Doctors were seeing patients-who often used their cellphones-in their homes, in parked cars and in one case on skyscraper scaffolding, where a construction worker stepped away for a quick doctor’s visit, said Linda Branagan, director of telehealth at UCSF Health. Telemedicine calls for outpatient care within the San Francisco academic medical system spiked from 2% of visits in February 2020 to more than 60% by that April. UCSF Health, which had contracted with Zoom for virtual visits since 2016, gave every doctor and clinician a personal link for its video conference line and a separate virtual waiting room. West pointed to the CARES Act and the loosening of telehealth regulations, which allowed doctors to be reimbursed for telemedicine at the same rate as for in-office visits. “It was ‘all bets are off’ once the pandemic hit,” said Heidi West, who heads the health care division at Zoom. Even before the pandemic, the Silicon Valley company offered a service tailored for health care practitioners that complied with the Health Insurance Portability and Accountability Act, which protects patient privacy, and could be synced with Epic Systems electronic medical records. Its revenue jumped 326% in the fiscal year that ended on Jan. Zoom became an overnight poster child for staying connected as employees in every line of business across the country worked from home. “Individuals want screen sharing, they want grid views, so we’ve added new capabilities since the pandemic began and will continue to do so.” “The expectations are rising,” said Diana Stepner, a SimplePractice’s vice president. The company said it hosted 17 million telehealth appointments last year. A one-stop shop for private practice clinicians, SimplePractice offers scheduling, an electronic medical records system and insurance claims filing along with its video services. Practitioners have depended on telemedicine to keep their businesses afloat in the pandemic, and Joseph plans to keep a portion of her sessions virtual. Joseph was already paying SimplePractice to house her practice’s electronic health records, so moving to another platform would have been time-consuming and costly, she said. Providers often were locked in with telemedicine options from services they were already using-or what they could afford. “Can we not make telemedicine systems as easy as that?” “On an iPhone, I can click one button to see my grandkids,” Madathil said. They required patients to download a desktop application or made them click through multiple steps to log in. But beyond connectivity issues, some services seemed designed for dissatisfaction. PitchBook estimates that revenue from the global telehealth market will hit $312.3 billion in 2026, up from $65.5 billion in 2019. Video conferencing vendors, including Zoom, tech giants like Microsoft and Cisco, and a host of telemedicine startups absorbed an explosion of demand over the past pandemic months. But the video services were not equally prepared for the titanic influx in users, said Kapil Chalil Madathil, an engineering professor at Clemson University who has researched how easy-or difficult-telemedicine platforms are to use. Major health systems, clinics and private practices alike pivoted swiftly to telemedicine when the COVID-19 pandemic forced the nation to shelter in place and patients could no longer safely venture into health care settings. But even though Joseph keeps links to both her SimplePractice and VSee accounts in her email signature, a last-minute switch-up can feel messy for clients, and she never charges a no-show fee when it’s an “act of God.” “But with a private practice, if you don’t get paid, you don’t eat.” For some sessions, she was able to hop onto her backup, VSee, which costs her $49 each month. “What they offer is phenomenal, especially being founded by a therapist,” said Joseph, a licensed clinical professional counselor. Livid, Joseph requested a small credit from the telemedicine service, which costs $432 monthly for her team of clinicians and trainees. During one hours-long service outage of SimplePractice in late May, PsycYourMind, which offers mental health counseling and group sessions for Black patients, lost about $600 because of missed appointments.
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