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Almost a century ago, a Norman Rockwell painting entitled “Doctor and Doll” appeared on the cover of the Saturday Evening Post, a popular American cultural magazine.
It showed an elderly man in a suit with a doctor’s bag at his feet, holding a stethoscope to the chest of a little girl’s toy doll. A cluttered desk and a worn chair sit on a forgetful rug. It’s an old picture of healthcare in America. A country doctor who takes care of his neighbors with a “home visit”.
Of course we know it wasn’t that easy. Health care was rudimentary compared to today’s standards – that is, if you had access to care at all. Average life expectancy reflected this. If you were born white in 1929 you might be lucky to turn 60. If you were black, you probably wouldn’t hit your 50.
While things are far from perfect, at least they have improved. A healthy lifestyle and modern medicine made life normal well into the 80s. Substantial racial differences persist, but the gap is closing. And the number of people with health insurance has never been so high. But while Medical (government-sponsored insurance for low-income people) now covers nearly 14 million people, many still lack adequate access to medical care.
Access to health care is a complex issue, but sometimes it’s as simple as geography. Taking an hour-long bus ride across town to see a doctor is impractical for most people. Add to this lost wages, lack of childcare and the fact that you don’t feel well, and it’s simply impossible.
Solutions in company health insurance that have been available for years, such as virtual support via an app or the telephone, were not an option for people at Medi-Cal.
Until the pandemic.
When the federal and state governments declared a state of emergency last spring, health centers qualified by the federal government such as WellSpace Health were able to take care of what had previously been prohibited, virtually by telephone and video.
Virtual care is very successful. In the past two weeks, 5,015 patients have received remote care instead of visiting our health centers. Half of the visits to primary care and 85% of visits to behavioral medicine were virtual. According to a statewide survey of community health centers that serve 1 in 5 Californians, the no-show rate has decreased by 75% since telemedicine was first introduced. A study conducted by the California Pan-Ethnic Health Network found that significant numbers of patients from colored communities practice telemedicine and have high levels of patient satisfaction.
As an internal doctor and chief physician at WellSpace Health, that makes sense. Technology has given us the ability to conduct a modern “home visit”. We can go to the patient and remove significant hurdles in the care. If the patient needs a practical exam or treatment, we can take this step. But often, especially in behavioral health, practical care is not required.
Our ability to provide virtual care as part of the contingency order is about to expire. Permanent approval requires action by the legislature and the governor during the budgetary process. Assembly Bill (AB) 32 by Assembly Member Cecilia Aguiar-Curry (D-Winters) provides the template for action.
In this budget cycle, the governor must seize a golden opportunity to address inequality in our health care system. The inclusion of the provisions of AB 32 in the final budget for fiscal year 21-22 ensures that all medical beneficiaries – regardless of where they seek treatment – will continue to use all telemedical modalities, including telephone coverage, for an indefinite period of time can.
Telemedicine may not be a good Norman Rockwell painting, but it is good medicine. It is an improvement, a step forward, that helps us become healthier and fill gaps in care.
It even brings back the home call.
Dr. Janine Bera is the Chief Medical Officer of WellSpace Health and Chair of the Telehealth Clinical Task Force for the California Primary Care Association.