FQHC Using Telehealth During COVID-19 Opposes Reinstating Barriers Post Crisis

Prior to COVID-19, regulatory and reimbursement challenges limited the use of telehealth. The COVID-19 crisis presented an opportunity for telehealth to demonstrate its value.  An FQHC in New Jersey, a COVID-19 hotspot, describes how telehealth allowed them to maintain patients’ access to care during the pandemic and advocates for keeping the telehealth-friendly regulations in place even after the crisis is over. 

In a recent interview, Lee Ruszczyk, Senior Director of Behavioral Health at Henry J. Austin Health Center (HJAHC), an FQHC in Trenton, New Jersey, shares how HJAHC responded to the COVID-19 pandemic by quickly converting from an in-office, clinic-based model of care delivery to an at-home virtual model in a matter of daysso that patients could continue to receive the care they need without having to physically come into the facility.  He explains how their organization was able to successfully pivot to telehealth, how patients have responded to the changes, and why it’s important that telehealth-friendly regulations remain even after the immediate threat of the coronavirus has passed. 

How have you used telehealth in order to maintain patients’ access to care during the COVID-19 crisis? 

To help reduce unnecessary exposure and contain the spread of the virus in our community, we closed 3 of our 4 locations and turned to telehealth as a solution to maintain patients’ access to care.  One of our sites remains open for necessary in-person visits or emergency medical or dental care.  All other services are noprovided virtually. 

It was an organization-wide, all-hands effort, but we were able to successfully switch to telehealth within one week. We quickly restructured existing workflows, designed new workflows, adopted new platforms for teleconferencing and telemedicine and shifted staff responsibilities to make this happen. We also had to convert our call center to a virtual operation so that inbound calls are automatically routed to the appropriate remote team member.  

We started using Doxy.me and Doximity Dialerto enable our patients and clinicians to connect virtually. Both Doxy.me and Doximity Dialer are free, secure and easy to use telemedicine solutions that allow patients to meet and communicate with their regular healthcare provider from the safety and comfort of home through their phone, tablet or any device that has internet access.  Both applications have been instrumental in allowing us to rapidly shift from clinic-based services to remote care during COVID-19. 

Fortunately, this was not our first foray into telehealth. About 2 years ago, we launched a telepsychiatry program in partnership with InSight + Regroup, to help address the growing need for mental health care in our community. This telepsychiatry program supplements the care provided by our onsite mental and behavioral health team and gives our adult patients access to a psychiatric nurse practitioner to help diagnose and treat anxiety, depression, addiction and other behavioral issues. Prior to COVID-19, patients receiving psychiatry services would come to the clinic at their scheduled appointment time to meet virtually with their telepsychiatry clinician.  However, in the wake of the coronavirus pandemic, we had to quickly shift these services from clinic-based to at-home care so patients can continue to get the behavioral health they need without having to come into the office. To help centralize scheduling and management of our medical and mental telehealth services, we moved our telepsychiatry clinician into Doxy.me as well. 

Since we are in an underserved area, not all our staff have access to internet services, or the technology and infrastructure needed to provide remote care and administrative services.  Therefore, we provided computers and Zoom phones for all staff members without access. 

There were a lot of moving pieces to juggle and a lot of new processes to put into place in a short period of time. However, we were able to make these changes with little to no interruption in patient care.  We are operating at 100% productivity even in this current environment. All our clinicians are still able to see their target number of patients per day, just virtually now instead of in-person. 

How have patients responded to telehealth? 

Patients have really embraced our new telehealth services. They appreciate the convenience and safety of being able to access care from home.  We’ve noticed that show rates are higher, and attendance is more stable with telehealth An HJAHC staff member reaches out to patients the day before a scheduled session to remind them of their upcoming appointment, educate them on telehealth, explain the process and what to expect  during a virtual visit and answer any questions. They also send patients a unique URL for their telehealth visit or a text invite with a link to join their virtual session. 

Patients without internet or technology that supports videoconferencing have the option to come into the clinic for services or receive care over the phone. 

How is your staff handling the COVID-19 crisis? How are they faring emotionally, physically and mentally?   

Our staff has certainly risen to the occasion during these challenging times.  Every member of our team has been extremely resilient and flexible in adapting to the operational changes that were quickly put into place in response to the COVID-19 crisis. Their commitment to the patients we serve has not wavered, even as they juggle unexpected changes and additional responsibilities in their own lives. 

It is worth noting that behavioral health clinicians may be experiencing many of the same mental health effects of COVID-19 as the patients they are treating.  That’s an unprecedented situation. For example, in the aftermath of September 11, behavioral health clinicians who were personally affected by the tragedy could excuse themselves if a patient’s story hit too close to home.  Similarly, our call center representatives are on the frontline answering calls from patients who are grieving the loss of a loved one due to COVID-19, while they, too, may have lost their own loved ones. This is unchartered territory for all of us. We’re unable to distance ourselves. We’re living it just as our patients are.    

People choose to work in an FQHC because they want to help vulnerable patientwho face significant health inequities.  From the security guard to the CEO, everyone here at HJAHC has the same purpose and  commitment to care.  That has become even more evident during all of this.  Our staff may be dealing with their own hardships and loss, but they show up, every day to continue to serve the underserved in our community. 

To what do you attribute your organization’s success in responding to COVID-19? 

The senior leadership at HJAHC has been extremely thoughtful, transparent, responsive, open-minded and inclusive.  All staff members have been invited to participate in the planning and execution of the operational changes that we put into place as a result of the pandemic.  It has been an all-hands, collaborative effort, not a siloed approach broken down by seniority, discipline (e.g., medical, dental, behavioral health) or job function (e.g., clinical versus administrative).   

We’re all in this together and we need each other to define new workflows, implement changes and continually refine our processes.  A problem or bottleneck in one area doesn’t just affect one person or department, it has a ripple effect.  To be effective and efficient, we recognized that we needed to brainstorm solutions and problem solve as a group.   

Early on, we met twice a day on Zoom to determine the most appropriate path forward and plan accordingly. Together we would create a daily to-do list, identify needs, assign responsibilities and discuss what was working and what needed to be improved. 

Now, we hold staff meetings three times a week to check in on each other and to collectively troubleshoot and resolve any problems that may have arisen since we last met.  We are constantly evaluating and refining our processes to make sure every patient has access to the care that they need when they need it.  It’s like we’re building the plane as we’re flying it. 

What do you think the future holds, post-COVID-19, in terms of healthcare delivery? 

Moving forward, I envision a hybrid model that includes at-home virtual care and in-person, clinic-based services. It will be driven by regulations, but my hope is that after COVID-19 the regulations would still allow the clinician to be at home and the patient to be at home rather than requiring one or both to be physically present onsite.   

Prior to COVID-19, telehealth was only a covered benefit for Medicare beneficiaries located in a rural or health professional shortage area and they had to travel to a local medical facility to receive services from a clinician in a remote location.  However, in response to COVID-19, CMS expanded access to telehealth services to waive the geographic and originating site requirements so Medicare beneficiaries could receive services in their own homes without having to travel to a health care facility. 

The pre-COVID-19 originating site requirement represents a significant barrier for our patientwho may lack transportation or cannot get to the clinic for care. With the currently relaxed telehealth regulations during COVID-19, these patients can now access the care that they need from home. 

What would it mean for your organization if the positive regulatory changes that were put in pace in response to COVID-19 were rolled back and we returned to the way things were prior to the pandemic? 

Given that we're considered an essential service, there was no other option for us. We either had to pivot to telehealth or close our doors. We are now seeing more patients each day through telehealth than we were previously able to see in-person at the clinic.  Telehealth has allowed us to serve more patients more efficiently.  

I don’t think you can put the genie back into the bottle now.  Our patients have enjoyed the flexibility of being able to access care at home. There are times when they cannot come to the clinic for a visit because they have a sick child or parent at homecannot take off from work or don’t have transportation; however, they still need care despite these logistical challenges.  There are also times when they may need care from a specialist who may not be immediately available.  For example, maybe there’s specialist in our community, but they aren’t accepting new patients or have extremely long wait times for an appointment. Or, maybe the closest specialist is in another city hundreds of miles away and our patients have limited ability to travel.  Telehealth is the ideal solution in both scenarios as it helps to expand access to care for underserved communities and populations. 

As an FQHC, our mission is to provide high-quality care to underserved populations, particularly those who are economically and medically vulnerable.  The relaxed telehealth regulations that were put into place in response to COVID-19 have allowed our patients to continue to have access to primary health care services.   

It would be unjust and unfair to take away the flexibility and access to care that telehealth affords once the pandemic is over.  At HJAHC, we serve an underserved and uninsured patient population. Our patients have enough to deal with.  They struggle with povertytransportation, food scarcity, and health disparities.  Can't we just give them a break? They have enough inequities and barriers to deal with, access to healthcare should not be one of them.

About Henry J. Austin Health Center 

Henry J. Austin Health Center is a private, non-profit, Federally Qualified Health Center (FQHC) in Trenton, New Jersey, that provides primary care, mental healthsubstance abuse treatment services and more to uninsured, underinsured and medically underserved individuals in the Greater Trenton community.  Established in 1969, their mission is to provide patient-centered, comprehensive, accessible, efficient, quality care to vulnerable patient populations with poor social determinants of health. HJAHC is the largest non-hospital based ambulatory care center in the city, serving approximately 13,000 individuals per year across their four locations. 

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