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photo by Dr. Steve Dobberfuhl

Dr. Steve Dobberfuhl, an internal medicine doctor at a South Austin private practice, conducts telemedicine appointments. (Dr. Steve Dobberfuhl)

University of Texas-Austin graduate student Lexie Wille, 26, had her first appointment with her therapist via video on her laptop as a result of the coronavirus pandemic.

Her therapist offered video sessions for patients who wished to avoid coming into the office.

"I have a good sense of how we work, and I have trust in our relationship," Wille said. "I felt like I would be able to have about as close as an experience in session as I normally do in person."

She decided to try it. It also made sense because Wille's session would be covered by her insurance—something that may not have been true just weeks earlier.


As the pandemic worsens, state and federal agencies are waiving telemedicine regulations in an effort to preserve access to care while limiting community spread.

Last week, President Donald Trump expanded telemedicine coverage for Medicare patients, a benefit already offered to those covered by Medicaid and the Children's Health Insurance Program, or CHIP. That same day, Texas Gov. Greg Abbott required state-regulated insurance plans to pay the same amount for visits conducted in an office, over the phone and by video.

"Gov. Abbott very wisely temporarily expanded telemedicine to include telephone calls in the short term to meet immediate patient need while providers are making decisions about their choices of tool," said Nora Belcher, executive director of the Texas e-Health Alliance.

These changes have been critical for clinicians, who rely on this income.

"The reduction of barriers, that's everything," said Dr. Steven Dobberfuhl, a board-certified internal medicine physician who's been in practice for 20 years. "That's been a game-changer for us."

About 75% of the patients at Dr. Dobberfuhl's practice, Adult Care of Austin on Menchaca Road, are 65 years or older, a group particularly vulnerable to the new coronavirus.

Before the disease arrived in Austin, Dobberfuhl had never used telemedicine. Now he and his colleagues are working to shift as many patients as they can to virtual visits.

While Austin Adult Care has a videoconferencing service, many visits take place over the phone or via FaceTime or the Android equivalent, Google Duo, which Dr. Dobberfuhl said are easier to use than some HIPAA-compliant platforms and allowed under the new emergency rules.

"Patients love it," he said. "My response already is…'This has been great.'"

Samantha Bray, a therapist and owner of Bray Counseling in Westlake, said her four-person team has transitioned about 95% of their patients to telemedicine sessions—even before it was clear that insurers would pay for them.

"That first week I was just willing to eat [the cost] because I didn't think it was ethically okay to just tell everybody, 'No sessions,' at this time when people are in panic," Bray said.

For now, the practice is maintaining its caseload, but Bray worries about the long-term financial impact, especially as the number of inquiries she has received from prospective patients has dropped about 70%.

"I anticipate having issues with claims. I know they [insurers] agreed to this, but we'll see what happens," she said. "And I also expect that in the following weeks more clients are going to see how they're impacted financially and have to make hard choices."
Telemedicine's embrace by insurers and healthcare providers is a significant change.

"So often our public healthcare system and public safety agencies are slow to move in terms of innovation," said J.C. Adams, CEO of Cloud 9, a local telepsychiatry startup that connects patients with mental health care professionals.

Now, the city of Austin is advising residents with coronavirus symptoms to use telemedicine services.

Baylor Scott & White is screening patients for coronavirus tests with its MyBSWHealth app and has expanded its telemedicine services to include nearly all of its providers. Ascension Seton and Austin Regional Clinic already offered telemedicine services, which they continue to expand.

In the last two weeks, Cloud 9 has fielded calls from local governments, healthcare agencies and community health centers looking to introduce or expand telemedicine services.

Adams anticipates that after the pandemic telemedicine services will be more widely available.

"I think the overwhelming majority of people in and around the healthcare sector are saying that this is going to definitely be the tipping point for telemedicine," he said.

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