors and patients' exposure to the coronavirus.
But there were kinks to work out.
"Everything was sort of bottlenecked through telemedicine," said Dr. Terry Rascoe, medical director of telemedicine virtual urgent care for Baylor Scott & White Health, which expanded its telemedicine services early on in the pandemic.
Over the last eight months, however, physicians and patients alike have discovered the benefits of telemedicine—and been able to return to in-person visits where they make sense now that the state has allowed elective procedures to resume.
"It was a crisis period (in March and April)," said Dr. Ashis Barad, medical director of virtual specialty care services for BSW Health. "We were replicating in-person care back then out of necessity. Really the hope now is to enhance care."
The telemedicine revolution
For Barad, who is also a pediatric gastroenterologist, this means using telemedicine for follow-up visits and for those families who may live far from his Temple clinic, which serves dozens of counties in Central Texas.
"Patients are going to drive this," he said of telemedicine's continued use. "And I think in general, our patients love telemedicine."
Other physicians echoed this assessment.
Although no longer a necessity, telemedicine continues to save patients time. Instead of spending hours commuting to a doctor's office and possibly losing out on pay, they can instead pop into a video or phone call for 30 minutes.
"The patients are really seeing the benefit of not having to take a half day off of work," Dobberfuhl said.
There are also benefits to the doctors themselves.
Dobberfuhl likes getting a glimpse into his patients' homes—a kind of 2020 house call.
"For better or for worse, I kind of like having a little bit of that insight," he said. (Although there are some occupational hazards that crop up: "I've had patients not put on shirts.")
Overall the change has been a positive one.
"It's a good revolution," Dobberfuhl said. "We all really hope that parts of it stay (beyond the pandemic)."
A tool in the toolbox
But telemedicine is not a panacea.
Many physicians and private practices are still reporting depressed patient volume as a result of the pandemic and haggling with insurance companies over reimbursement rates.
"They're still struggling," said Tom Banning, CEO of the Austin-based Texas Academy of Family Physicians. "There's no question about that."
Although telemedicine is useful in many instances, it doesn't address every problem caused by the pandemic. Banning estimates that patient volume has rebounded to about 85% of pre-pandemic levels, but that still leaves a 15% gap, which he attributed in part to patients losing their jobs—and with them their health insurance.
"I think telemedicine is just going to be one bullet in the gun," he said of the challenges facing doctors today.
Another reason for the drop in patient volume may be the success of COVID prevention measures.
"This time of year we're typically slammed," said Dr. Brian Temple, a co-owner and partner at Beansprout Pediatrics, which has locations in Bee Cave, Dripping Springs and Spicewood.
With kids wearing masks and social distancing, however, the common flu and cold cases are much less common.
Still, telemedicine is a useful tool for Temple's practice, especially for screening patients with COVID symptoms without having to bring them into the office, where they might infect staff.
With cases surging, this is a critical safeguard.
"If we didn't have that, I don't know what we would do," he said.
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Austin's Delta 8 industry has been turned on its head after Texas health officials clarified that the cannabinoid is on the state list of illegal substances, though it was previously believed to be legal by most retailers, consumers and manufacturers.
House Bill 1325, which was signed in June 2019 by Gov. Greg Abbott, and the Farm Bill, signed into law by former President Donald Trump in 2018, legalized any hemp product containing less than .3% THC. The same bills were thought to have made Delta 8 legal, though the Texas Department of State Health Services added a notice on its website saying it was still a controlled substance as of Friday, Oct. 15.
Both the federal and state governments keep separate lists on what is considered a controlled substance. Marijuana is considered Schedule I, a category reserved for substances with "no currently accepted medical use and a high potential for abuse," both statewide and federally.
Austin-based CBD retailer Grassroots Harvest CEO Kemal Whyte, like many CBD shop retailers, was blindsided by the announcement. Many small businesses rely on Delta 8 for their sales—Green Herbal Care CBD said about 90% of its sales come from Delta 8—and Whyte said he is frustrated by the inconsistencies in the drug scheduling system.
Since 87% of Texans support the legalization of marijuana, at least for medical use, per a recent poll, Whyte said he wonders who this legislation is for.
"It's gonna have a massive impact on small businesses—there's just no way around it," Whyte said. "The reality is, we don't want to push out anything bad for our customers, we want this to benefit our customers and to help them. If we can make money while doing it, that's the American dream. What are we doing, whose benefit is this for?"
Delta 8 surged in popularity after the perceived legalization—consumers enjoyed its lower psychotropic potency, decreased anxiety while using it and the peace of mind as a legal way to get high. So in order to protect their products and livelihoods, both Grassroots Harvest and Austin-based manufacturer Hometown Heroes are taking legal action.
Whyte said Grassroots Harvest is suing DSHS, saying their action is creating negative effects in the market. Meanwhile, a Hometown Heroes spokesperson said the company is in the process of filing a temporary restraining order that would pause the ban on Delta-8 in the state of Texas.
Threats against Delta 8 are not new—DSHS lost a lawsuit trying to make "smokable hemp products" illegal last year and Texas lawmakers had been considering a bill that would make Delta 8 illegal, though it was dropped after the clarification was made.
Hometown Heroes released a formal statement in response to the DSHS rule.
"I need to be clear—we love Texas, we're just choosing to fight for the will of the people in regards to cannabis in Texas," Hometown Hero CEO Lukas Gilkey said in a statement. "(Texas DSHS) are using backhanded ways to create legislation and go against the will of the people."
Whyte laments the fact that it would be easier legally to "open up a strip club that also sells guns," and said he can't post customer testimonials that mention the benefits of Delta 8 without getting hit with a cease and desist from the Food and Drug Administration. Whyte said he isn't opposed to regulation—far from it—he just wants to see it go through the correct channels.
"The fact that they're stunting our ability to communicate with our clients that want to learn about this, you're preventing us from communicating with them and teaching them, or spreading information that we know," Whyte said. "I think that that in and of itself opens up a lot of questions."
Grassroots Harvest still has Delta 8 products on its shelves for the time being but for how long, Whyte doesn't know.
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Austin Public Health and other clinics around Austin are now providing booster shots for all three vaccines, including Pfizer, Moderna and Johnson & Johnson, to fully vaccinated individuals after both Pfizer and J & J were approved by the CDC on Wednesday.
APH and Austin clinics, which were already administering the approved Pfizer booster, will begin distributing shots as soon as Friday.
Those who received the second dose of the Pfizer and Moderna vaccine more than six months ago are elligble to receive a booster if they are over 65 or if they are over 18 and:
- Live in a long-term care environment
- Have underlying medical conditions
- Work or live in high-risk settings, such as schools, hospitals or correctional facilities
Austin-Travis County Health Authority Dr. Desmar Walkes said in a media Q&A Friday that APH is encouraging boosters just as much as they have urged residents to get their first and second doses.
"Boosters are incredibly important to keeping our community protected and hospitalizations low," Walkes said. "If we can stay on top of our vaccinations, we provide protections for our most vulnerable and make it that much harder for COVID to spread in our community."
Eligible residents are free to choose the same booster as their first doses or "mix and match," per the CDC announcement.
Those looking for another dose can simply bring their vaccination card to APH centers or the dozens of Walgreens and CVS locations in the metro, which began administering doses Friday.
Additional updated guidance from the CDC allows for all eligible individuals to choose which vaccine they receive as a "mix-and-match" booster dose. It is advised to remember to bring your CDC COVID-19 Vaccination Card showing the original doses with you when going for booster shots.
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