COVID - 19 Update
Dr. Joseph Bryer's Message About COVID-19 (Coronavirus Illness)
UPDATE: March 22, 2020
Due to increasing community spread of COVID-19 coronavirus illness, we will be unable to meet for face-to-face office visits at this time, and until further notice.
There are several options for planned visits: secure videoconferencing using an app called Lifesize; less secure videoconferencing via FaceTime or Google Duo if you are unable to operate Lifesize; and telephone visits.
The U.S. Center for Medicare Services (CMS), which administers Medicare, published on March 17 their position on telemedicine services during this national health emergency. Medicare will reimburse providers for videoconference telemedicine services using tools such as Lifesize, but also temporarily via FaceTime, Duo, and similar applications. They will not reimburse a typical session which involves telephone contact only. ComPsych (Dupont-related insureds) will pay for telemedicine and telephone sessions; Highmark BCBS refers insureds to access your member website or call the customer service number on the back of the insurance card to discuss whether they will pay for telemedicine or telephone sessions.
Please contact my office via telephone and leave a message as to how you’d like to proceed. Please also inform me of your preferred email address, since this will be required to set up Lifesize telemedicine visits. As an alternative, email me (firstname.lastname@example.org) from your preferred email account, and include the word “Telemedicine” in the subject line. I will record the email address and, no less than two business days prior to our planned visit, I will email Lifesize instructions, and a link to click at the time of our planned appointment.
If you cannot access email from your cell phone or tablet, I am able to send you a link to our session via text message at our appointment time. In that case, be sure to download the software app prior to the meeting, and please let me know ahead of time that you’d like to use this method.
Here are Lifesize instructions if you would prefer to read now, and to download the Lifesize application to your computer, cell phone, or tablet in advance of our appointment.
Please contact me with any questions or concerns you may have.
My hopes and best wishes to you and your loved ones during these uncertain times,
Joseph Bryer, MD
Update: March 14, 2020
The emergence and community spread of coronavirus illness (COVID-19) is likely to affect healthcare delivery in numerous ways. One of the potential impacts is to limit our ability to meet for face-to-face visits in my office. Given the public health need to isolate those exposed or infected, if I were to become exposed or infected it would be dangerous or impossible for you to meet with me. Similarly, if a patient or household member were to become exposed or infected, it may be dangerous or impossible for us to meet. Finally, even if neither you nor I become infected, our ability to meet for office visits would be precluded by any geographic isolation orders that may be implemented, as has happened in regions of New York State, China, and Italy.
The majority of those infected with the virus will have mild to moderate illness, but up to 20% may require hospital care. The mortality rate varies depending upon location and other factors, but appears to be 2-3% generally, and as high as 15% among those over age 80.
In view of the possible impact on our ability to meet for office visits, I have been considering ways to preserve continuity of care of my patients. Assuming absence of severe illness requiring hospitalization, telecommunication technologies permit some measure of continuity of care. Telephone communication affords a minimum level of continuity of care. Several videoconferencing applications, such as FaceTime and Skype, are widely available; however, federal regulations (HIPAA) mandate specific security and privacy requirements that make these tools unacceptable. Fortunately, there are videoconferencing applications that have come to market within the past several years that are HIPAA compliant. One such application that I have researched is called Lifesize. This application is user-friendly and affordable for both you (free) and me to use. It requires minimal software for you to download, and can be utilized on multiple devices, including personal computers, laptops, tablets, and cell phones. Lifesize has signed a Business Associate Agreement (BAA) with me to confirm their compliance with HIPAA regulations, and this gives both me and my patients who may utilize this videoconferencing tool peace of mind regarding security and privacy. All Lifesize sessions are encrypted end-to-end, and there is no recording of sessions whatsoever—not by me or by Lifesize.
Your insurance company may reimburse you for telehealth visits via secure videoconferencing, and possibly even for telephonic sessions. Medicare does not normally reimburse for either type of session. However, on March 6, the President signed into law a supplemental spending package to support COVID-19 treatment efforts, and it calls for reducing some of the requirements for payment for telemedicine sessions. Exactly how this will be instituted is not yet clear, but a real-time audiovisual connection between provider and patient is a specific requirement, making telephone-only contact for sessions not reimbursable. Assuming that I could not submit claims to Medicare for our telemedicine sessions, the charge for telephone or videoconference sessions is at my usual rate of $135 per 25 minute visit, and I can send you receipts for payments received by check or credit/debit card. These rates will apply regardless of insurance type–including Medicare until there is clarity on the details of how this new law will be implemented.
On the day of our scheduled appointment, or perhaps the day before, I will send you a message via email or text message to your cell phone, which includes a link to the meeting. At the time of our scheduled meeting, you would simply click on the link as instructed in the message. You will be asked to permit Lifesize to utilize the microphone and camera on your device, which you should Allow. If I have already logged in to our meeting, you will see me immediately; if not, wait a minute or two and I will join.
Moving forward, unless either of us is affected by the illness and therefore unable to meet face-to-face, I will assume you will attend office appointments. If, on the other hand, it would be necessary or preferable not to meet face-to-face, all you would need to do is leave a voicemail message well prior to our appointment that you desire a videoconference session and your preferred route for me to deliver the meeting link to you.
As always, please contact me to discuss any questions or concerns you have about these or other issues.