Best Practices in the Management of IBD During COVID-19 - Episode 5
Miguel Regueiro, MD: It’s interesting. We’re about 50% right now in Cleveland for our GI [gastrointestinal] patients in telehealth. Clinics that are more in the community in the region probably have more in-person visits. People are more comfortable and want in-person visits, but at the tertiary centers, we’re about half and half. I think telehealth is here to stay. Another comment is about the payment for telehealth. So far, the insurance is paying for telehealth.
The telephone-only visits are a bit challenging because they’re being paid for but at a lower rate. That’s probably going to go away. Doug, you alluded to this medical home concept. I’ve been finding it interesting that our psychologists and our dietitians are popular on telehealth. Our patients are enjoying that. There were some stumbles in reimbursement, but even that’s worked out well.
Telepsychiatry and telepsychology fields have been doing this for about 10 years, and this is a time when I’m seeing our patients use this even more to build a healthy lifestyle, get exercise, have a good diet, and make sure they’re sleeping. They are still getting plugged in with the team and not deferring care.
Jean-Fred, when we talk about monitoring patients and this concept of remote monitoring or trying to keep people maybe at home or in an isolated environment, I know we don’t have formal remote monitoring, but how do you look at remote monitoring? What are you telling your patients?
Jean-Frederic Colombel, MD: I fully agree that telehealth is here to stay. At [the Icahn School of Medicine at Mount] Sinai, we are back to 80% live visits because the telehealth system is not perfect. There is no physical exam, especially in some patients with perianal disease. I think it’s OK. It will be fine for intermediate visits or this fine control that Doug was talking about, but it will never replace a face-to-face visit.
The first thing we should tell our patients when it is a face-to-face visit is about wearing a mask, social distancing, and this concept of shielding. They have a very interesting recommendation from the BSG [British Society of Gastroenterology] with different levels of shielding. If you have a patient with IBD [inflammatory bowel disease] who is more than 60 years old; has comorbidities such as obesity, cardiac problems, or diabetes; and on the top of that is on steroids—azathioprine and so on—you should take extra precaution about shielding.
Wearing a mask and social distancing is for everybody, and we must be even more careful for patients who are at risk for bad outcomes. This is key. This is the first message. What was your second question?
Miguel Regueiro, MD: It was aboutremote monitoring. Are you using more faecal calprotectin?
Jean-Frederic Colombel, MD: We are doing a lot of faecal calprotectin. I was talking with my French colleagues, and they are now doing a lot of at-home testing with the stool, which is nice, but we don’t have access to that, unfortunately. This is where our remote monitoring is fine. It’s much more advanced in Europe. There are recent studies from the Netherlands using telemedicine. I’m pretty sure about that.
There was an IBD tool that they were using, and they showed that it’s cost effective and it works. I completely agree with you that, for the psychologists and dietitians, this is what they have been doing for many years. This works well because they don’t need a physical, so it’s easier.
Douglas C. Wolf, MD: I am going to interject and say that that we lose something in our face-to-face visits now by having the face mask. It was a real plus with telehealth to be able to look somewhere in the eye and see the facial smile and the whole interaction. That’s a benefit of telehealth. As far as the remote monitoring, I’m using a lot more of the home stool-monitoring systems in which patients are shipped something. I won’t name the vendors, but they’re shipped a container, and it’s simple. They’re probably more successful at completing that calprotectin, C diff [Clostridium difficile], and other analysis than doing it at LabCorp or Quest. There are some maneuvers that we’re learning that are improving health care in 2020 as a result of this.
Jean-Frederic Colombel, MD: I agree, Doug. It’s true what you are saying, because patients are often in their home environment and are relaxed. They sometimes come with a partner, and they sometimes tell you things that they will not say in your office.
Miguel Regueiro, MD: That’s true.
Jean-Frederic Colombel, MD: I agree, Miguel. We sometimes access the exam room in the clinic, and we have this mask and these goggles. You look as if you’re from Mars, and then the patient is a bit scared in a way. It’s not a perfect visit.
Miguel Regueiro, MD: It’s more sterile and less personal. I had a patient saying that they’d rather do virtual visits than come in. They have to get screened on the way in. Everybody is wearing masks. The rooms are all being disinfected. When they’re at home, they’re with whomever they want. Telemedicine is here to stay. I’m a big believer. It’s an interesting world we’re living in.
Transcript Edited for Clarity