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April 16 AARP Coronavirus Tele-Town Hall

Experts share information about COVID-19 and how to protect yourself

April 16 Tele-Town Hall

Coronavirus: Telehealth

Experts at this week’s live Q&A event addressed questions and provided guidance related to telehealth. They covered the basics of electronic and virtual services and how to access them. Learn more about how Medicare and private insurances have adjusted and expanded their rules for testing, prescriptions and out-of-network care during the pandemic. Listen to a replay of the event below.

CORONAVIRUS  Tele-Town Hall April 16, 2020

Jean Setzfand:  Hello, I am AARP Senior Vice President Jean Setzfand, and I want to welcome you to this important discussion about the coronavirus. AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years.

In the face of the corona pandemic, AARP is providing information and resources to help older adults and those caring for their loved ones. Today we're talking with experts about telehealth options and discussing how Medicare and Medicaid and the private insurance have adjusted regulations to expand telehealth access during the global pandemic.

If you've attended one of our tele-town halls, you know that this is very similar to a radio talk show, and you'll have the opportunity to ask questions live. If you’d like to ask a question about the use of telemedicine during this global pandemic, please press star three on your telephone to be connected with an AARP staff member who will note your name, your question and place you in queue to ask that question live. 

Let me introduce our expert panel today. Today we have Andrew Gettinger, M.D., chief clinical officer from the Office of the National Coordinator of Health Information Technology for the U.S. Department of Health and Human Services. We’re also joined by Tricia Neuman, doctor of science, senior vice president at the Henry J. Kaiser Family Foundation. Lastly, we are joined by Dr. Joe Kvedar, M.D., and president-elect of the American Telemedicine Association.

AARP is convening this tele-town hall to ensure you have access to information about the coronavirus. While we see an important role for AARP in providing information and advocacy related to the coronavirus, you should be aware that the best source of information around health and medical information is right now coming from the Centers for Disease Control and Prevention, otherwise known as the CDC. You can access more information at cdc.gov/coronavirus.

Just so you know, this event is being recorded and you can access the recording at aarp.org/coronavirus, roughly about 24 hours after our event today. 

Today we're talking with experts about how to stay safe, healthy and connected during the global coronavirus pandemic. These are very trying times for many of us and we are here to help you. AARP is advocating tirelessly for our members and all people age 50 and older during the pandemic.

Let me share some of the efforts that are underway. [Technical difficulties] 

First, AARP has fought to ensure that Americans whose primary source of income is social security will also receive payments of up to $1,200 in the recent economic stimulus package. We've also pushed for expanding unemployment insurance benefits, as well as paid sick leave and family leave for people who are taking time off to care for themselves and for their loved ones.

While we've been hard at work in Washington, D.C., AARP representatives across the country are also fighting for you by working with state policymakers on a range of issues from virtual visitations to nursing home telehealth, paid leave and preventing evictions, foreclosures and utility disconnects. 

I just want to share a few of these with you. AARP has successfully advocated to expand telehealth services for the residents of Alaska, Idaho, Illinois, Indiana, Michigan, New York, Tennessee and West Virginia to help people get the health care they need during these times. AARP state offices are heavily involved in advocating for the safety of people in nursing homes and long-term care facilities and fighting to ensure that family members receive information and are able to stay in touch with their loved ones in these facilities.

All of these are important victories for older Americans and would not have been possible without the phone calls, the emails, actions from all of you on the phone, AARP members, volunteers, older adults across the country. We really want to thank you. Now let me get back to introducing our distinguished guests.

We are joined today by three really distinguished individuals. First, we have Dr. Andy Gettinger. After more than 30 years of clinical practice in both the OR and ICU, Dr. Andy Gettinger transitioned to health care policy. Presently, Dr. Gettinger is the chief clinical officer for the Office of the National Coordinator of Health Information Technology located within the U.S. Department of Health and Human Services. Dr. Gettinger has extensive experience in the field of health information technology and has led the development of electronic health records systems. He's a board-certified anesthesiologist and also critical care medicine. 

Secondly, we have Dr. Tricia Neuman. As senior vice president, Dr. Neuman oversees the Henry J. Kaiser Family Foundation’s policy analysis and research pertaining to Medicare and health care coverage and the care for aging Americans and people with disabilities. She's also executive director of the Kaiser Family Foundation’s program on Medicare policy. Her work focuses on health and economic security of older adults, prescription drug costs, payment and delivery system reform and policy options to strengthen Medicare for the future. 

Lastly, we have an internationally recognized leader, Dr. Joe Kvedar, in the field of connected health. Dr. Kvedar is vice president of connected health at Partners HealthCare and a professor at Harvard University Medical School. And he also cochairs the American Medical Association’s digital medicine payment advisory group. Starting next month he'll begin his tenure as a president for the American Telemedicine Association, an organization dedicated to accelerating the adoption of telehealth.

Again, thank you so much for joining us today to our distinguished guests. We're going to get started with our discussion and for the listeners, if you want to ask a question, please remember to press star three to be connected with one of our staff members. 

So, Dr. Gettinger, let me begin with you. For the past couple of weeks, the coronavirus has changed the way that we navigate our daily lives. The visit to the hospital, the doctor's office is now intimidating. And we're hearing and seeing more experts talk more about telehealth. Let's begin there. What exactly is telehealth? 

Andrew Gettinger:  Thanks Jean. And this was a perfect lead in — the technical difficulties are the kinds of things that doctors, other clinicians and patients face as they transition from the typical face-to-face office visit or hospital visit to what I'm going to define as telehealth, which is synchronous, meaning it happens with people simultaneously, non-face-to-face, meaning taking advantage of some technology to provide care. And there are a variety of ways that can happen anywhere from a regular telephone calls similar to what we're doing today, all the way up to full high-definition, high-resolution videoconferencing, which had historically been how a lot of telemedicine was accomplished. You know, telemedicine isn't anything new. We've had this huge transition in the past month, but it has been around for quite a while and I'm going to leave out a couple of things.

I'm not going to talk about tele-radiology, where radiologists are looking at and interpreting images remotely from hospitals from around the world. Actually, I'm not going to talk about tele-ICU. It's almost 20 years old, where critical care specialists have been able to extend their reach out into community hospitals that don't have board-certified critical care doctors. That's been a very successful form of telehealth. 

What I'm really going to talk about is the kind of telehealth that I think many of the listeners are interested in. We had a public hearing yesterday and heard from a number of the large systems how extensively things have changed. The CIO from the University of Michigan described just the incredible engagement by his clinicians. One of the things he did point out though is each clinical discipline has different capability to participate in telehealth. So a family practice doctor, an internist, their practice is much more amenable than some of the other practices. So ophthalmology is a good example of a practice that really depends on technology and measurement in the office, so it's much harder for the ophthalmologist. So telemedicine is not a single kind of thing. 

And I do want to share with the audience that the U.S. government, the Department of Health and Human Services, is releasing in the next day or two, a telemedicine.HHS.gov website with a lot of really good information both for patients and for clinicians who have not been doing this before, but find themselves transitioning into this new space.

Jean Setzfand:  That's terrific. Thank you for that. And thank you for being so gracious in saying that the technology failures were planned. They weren't. But sure enough, in the days that we're living in today the flexibility's definitely necessary. So I really appreciate that. And I think you alluded to this before, so let's talk a little bit about the changes. 

So, the Centers for Medicare & Medicaid Services, otherwise known as CMS, and private insurers have really relaxed the regulations and expanded coverage as a result of social distancing and staying at home. Talk a little bit about some of the most significant changes. You've alluded to this already in terms of the different types of care — are these changes only available to the care tied to the coronavirus at this point, or is it broader than that? 

Andrew Gettinger:  No, it's completely broader than that. All clinical care can be billed for telemedicine at this time and some of the requirements historically have, as you've mentioned, been relaxed, including relaxation of the ability to use the telephone as a means of conducting telemedicine. That's particularly important in rural areas where broadband is not readily available either for clinicians or for their patients. So that's an important element. 

The other element that's important is the Office of Civil Rights has allowed a relaxation of some of the HIPAA rules. Those are the privacy and security rules. So clinicians can use a variety of means, things like FaceTime, Zoom, regular ways of interacting with patients that they wouldn't normally use because of concerns about security and privacy.

I will point out that there are some challenges for clinicians to be able to do that. They need to understand how to document those encounters in the record, how to tie it in with their administrative systems like scheduling and, typically, clinicians depend on a team in the office, and when you're doing it from home, you are the entire team. So making sure that all of the content gets recorded and covered appropriately requires some adjustments in all parts. 

Jean Setzfand:  That's great. Thank you for that. So it’s important to note that it's not that you need computers or whatnot. The rules have relaxed it so that telephone connections are available. But it’s important for the physicians to note all the changes and challenges as well. OK, I want to double-check. We are having, unfortunately, some technical difficulties. And Dr. Neuman, are you on the line yet or not? All right. I don't think I hear Dr. Neuman on yet. We're going to try to get her back on so that we can have a chat with her about some of these changes. 

OK, we are going to shift quickly to chat with Dr. Kvedar. Dr. Kvedar, we talked a little bit about the different types of care. Dr. Gettinger just mentioned that, for example, internists may be a good route to take in terms of telemedicine, whereas ophthalmology may not. Can you tell us a little bit more about the appropriate terms of clinical care for telehealth? And when you think about it from the patient's perspective, are there things that we need to do differently in preparing for these appointments?

Joe Kvedar:  Yeah, thanks for asking. Very exciting to participate today and I completely agree with everything that Andy said. I guess I would punctuate a couple of things. Probably the best utilization is, these days anyways, in mental health. Even before the pandemic, mental health was taking off as a primary user. That's a wonderful thing because the need for mental health is so acute right now. Many mental health providers are very comfortable interacting with their patients over video link and have been doing so. 

On the other end of the spectrum, as was pointed out, anything that's procedural really can't be done this way. But then there's this middle ground of things like chronic illness management. If you have high blood pressure or type 2 diabetes or congestive heart failure, illnesses like that, that really are about checking in with the patient and making sure that they're following certain parameters of their health and if those parameters are stable, things like your daily weight, if you're a heart failure patient, or your blood pressure , if you're tight, maybe you're starting a new blood pressure medicine. With proper in-home tools like a blood pressure cuff or a weight scale, those conditions can be managed very well in this way. And again, thank goodness for that, because many of those people are at higher risk for contracting the virus. 

Virus screening, in many cases, we can do that via phone. It's a lot about asking questions and I think many are doing that. In our own delivery system we now have a software program where people can text or dial in and go through an algorithm with a computer to see if they need to be triaged to get a COVID test or not. And, of course, we have human backup, doctors and nurses, backing that up, but the first step is simply interacting with a piece of software. 

So the screening for the virus in many cases can be done this way. And then if people have contracted the virus, but if they're, say convalescing at home and have mild symptoms, a lot of that follow up can easily be done this way as well because it's about calling an individual and doing a series of questions.

The way I've framed it for my clinician colleagues who've been asking about this is to think about the times when you've interacted with a patient, when in order to get the information you need to make a clear decision, you didn't have to touch the patient. And I think that opens up people's thought processes. 

In terms of preparing for such a visit, I think a couple of things. Don't be afraid of the technology. These days if you're comfortable with FaceTime because you FaceTime with your family members, ask your doctor's office if they're willing to do FaceTime. Be proactive. Again, we can always revert to telephone for 90 percent of what we need to do.

And the real prep is gathering information about your health. Whether you realize it or not, when you visit a doctor in the office, your clinician is doing all kinds of observations about your health when they're talking to you, when they're looking at you, etc. And it will be easier for them to, again, collect that information and make a good decision about your care if you are prepared.

So if you're following your blood pressure, make sure you have your readings. If you're following your blood sugar, make sure you have your readings. Any symptoms that you're following, keep a diary. If you're doing something about food, keep a diary. It may sound like common sense, but when you go into the office, a lot of people expect the clinician to draw that information out of them, and it's just going to be easier in this kind of an environment of you are prepared with that ahead of time. 

Jean Setzfand:  Great. That's terrific. And I think to the point that you raised Dr. Kvedar and also Dr. Gettinger, there are pieces of information out there. I want to reinforce that. On hhs.gov there's new information available to those providers, as well as patients, on telemedicine. And also I want to direct your attention to resources that AARP has available to consumers at aarp.org/coronavirus. We have highlighted a special section around telehealth, telemedicine, in the middle of the aarp.org/coronavirus today. So I invite you to take a look at that information so that you can be prepared and know the beginning steps of just how to access this type of service.

Dr. Neuman, are you back on? No? Okay. We will continue to try and get Dr. Neuman back on. But we have lots of live calls. So now it's time to really address the calls that have already come in. I want to turn to those questions and see if we can have Dr. Gettinger and Dr. Kvedar address those.

So please press star three at any time on your telephone keypad to be connected with AARP staff to share your question. And it's my pleasure to be joined today with my colleague Jesse Salinas, AARP vice president of programs. Jesse's going to be organizing all of our live calls today. So welcome, Jesse.

Jesse Salinas:  Thanks Jean. I'm happy to be here for this important conversation. 

Jean Setzfand:  Wonderful. So who do we have online today? 

Jesse Salinas:  Jean our question today is from Patricia in Georgia. 

Jean Setzfand:  Wonderful. Welcome Patricia. What question do you have for us today? 

Patricia:  I'm concerned with all of the discussion about disparities and minorities. How will this teleconferencing really get to those communities? And are there any protocols that have been set up that specifically explain when we can use this new technology? When is it appropriate? Is it a supplement or is it replacing what one is expecting from the health care system?

Jean Setzfand:  Thank you, Patricia. Great question. Let me turn to Dr. Kvedar first. And I'll also have Dr. Gettinger comment on as well. Dr. Kvedar, what do you think about that question? 

Joe Kvedar:  Well, I'm so glad you called in and asked because we're very concerned about that. I think I would just underscore as a first response, and I appreciate this, no one response solves everything you asked, right? It's a very complicated matter. I would say the good news is it's on everyone's mind and we want very much to have an equitable response that includes as many participants in our health care system as we can. So the first response is that we now have, as was said, the access to the opportunity to take care of you by telephone. And that should help with any digital divide for the most part. Again, there's going to be some people that are always fall off, unfortunately, so that's I think the main answer I would have to that. And just to also say that if it's any solace to you, there's a lot of people that are very concerned about making sure that our response to this is equitable and that we don't make create a digital divide where one doesn't exist.

I don't know, Andrew, if you have other thoughts.

Jean Setzfand:  Dr. Gettinger, do you have any additional comments to add here? 

Andrew Gettinger:  Yeah, I think it is something that the federal government is very focused on. A lot of our support in that space goes through state Medicaid programs. There's also one other thing that was done as part of the congressional appropriations. They appropriated $200 million for the Federal Communications Commission to spend to foster telemedicine, including some of the devices that Dr. Kvedar mentioned before. And some of those are targeted for communities that don't necessarily have access on their own. 

Jean Setzfand:  That's great. Thank you for letting us know about the expansion. Let me just check in again. Dr. Neuman, have you been able to rejoin us? Not yet. Okay. All right. We'll continue to check. All right Jesse, who else is online? 

Jesse Salinas:  Our next question is from Sandy in Maryland. 

Jean Setzfand:  Thank you, Sandy. You can go ahead with your question.

Sandy:  Hi. I have a question. I'm really concerned about this next month. I had to cancel my appointment to have my eyes dilated. And as you know, there are some things you cannot do by teleconference, you know. But how do you weigh what's more important? Going to the doctor for a test like that or staying home and being safer from the virus because you take a risk going to the doctor. But which is more important, to not go to the doctor or go to the doctor? 

Jean Setzfand:  That’s right. Thank you so much, Sandy. I think that's a question that's weighing on all of our minds today. Dr. Kvedar, I'm going to start with you on that question again. How should we consider that? Dr. Kvedar?

Joe Kvedar:  That's something I deal with every day myself. I am having these barriers….

Jean Setzfand:  I think we're losing you again Dr. Kvedar. Can you hear us? OK, Dr. Gettinger, can you hear me?

Andrew Gettinger:  I can. 

Jean Setzfand:  Can you help us with Sandy's question? How do you weigh the options of actually going to see a doctor? Let me get you to opine on that question.

Andrew Gettinger:  It is a difficult question. What are the actual risks of going into the office versus the risks of not getting timely care? What I would suggest is that the best way to figure out what the best course for an individual is to be in touch with your physician or other care provider, express the concern you have and see how that trained professional helps you evaluate the right course of action for you.

Jean Setzfand:  Great, thank you for that. Is Dr. Kvedar back on? 

Joe Kvedar:  I think so. Can you hear me all right?

Jean Setzfand:  I can hear you. Perfect. Thank you. All right, I'm also going do another sound check for Dr. Neuman. Dr. Neuman, are you with us? 

Tricia Neuman:  I am here. Can you hear me? 

Jean Setzfand:  Oh, wonderful. We can hear you. Thank you. We are really putting our technology lines on a test today as we talk about telehealth. I actually want to turn to Dr. Neuman for a second right now. 

We talked a lot about the changes and the relaxation of the rules, particularly with Medicare. I'd like to turn to you to talk a little bit about that. What are some of these adjustments, particularly from a time standpoint? We understand that there's an end date to some of these adjustments. Can you tell us a little bit more about that? 

Tricia Neuman:  Well, I think we don't really know because this is really a transition during an emergency period. And so for the period of this emergency, Medicare has waived a number of rules to make it easier for people to be in communication with their health care providers via telehealth and various devices. My understanding is that once we are over the emergency period, then Medicare rules will revert back to the way they were prior to the current virus crisis. Now, that said, I do suspect there could be a fair amount of pressure to change the rules if it turns out that patients and their doctors recognize that there may be some benefits to having broader use of telehealth, particularly in certain circumstances for people who have difficulties getting to the doctor or when maybe the trip is more onerous than necessary, but that all emerges after the emergency period is over. At that point, it goes back to sort of business as usual for Medicare, which had a much more restrictive set of rules for how telehealth can be used.

Jean Setzfand:  That's really helpful. Thank you for that. And I know you've been studying this all along too, so you've been looking at sort of the possibilities, as well as the limits of telehealth, for the older adults. What have you seen? Can you give us some insights on that front? 

Tricia Neuman:  Yes. We've seen both a broadening of availability of devices and access to telehealth, at least through Medicare Advantage plans. And what we've also seen is that more and more older people are able to connect through the internet with devices in their own homes. That's a change. That's been gradually changing over the years, which at least puts many older people in a position to try telehealth services now that they are allowed.

We did a recent survey and found that nearly 7 in 10 adults 65 and older said they have a computer or smartphone or tablet at home. And so that's really good news in terms of being able to reach out and communicate with their health care providers. Yes, there are real differences by income. There are differences by race and ethnicity, and I did hear the conversation before and there is a real digital divide. But the overall numbers are ticking upward and that's, I think, promising for changing the way in which doctors and patients and others communicate. 

But what we don't know is whether older adults will feel comfortable using these devices and talking to health care providers. That will be a real change. We are seeing actually very few people with experience with telehealth. Across the board just about a little bit more than 10 percent of people of any age say they've talked to a medical provider in the past few weeks via video or some other kind of device. So I think people of all ages are trying to get used to the new world in which we are living and becoming comfortable, as are their doctors.

But it's not clear yet whether older adults will want to use these devices to talk with their doctors. We know that today they are much less likely to do video chatting with their friends and families than younger folks. So it's a bit too soon to tell. There's at least an infrastructure in place so that people may learn to use these devices, may develop a higher comfort level. But for now, not many people are doing that. So we'll just see over time. And as doctors and patients become more comfortable and more familiar with this form of communication, it may become more common and we may learn how best people communicate via video chatting and telephones, and if that works or not. So in some ways, this is a both an opportunity and an experiment. 

Jean Setzfand:  Right. Makes sense. Wonderful. All right, we're going to turn to the phone lines. I’ll invite Jesse back into the conversation. Jesse, who do we have on the line? 

Jesse Salinas:  Our next call is going to be from Facebook. This is from Judy, and she's asking if she goes to the doctor once a year for a wellness check, is it really safe to do at telehealth visit remotely?

Jean Setzfand:  Great. All right. Let me again begin with Dr. Kvedar. What do you think about that question from Facebook? 

Joe Kvedar:  Well, I think that's stretching it. So much happens in that once a year checkup. Usually, if you have a high-quality doctor, you're having a conversation about everything from your family members to your chronic illnesses, your health prevention, the things that are needed next, whether it's your colonoscopy or a Pap smear or what have you.

And then there's that physical exam in the office, and probably some lab tests get drawn. Again, I think it's a bit of a stretch to try to do all that via telehealth. It's probably possible in extreme circumstances to do most of it without some of the physical exam part, but it really isn't ideal.

I think more likely that, and I think before I got cut off before I was saying that, if you have something routine like that, it's probably OK to put it off a month or two rather than expose yourself to a health care environment right now. The telehealth should really be mostly for follow-ups, mostly for tracking things that you already have a care plan for, those kinds of things as opposed to a yearly checkup, I think. 

Jean Setzfand:  Great. That's really a clear guidance. Thank you for that, Dr. Kvedar. Again, as Dr. Neuman said before, there is an interesting environment for us to really get better accustomed to telehealth. So let's take some more questions to try to help people get greater guidance on us. Jesse, who else is online for us? 

Jesse Salinas:  Your next question is from Cheryl in Ohio. 

Jean Setzfand:  Great. Welcome, Cheryl, what's your question?

Cheryl:  This is Cheryl. I’m wondering, because I just used this virtual [method] , which was wonderful for a dermatology problem, which I've had removed because it was squamous cell … is this going to be covered by Medicare, by our insurances, since it is something that's up and coming? And rather than have to drive, which I would have had to a distance, where are we going with this as far as the coverage? 

Jean Setzfand:  Thanks for that question, Cheryl. Dr. Neuman, let me turn to you first. What are your thoughts on that?

Tricia Neuman:  Well, I hate to say it, but it depends. At the moment this is a covered service, but it's not clear what will happen in the future. And it depends on where you get your coverage. If you’re covered by a Medicare advantage plan, which is a Medicare HMO or PPO, these plans have the flexibility to cover telehealth services, so it would be covered if you happen to be in one of those plans. If you're in traditional Medicare, and at the moment the majority of people covered by Medicare are in the traditional Medicare program, then it may not be covered, particularly if you don't live in a rural area, which is the part of the country where Medicare does allow for this coverage. And that's why I've been saying I think that after this period of time there may be more pressure to make changes to Medicare. If patients and physicians are comfortable with telehealth, at least in certain circumstances, there may be more pressure to make this a covered benefit, much as it is for Medicare Advantage plans.

Jean Setzfand:  That makes a lot of sense. Is there any guidance, Dr. Neuman, for Cheryl? Is there a number that she can call to check in to see if that's covered or not? 

Tricia Neuman:  I think, again, it would depend on the plan that you're in. If you're in traditional Medicare, you can always call 1-800-MEDICARE to confirm, or you can ask your doctor because I'm sure your doctor has access to that information. If you happen to be among the people enrolled in a Medicare Advantage plan, then you would want to call that plan to find out what they do and do not cover. 

Jean Setzfand:  Great. Thank you for that. All right, let's turn to another call online. 

Jesse Salinas:  Our next question is going to be from Gilda in Oregon. 

Jean Setzfand:  Gilda, welcome. What's your question? 

Gilda:  Hello. I have an iPad Air 2. My question is, what devices are better appropriated for a virtual or a screen time with my primary care provider?

Jean Setzfand:  Great. Thank you for that. So a question around devices. Let me begin with Dr. Gettinger. What's your advice on that? Computer, iPad or smartphone? 

Andrew Gettinger:  I think it really depends on how you're communicating with your doctor. If you are using your computer or your iPad just for a voice call, it doesn't matter. If you are using it for video resolution and a face-to-face telemedicine call, then it's whatever device has the best resolution.

Some of the newer iPads have incredible resolution. Some of the other devices have incredible resolution. I think I just saw last week a comment that some of the smartphones don't have as good a resolution. So it's really about the resolution of the device more than the actual device.

By the way, it's not just looking at you. It's also the ability to see something that most clinicians don't get to see routinely … the environment in which you live. And that can tell a lot about you as well. 

Jean Setzfand:  That's really great guidance. Thank you so much, Dr. Gettinger. All right, Jesse, who else do we have online there?

Jesse Salinas:  Our next questioner is Mary from Massachusetts. 

Jean Setzfand:  Welcome, Mary, what's your question?

Mary:  Hi. Yes, I think that it's wonderful that we've been using telemedicine for all those uses that the doctor described previously. But what about for older adults who do need to have tests for procedures during this emergency time? Do you have any advice about if it’s safe for them to visit their doctor's offices or go to have blood drawn? 

Jean Setzfand:  Great question, Mary. Thank you for that. Dr. Kvedar, what do you think about that? I think we heard that before, but I think some more guidance from you would be helpful.

Joe Kvedar:  Well, I would say follow your doctor's advice. Those of us that provide care are all acutely aware of the risk-reward ratio of deciding to ask someone to come into a facility. But if you need a blood test, if you need a X-ray, if you need to be examined in person, we're going to take every precaution. Every facility that I know of around where I live, there's someone to greet you at the door, they ask you your screening questions, they make you use Purell, they make you wash your hands, they give you a mask. Then when you're in a waiting area, you're always six feet from anyone else in the waiting area.

So I think we do our best. We wipe rooms down, we clean them with Clorox, we do all kinds of things now to minimize your risk. The most minimal risk is staying at home. But if someone who's taking care of you says, “We think you should have X, Y, Z test or X, Y, Z exam,” I would follow their advice. 

Jean Setzfand:  Great. Thank you for that guidance. All right, Jesse, who else do we have online today? 

Jesse Salinas:  Our next question is from Virginia in Georgia.

Jean Setzfand:  Welcome Virginia. What’s your question?

Virginia:  Hi. My question is kind of a two-part question — how would you address the challenges of reimbursement and coverage for telehealth services from a provider side? And then the second part of the question is how to bridge the telehealth gap between insurance companies and medical centers for quality, telehealth services, locations?

Jean Setzfand:  Great. Thank you for that question, Dr. Neuman, how would you address that question for Virginia? 

Tricia Neuman:  Well, I think I want to hear the second question again, but on the first question, providers are being paid by Medicare as they would be paid for a visit during this period of time. So this allows providers to continue to charge for a visit and get paid for a visit even if it is happening electronically.

Your second question, I would love for someone to repeat that. 

Jean Setzfand:  Sure. I think Virginia was also asking about the two sides of the coin. The patient and provider also have in this time a need to understand the reimbursement process. So any guidance around getting to close that gap, as well.

Tricia Neuman:  Well, that's a great question. I think we've been talking a lot about the learning curve for patients. But honestly, I think there's also a huge learning curve that has taken place with providers. Some providers are far more comfortable and familiar with the processes of telehealth than others. And that is primarily around patient care, but also around billing. And I think for that, providers really need to work with the payers that reimburse them for their services normally. So whether it's Medicare, then it should be Medicare, if it's private insurers then private insurers. Because in a system like ours with multiple payers, the rules pertaining to payment and the amount of payments vary from payer to payer, and that would include Medicaid, as well. 

Jean Setzfand:  Wonderful. Thank you for that. All right, let's turn to another call. Jesse, who else do we have online? 

Jesse Salinas:  Let's bring on Diane from Florida.

Jean Setzfand:  Welcome Diane. What is your question?

Diane:  OK. I'm wondering about dental. How do you facilitate, or is it possible to do a dental visit through telehealth? You know, I'm thinking I’ve got a little bit of pain and I'm thinking it may be the start of an abscess. How do I deal with that or with dental in general?

Jean Setzfand:  Great. Thank you for that question, Diane. Dr. Kvedar I can turn to you for that question? 

Joe Kvedar:  You can although my knowledge is probably not perfect. I know that there are a number of tele-dentistry organizations, companies. I believe most of their efforts are around more chronic follow-up, as we talked about before. Something that's acute like that, where there's tooth pain and a possible abscess, I think has to be seen in person. I know around where I live, most of the dentist offices are taking calls for emergencies and handling them, so that would be my advice on that. 

Jean Setzfand:  Great. Thank you so much for that. I want to highlight a resource that AARP has available. Sometimes it’s really nice to have a friendly voice help you through these challenging times. AARP’s Community Connection is a toll-free service for all adults 18 and We have trained volunteers standing by to provide a friendly call just to help, maybe connect with a person to have an informal conversation during these trying times.

If you'd like to speak to someone Monday through Friday from 9:00 to 5:00 p.m. Eastern time, feel free to call this number, [888] 281-0145, and leave us your information. A volunteer will be getting back to you. And you can even set up a recurring call like every Wednesday at 2:00 for a check-in.

Again, it's a free service, AARP Community Connections for all adults, regardless of your membership, and we do also have bilingual capabilities, including Spanish. And if you stay online to the end of this call, we'll also be providing an option for you to connect directly to AARP Community Connections.

All right, let's hear some more from our experts. Dr. Neuman, we talked a little bit about this before. In what ways have the regulations been relaxed and coverage expanded for Medicare? And how do, particularly, private insurers align with these coverage changes?

Tricia Neuman:  Well, prior to the coronavirus pandemic, Medicare really had a pretty restrictive definition for what it would cover. Generally it restricted full telehealth coverage to people living in rural areas and then only if individuals had a long-standing relationship with their provider and with certain devices.

So this is very much of a new world for Medicare and for Medicare beneficiaries. Medicare Advantage, the private plans, have had more flexibility. So over this period of time, Medicare Advantage plans, most of them, actually do offer some telehealth services and it will be interesting to see how much they have expanded the services that they cover and whether they continue to do that after the emergency. 

Medicare has also allowed more providers to do telehealth services. And this may have come up when I wasn't on the call, but I'm thinking of federally qualified health centers, rural health clinics that can provide these services directly. There's more opportunity for home health agencies and hospice providers. The whole idea is to protect patients and protect providers and to allow people to stay at home, to shelter in place, to minimize their risk of getting infected, helping both patients and the caregivers who take care of them. The changes in the rules that have been made for the emergency period could have profound implications in the future for how coverage is treated. But in the meantime, it's really helpful for people because now people have the opportunity, they can call their doctor, they can talk about a problem, they can use just a plain old telephone and make life much easier during this period of time when they're just staying home.

And I think it's also an opportunity for people to reach out to others who may be less comfortable with technology and to help neighbors and family members become more comfortable so that they, too, can use the various devices that are available to them. And ask for help. If you have the technology but you don't know how to use it, this is a great time to try to learn so there are ways to reach out to more people, medical providers and family members and friends. 

Medicare also, by the way, has made a few other really important changes beyond telehealth. For example, Medicare, like private insurers, has waived cost sharing for testing, which is a significant financial help to people who need to be tested.

It also has required part D plans to provide a 90-day supply of medications, which allows people to stay at home for a longer period of time rather than go to the pharmacy. And that too is enormously helpful for people, particularly if they're at greater risk of infection. And it’s said that if a future vaccine comes to market, it will be covered with no cost sharing. So for people who may be concerned about what will be the cost of a vaccine if it comes along, that should not be an issue. 

Jean Setzfand:  Great. Thank you for that. Thank you for highlighting those changes and also reminding us this is a way that if you don't know how to get connected through telehealth, telemedicine services, maybe reach out to others to ask for some help as well. Again, let me remind folks that you can go to aarp.org/coronavirus and there is a special section around telehealth, the one, two, three beginning steps of how to get connected. 

Thank you for that, Dr. Neuman. Dr. Kvedar, obviously with the trying times, I think more and more folks are experiencing new or heightened anxiety or depression and other psychological issues. You mentioned this before, but how can telehealth help folks in these circumstances? 

Joe Kvedar:  Well, it's a wonderful solution. In some ways we tend to think that it may be better than a face-to-face interaction simply because as an individual has anxiety or depression, it's a big challenge to leave your house and travel to a facility to see someone. So we can see you right now in your own home. And I think it was one of my colleagues mentioned earlier that we get to see what's around you in the home and that's very important for us in terms of understanding your environment and how that impacts your mental health. 

Before the pandemic, approximately 48 percent of mental health professionals had used some sort of telehealth in their practice. So most of them are well equipped. Another thing to just mention is that the physical exam in a mental health visit is talking to the patient, so it's ideal from that perspective as well. 

There is one caveat I have to mention, which is that even before this public health emergency there was a backlog of need for mental health services, and now it's even more acute. So there's not enough mental health practitioners to go around, unfortunately. But the technology allows us to connect with people very well and is a great solution for that problem. 

Jean Setzfand:  Great. Thank you for that reminder and also sharing your thoughts on telehealth and mental health support.

Before we turn back to your live questions, I do want to provide a quick AARP Fraud Watch Network coronavirus alert. Scammers, unfortunately, are still trying to get your money and personal information by pitching fake cures and even constructing fake testing centers in some communities.

They are offering bogus investments, impersonating medical professionals to collect payments, posing as global health authorities, conducting phishing campaigns designed to trick recipients with malware or ransomware. This week, coronavirus stimulus payments are beginning to hit bank accounts, and the scammers are trying to get a piece of that action, unfortunately.

Scammers are calling, emailing or texting saying that they need money or bank account information to deposit or speed up your stimulus check payments. It's important to know that the federal government will not be calling to ask for information before processing any of the stimulus payments.

For official information on economic impact payments, please visit the corona tax relief page at irs.gov. If you suspect a scam, please visit aarp.org/fraudwatchnetwork. You can search scams in your area or actually report a scam. Take action and fight against scammers, or you can call our help line. The fraud watch network helpline is at [877] 908-3360. We have volunteers on staff to answer your calls at [877] 908-3360, the fraud watch network helpline. 

All right, let's take more of your questions, and we'll get Dr. Kvedar, Dr. Neuman, and Dr. Gettinger to respond to them. Jesse, who else do we have online? 

Jesse Salinas:  We're going to bring on Ken from Michigan. 

Jean Setzfand:  Hello Ken.

Ken:  Hi. How are you? So my question is are there any potential medical malpractice issues specifically related to providers of telehealth? 

Jean Setzfand:  Thank you for your question, Ken. Let me begin with Dr. Gettinger, what do you think about that?

Andrew Gettinger:  I think it's a great question to ask. I think many physicians and other clinicians have asked similar questions. I think if you provide effective care, you do all the things via a telemedicine visit that you do in the office absent the obvious physical exam, it's unlikely that the fact that it's a telemedicine visit would increase your risk in the liability space. I say that with the caveat that I am not an attorney and not necessarily an expert. But certainly in 30 years of practice, I didn't practice being worried about those things. I just wanted to take good care of my patients, and that's what telemedicine allows us to do during these very difficult times. 

Jean Setzfand:  Thank you so much for that, Dr. Gettinger. Jesse, who else do we have online today? 

Jesse Salinas:  Yeah, we're going to bring on Queenie from New York.

Jean Setzfand:  Hello? 

Queenie:  Hello. Hi. I am a high-risk patient, and I'm very concerned about the experience that I had at the hospital when I went because I'm an asthmatic and my doctor advised me to go to the hospital. On my first visit there I was given a chest X -ray and a flu shot … and they sent me home with some asthma medication and told me to stay in for 14 days.

Fourteen days afterwards, I called my primary doctor and I was still feeling not well, so he told me he wanted me to return. I returned to the same hospital, and when I got there they took a CAT scan, did another X-ray, did the virus test and told me that I had an infection of the chest. The doctor said that she was, you know, concentrating on having me admitted. But she said there was no room at the hospital that I was at, so she was going to have me admitted to one of their sister hospitals. And so I asked her, was it a designated virus hospital? She said yes. So I informed her that I had been tested and I had a negative test. 

And I asked her, would I be in a private room? She said no, that I would be sharing a room with someone else who has the virus. And I was just very, very concerned because if I don't have the virus, then why am I going to be sharing a room with patients that do have the virus?

Jean Setzfand:  Thank you, Queenie. Thank you for that. Dr. Kvedar, in the circumstance like this, would telemedicine be helpful in any way given the circumstances that we just heard from Queenie. 

Joe Kvedar:  No, sadly, I don't think so. I think the need for the testing that she described, the fact that she has asthma, I think, from what I'm understanding, that the doctors are very, very, very concerned about making sure she was well taken care of.

The last part is hard to know without having been there. I don't think anyone would knowingly put you in the same room with someone who had coronavirus. I think that's unlikely. I know hospitals are stretched right now for capacity, but people are getting sick with things other than the virus, and an asthma attack or a chest infection made worse by asthma is a serious thing.

But again, I don't think telemedicine is going to play a role in sorting that out, unfortunately. 

Jean Setzfand:  Well, thank you for that guidance, Dr. Kvedar. All right Jesse, who else do we have online? 

Jesse Salinas:  Our next question is from Facebook. We have Monica and she's been asking weather copays and deductibles are waived for telehealth and specifically around chronic care management and things like that.

Jean Setzfand:  Great. Thank you for that. Dr. Neuman, what do you think about that question? 

Tricia Neuman:  Well, I think it's going to vary across different insurers. So I don't think there is a single answer to that question as far as I know. So yes, it's covered, but cost sharing is not routinely waived. Cost sharing is waived, as I think I mentioned before, if it's a physician’s visit associated with a test, but not consistently so. 

Jean Setzfand:  So probably some legwork and some extra research is needed to figure that out. Great. Thank you so much for that. Jesse, who else do we have up next for our calls? 

Jesse Salinas:  Let's bring online Jean from Massachusetts. 

Jean:  Hello, everyone. This is Jean from Massachusetts. I run a council on aging and, while we are not physically open, we're making a tremendous number of care calls out to our patrons. 

And we are dealing with a high degree of social isolation, and we know who these folks are and we can talk to them at length. However, because we are a community-based services organization and not a clinical organization, we can't really intervene to let their physician know what we're finding out. So my question is, are physicians who have profiles of patients that are seniors that are prone to mental health issues, are you proactively calling and reaching out through telehealth to these patients? And if so, is this covered? And what are the various physicians doing regarding the fact that, you know, on a typical day I had 150 to 160 seniors coming through for a range of activity, one being connectivity to other human beings. And now they cannot, but we are making care calls out to them.

So what is the health care system doing proactively through things like telehealth to connect with these older adults?

Jean Setzfand:  Great. Thank you for that question. Dr. Gettinger, I think I'm going to start with you. Do you have any thoughts on that? 

Andrew Gettinger:  Well it's, again, a great question. I don't have any particular insight into what community clinicians are doing.

What I did hear yesterday, which was a bit surprising but really happy news, was from the secretary of the VA who described, that in these circumstances, again an older population with a lot of medical needs, that in this window of time, that population was actually doing much better than expected.

In a variety of ways, not the least of which, they've seen a dramatic reduction in veterans who've hurt themselves. He attributed that to the increased communication that was going on via telemedicine-type encounters. Again, that's the VA population. I'll let others comment more generally on the community.

Jean Setzfand:  Dr. Kvedar or Dr. Neuman, do you have any thoughts on the last question? 

Joe Kvedar:  I would just say our clinicians are pretty stretched right now. So it may not be happening to the degree that we would like, and I completely would just endorse the knowing the impact that social isolation has, and it's a significant one.

But that said, I think, as I said earlier, our mental health professionals are sort of dealing with as much incoming and, sadly, may not have the capacity to do a lot of proactive outbound outreach. 

Jean Setzfand:  And Dr. Neuman. 

Tricia Neuman:  The only thing I'd add is I'm hearing, and this is really word of mouth, this varies by medical profession and practice. Some physicians and mental health providers specifically are reaching out to offer their patients the opportunity to get treated, which is not to say that there aren't capacity issues. Of course there are. But I am hearing of some outreach from providers, and I'm just wondering if the caller might want to think about encouraging the clients that you see who are dealing with depression or other concerns related to social isolation, to reach out directly to their physicians or other providers in order to get help. Either to maintain some kind of connection in an ongoing way with a mental health provider or to find someone else who might be able to provide support during this period.

Jean Setzfand:  Great. Thank you for that. All right, Jesse, who else do we have on the line? 

Jesse Salinas:  We've got Tony from Washington on the line.

Toni:  Yes. I would like to know in terms of the security and privacy of utilizing Zoom and telehealth. My provider is about 16 miles from where I live in Port Angeles. I take paratransit, ADA transportation, to get there and I only have that transportation. I would like to know about this because I understand the provider and the provider’s clinic only uses Zoom for telehealth if I ever needed to see or talk to my doctor. What do I do? How do I approach this?

Jean Setzfand:  Thank you for that question. Dr. Kvedar and Dr. Gettinger, I know you both talked about this. Let me begin with Dr. Kvedar. What are your thoughts around the various forms of video connections, for example with Zoom and everything that we're hearing about privacy concerns there?

Joe Kvedar:  Thanks. Thank you. It's a wonderful question. I think the news is good. There have been news stories about people breaking into Zoom meetings. And as far as I know all of the ones that I'm aware of were times when people posted a Zoom link on some kind of a public forum, such as Facebook or Twitter. Again, most of the ones I heard about were Alcoholics Anonymous meetings or Narcotics Anonymous meetings. Although I think those were very sad stories because of the meanness and nefarious intent of the person who dialed in, I wouldn't call it hacking because the link was out there in public. 

I think if your doctor wants to use Zoom, make sure that they share that Zoom link with you in a very private way, maybe over a patient portal, something like that. And I think the likelihood that you'll have your privacy interfered with is extremely low. The other thing I would say is that the real important part of the privacy conversation is how your visit is documented in the electronic record. And again, that's not changed. We have as private as possible systems for our electronic records. So I would just close by saying, I think the chance of having your privacy invaded in a telehealth interaction is extremely low, and I wouldn't let that get in your way of having a conversation with your doctor in this way.

Jean Setzfand:  Right. Thank you for that. Dr. Gettinger, anything to add to that?

Andrew Gettinger:  No, I completely agree. The only thing I would add is the FBI has put out some guidance for Zoom gatherings generally. And some of that guidance involves always using a password, in addition to making sure that the link is private. Then there are actually, and I'm not sure which version your physician uses, but there's the free version, which has been a little bit more susceptible. The professional version or the version that you pay for has more security options available within it. 

Jean Setzfand:  Great. Thank you for that guidance. So I think we have a few more calls online. Jesse, who else do we have online? 

Jesse Salinas:  Our next question is going to come from Reed in Wisconsin.

Reed:  Hi, this is Reed. I have concerns about the digital divide. I know here in Wisconsin, the governor this year had gotten funding for access to broadband for more of the state. And what the intent there is, is that a lot of this sophisticated telehealth takes place with the bandwidth that would be very useful to diagnosticians. You pretty much have to have broadband for some of those things. It seems to me that it tends to be a geographic divide where the rural areas, the companies that provide it don't seem to have the economic wherewithal or impetus to provide it. I just wondered what the thoughts are there?

Jean Setzfand:  Great. Thank you for that question. Dr. Gettinger, I'm going to start with you. 

Andrew Gettinger:  Yeah, I think that's a real issue and I can assure you that a number of us in the government are talking about it. At least historically just to go back many years when the only way we communicated in rural areas was with landlines. Folks who were providing clinical care or available on call would get priority. The FCC, when it was regulating in a different way, ensured that telecommunication providers did that for clinicians. I'm imagining a future state where telecommunications for clinical purposes would be equally supported, and we completely recognize that that's not the case now. 

And the bad news is as so much of digital connectivity moves to 5G, and fiber and copper lines are not how things get to people, especially in urban areas, in rural areas 5G just doesn't have the distance penetration that will be necessary. So I think this is not going to go away as an issue. I'm in rural New Hampshire currently, and I've seen local communities recognize that their vitality and future depends on doing broadband so that broadband is becoming a service that’s not just telecommunication companies, but is a service by the local community as well. 

Jean Setzfand:  Great. Thank you for that. Dr. Kvedar, do you have any thoughts to add to that from the Telemedicine Association perspective? 

Joe Kvedar:  Well, we advocate for more broadband for more people. It's a real issue. I'll go back to saying that all is not lost given that during the public health emergency we can use telephone, and I mentioned that earlier. But it doesn't take away from my enthusiasm for having more broadband for more citizens, especially in rural areas. I completely agree. It needs to be done. 

Jean Setzfand:  Great. Thank you. All right, I think we have time for just one last question. Jesse, who's our last question?

Joe Kvedar:  The next question comes from Facebook. It's Jim from Colorado, and Jim is asking whether there's any relief for Medicare premium payments during this pandemic? They say they pay a lot for insurance and they really could use some help right now. 

Jean Setzfand:  Great question. Dr. Neuman, can you help us with that question?

Tricia Neuman:  Well, that is a great question. I have heard discussion about providing relief on cost sharing, particularly for COVID-related treatments. I have not heard anything about providing relief to people with premiums. I mean it is a serious concern that many people on Medicare, not exclusively Medicare, but many people on Medicare struggle with health expenses. I think what this situation is bringing to light is that it's premiums, it's cost sharing. It's the whole package together that could consume a fairly large share of people's retirement income. I'm just sorry to say I haven't heard any discussion about premium relief. 

Jean Setzfand:  Thank you for highlighting that for us. We are running out of time, so let me ask our esteemed panelists to give us some closing thoughts. Beginning with Dr. Gettinger, moving to Dr. Kvedar and Dr. Neuman, any thoughts that you have for our members, our listeners today? What are some last thoughts you'd like to leave us with? Dr. Gettinger, do you want to kick us off? 

Andrew Gettinger:  Absolutely. You know, just as we experienced on the call today, a little bit of bumpiness here, a little bit of bumpiness there. Stepping away, I would say the call was very successful. I would say, being tolerant, being patient, telemedicine for many clinicians and for many patients is a new mode of care, and I believe it's one that is here to stay. But it's going to take us a little while to work out all the kinks, figure out what best practices are for individual clinicians, as well as for patients. So I continue to be very optimistic and enthusiastic. Thanks for asking. 

Jean Setzfand:  Thank you, Dr. Kvedar.

Joe Kvedar:  Well, actually my colleague’s enthusiasm and thanking you for inviting me to this. What I've been reminding folks like your listeners, so this is the plea, if you have a good experience, tell your congressman or senator that you don't want to go back to having only one channel if health care delivery, which is having to go into the office.

As we said, not everything is going to be ideal for telehealth. But I would say the flip side is if we can't emerge from this crisis with more than one channel for health care delivery, then it's a sad day for our country that we have to go back to what is really 20th century style of delivering a service. You have to come see me in a physical location, and that's the only way to get something done. So speak up, talk to your politicians. Make sure they know that you don't want to go back. 

Jean Setzfand:  Thank you so much. And Dr. Neuman. 

Tricia Neuman:  Yeah, I agree it's going to be very hard to put the genie back in the bottle. And I also agree that patients and doctors are at a steep learning curve right now. This is a time when people are working out the kinks, who want to use this time to learn how well telehealth works, when it works, when it doesn't work and how to make it work better. This is an opportunity to use a new technology or an old technology in a new way to help us all stay safer.

It's an opportunity for people who are not so familiar with this type of technology or communicating in this way with their doctors to become more comfortable with it, if they choose to, and help us all figure out when this is the right line of communication and how to make it work in the best possible way to improve our safety and to improve the communication that we have with each other. 

So I think this is a great opportunity. And I think it's highly unlikely that we'll go back to business as usual without so much reliance on telehealth. But how we use it, when we use it, is still an open question.

Jean Setzfand:  Great. Thank you for that. Again, thank you so much for your patience with us today. I think we were modeling the beginning of the future of telehealth with our technical difficulties. But thank you so much for your optimism. Thank you so much for your practical guidance. I think we hopefully have allayed some questions and concerns from our listeners today, and it's been such an informative discussion.

I want to thank each of you for joining our call. And I want to thank all of our listeners, our AARP members, volunteers, for participating in this discussion. Again, let me just tell you that we do have the ability to provide you a friendly voice through our AARP Community Connections. We have trained volunteers standing by, as I said before. This is a free service for all adults regardless of your membership, and we do offer some bilingual capabilities, including Spanish. To be connected right now to AARP Community Connections, you can just press star zero on your telephone keypad and your call will be rerouted to the service. 

AARP is a nonprofit, non-partisan membership organization and we've been working hard to promote the health and well-being of older Americans for more than 60 years. In the face of this crisis, we're providing information and resources to help older adults and those caring for them to protect themselves from the virus, prevent it's spread to others while taking care of yourself. All the resources referenced, including a recording of today's Q&A event, can be found aarp.org/coronavirus by April 17th. Please visit that website if your question was not answered. You'll find the latest updates, as well as information created specifically for older adults and family caregivers. 

We hope you’ve learned something that can help keep you and your loved ones healthy. Be sure to tune in next week for our next AARP tele-town hall. We are in fact offering two Q&A events next Thursday, April 23. The first will be at the same time, 1:00 p.m. Eastern time, where we're going to be focused on caring for your loved ones and facilities such as nursing homes and long-term care facilities. And we'll also be offering a separate topic for a conversation at 7:00 p.m. Eastern time focused on the unfortunate disparate impact of coronavirus. 

But I want to thank you again for joining us today. Have a good day.

And this concludes our call.

 

 

CORONAVIRUS  Tele-Town Hall April 16, 2020

Jean Setzfand:  Hello, I am AARP Senior Vice President Jean Setzfand, and I want to welcome you to this important discussion about the coronavirus. AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years.

[00:00:18] In the face of the corona pandemic, AARP is providing information and resources to help older adults and those caring for their loved ones. Today we're talking with experts about telehealth options and discussing how Medicare and Medicaid and the private insurance have adjusted regulations to expand telehealth access during the global pandemic.

[00:00:39] If you've attended one of our tele-town halls, you know that this is very similar to a radio talk show, and you'll have the opportunity to ask questions live. If you’d like to ask a question about the use of telemedicine during this global pandemic, please press star three on your telephone to be connected with an AARP staff member who will note your name, your question and place you in queue to ask that question live. 

[00:01:23] Let me introduce our expert panel today. Today we have Andrew Gettinger, M.D., chief clinical officer from the Office of the National Coordinator of Health Information Technology for the U.S. Department of Health and Human Services. We’re also joined by Tricia Neuman, doctor of science, senior vice president at the Henry J. Kaiser Family Foundation. Lastly, we are joined by Dr. Joe Kvedar, M.D., and president-elect of the American Telemedicine Association.

[00:01:52] AARP is convening this tele-town hall to ensure you have access to information about the coronavirus. While we see an important role for AARP in providing information and advocacy related to the coronavirus, you should be aware that the best source of information around health and medical information is right now coming from the Centers for Disease Control and Prevention, otherwise known as the CDC. You can access more information at cdc.gov/coronavirus.

[00:02:21] Just so you know, this event is being recorded and you can access the recording at aarp.org/coronavirus, roughly about 24 hours after our event today. 

[00:02:33] Today we're talking with experts about how to stay safe, healthy and connected during the global coronavirus pandemic. These are very trying times for many of us and we are here to help you. AARP is advocating tirelessly for our members and all people age 50 and older during the pandemic.

[00:02:54] Let me share some of the efforts that are underway. [Technical difficulties] 

[00:02:57] First, AARP has fought to ensure that Americans whose primary source of income is social security will also receive payments of up to $1,200 in the recent economic stimulus package. We've also pushed for expanding unemployment insurance benefits, as well as paid sick leave and family leave for people who are taking time off to care for themselves and for their loved ones.

[00:03:24] While we've been hard at work in Washington, D.C., AARP representatives across the country are also fighting for you by working with state policymakers on a range of issues from virtual visitations to nursing home telehealth, paid leave and preventing evictions, foreclosures and utility disconnects. 

[00:03:44] I just want to share a few of these with you. AARP has successfully advocated to expand telehealth services for the residents of Alaska, Idaho, Illinois, Indiana, Michigan, New York, Tennessee and West Virginia to help people get the health care they need during these times. AARP state offices are heavily involved in advocating for the safety of people in nursing homes and long-term care facilities and fighting to ensure that family members receive information and are able to stay in touch with their loved ones in these facilities.

[00:04:19] All of these are important victories for older Americans and would not have been possible without the phone calls, the emails, actions from all of you on the phone, AARP members, volunteers, older adults across the country. We really want to thank you. Now let me get back to introducing our distinguished guests.

[00:04:43] We are joined today by three really distinguished individuals. First, we have Dr. Andy Gettinger. After more than 30 years of clinical practice in both the OR and ICU, Dr. Andy Gettinger transitioned to health care policy. Presently, Dr. Gettinger is the chief clinical officer for the Office of the National Coordinator of Health Information Technology located within the U.S. Department of Health and Human Services. Dr. Gettinger has extensive experience in the field of health information technology and has led the development of electronic health records systems. He's a board-certified anesthesiologist and also critical care medicine. 

[00:05:24] Secondly, we have Dr. Tricia Neuman. As senior vice president, Dr. Neuman oversees the Henry J. Kaiser Family Foundation’s policy analysis and research pertaining to Medicare and health care coverage and the care for aging Americans and people with disabilities. She's also executive director of the Kaiser Family Foundation’s program on Medicare policy. Her work focuses on health and economic security of older adults, prescription drug costs, payment and delivery system reform and policy options to strengthen Medicare for the future. 

[00:06:00] Lastly, we have an internationally recognized leader, Dr. Joe Kvedar, in the field of connected health. Dr. Kvedar is vice president of connected health at Partners HealthCare and a professor at Harvard University Medical School. And he also cochairs the American Medical Association’s digital medicine payment advisory group. Starting next month he'll begin his tenure as a president for the American Telemedicine Association, an organization dedicated to accelerating the adoption of telehealth.

[00:06:31] Again, thank you so much for joining us today to our distinguished guests. We're going to get started with our discussion and for the listeners, if you want to ask a question, please remember to press star three to be connected with one of our staff members. 

[00:06:47] So, Dr. Gettinger, let me begin with you. For the past couple of weeks, the coronavirus has changed the way that we navigate our daily lives. The visit to the hospital, the doctor's office is now intimidating. And we're hearing and seeing more experts talk more about telehealth. Let's begin there. What exactly is telehealth? 

[00:07:07]Andrew Gettinger:  Thanks Jean. And this was a perfect lead in — the technical difficulties are the kinds of things that doctors, other clinicians and patients face as they transition from the typical face-to-face office visit or hospital visit to what I'm going to define as telehealth, which is synchronous, meaning it happens with people simultaneously, non-face-to-face, meaning taking advantage of some technology to provide care. And there are a variety of ways that can happen anywhere from a regular telephone calls similar to what we're doing today, all the way up to full high-definition, high-resolution videoconferencing, which had historically been how a lot of telemedicine was accomplished. You know, telemedicine isn't anything new. We've had this huge transition in the past month, but it has been around for quite a while and I'm going to leave out a couple of things.

[00:08:21] I'm not going to talk about tele-radiology, where radiologists are looking at and interpreting images remotely from hospitals from around the world. Actually, I'm not going to talk about tele-ICU. It's almost 20 years old, where critical care specialists have been able to extend their reach out into community hospitals that don't have board-certified critical care doctors. That's been a very successful form of telehealth. 

[00:08:54] What I'm really going to talk about is the kind of telehealth that I think many of the listeners are interested in. We had a public hearing yesterday and heard from a number of the large systems how extensively things have changed. The CIO from the University of Michigan described just the incredible engagement by his clinicians. One of the things he did point out though is each clinical discipline has different capability to participate in telehealth. So a family practice doctor, an internist, their practice is much more amenable than some of the other practices. So ophthalmology is a good example of a practice that really depends on technology and measurement in the office, so it's much harder for the ophthalmologist. So telemedicine is not a single kind of thing. 

[00:10:02] And I do want to share with the audience that the U.S. government, the Department of Health and Human Services, is releasing in the next day or two, a telemedicine.HHS.gov website with a lot of really good information both for patients and for clinicians who have not been doing this before, but find themselves transitioning into this new space.

[00:10:40]Jean Setzfand:  That's terrific. Thank you for that. And thank you for being so gracious in saying that the technology failures were planned. They weren't. But sure enough, in the days that we're living in today the flexibility's definitely necessary. So I really appreciate that. And I think you alluded to this before, so let's talk a little bit about the changes. 

[00:11:01] So, the Centers for Medicare & Medicaid Services, otherwise known as CMS, and private insurers have really relaxed the regulations and expanded coverage as a result of social distancing and staying at home. Talk a little bit about some of the most significant changes. You've alluded to this already in terms of the different types of care — are these changes only available to the care tied to the coronavirus at this point, or is it broader than that? 

[00:11:29]Andrew Gettinger:  No, it's completely broader than that. All clinical care can be billed for telemedicine at this time and some of the requirements historically have, as you've mentioned, been relaxed, including relaxation of the ability to use the telephone as a means of conducting telemedicine. That's particularly important in rural areas where broadband is not readily available either for clinicians or for their patients. So that's an important element. 

[00:12:12] The other element that's important is the Office of Civil Rights has allowed a relaxation of some of the HIPAA rules. Those are the privacy and security rules. So clinicians can use a variety of means, things like FaceTime, Zoom, regular ways of interacting with patients that they wouldn't normally use because of concerns about security and privacy.

[00:12:49] I will point out that there are some challenges for clinicians to be able to do that. They need to understand how to document those encounters in the record, how to tie it in with their administrative systems like scheduling and, typically, clinicians depend on a team in the office, and when you're doing it from home, you are the entire team. So making sure that all of the content gets recorded and covered appropriately requires some adjustments in all parts. 

[00:13:26]Jean Setzfand:  That's great. Thank you for that. So it’s important to note that it's not that you need computers or whatnot. The rules have relaxed it so that telephone connections are available. But it’s important for the physicians to note all the changes and challenges as well. OK, I want to double-check. We are having, unfortunately, some technical difficulties. And Dr. Neuman, are you on the line yet or not? All right. I don't think I hear Dr. Neuman on yet. We're going to try to get her back on so that we can have a chat with her about some of these changes. 

[00:14:14] OK, we are going to shift quickly to chat with Dr. Kvedar. Dr. Kvedar, we talked a little bit about the different types of care. Dr. Gettinger just mentioned that, for example, internists may be a good route to take in terms of telemedicine, whereas ophthalmology may not. Can you tell us a little bit more about the appropriate terms of clinical care for telehealth? And when you think about it from the patient's perspective, are there things that we need to do differently in preparing for these appointments?

[00:14:51]Joe Kvedar:  Yeah, thanks for asking. Very exciting to participate today and I completely agree with everything that Andy said. I guess I would punctuate a couple of things. Probably the best utilization is, these days anyways, in mental health. Even before the pandemic, mental health was taking off as a primary user. That's a wonderful thing because the need for mental health is so acute right now. Many mental health providers are very comfortable interacting with their patients over video link and have been doing so. 

[00:15:31] On the other end of the spectrum, as was pointed out, anything that's procedural really can't be done this way. But then there's this middle ground of things like chronic illness management. If you have high blood pressure or type 2 diabetes or congestive heart failure, illnesses like that, that really are about checking in with the patient and making sure that they're following certain parameters of their health and if those parameters are stable, things like your daily weight, if you're a heart failure patient, or your blood pressure , if you're tight, maybe you're starting a new blood pressure medicine. With proper in-home tools like a blood pressure cuff or a weight scale, those conditions can be managed very well in this way. And again, thank goodness for that, because many of those people are at higher risk for contracting the virus. 

[00:16:23] Virus screening, in many cases, we can do that via phone. It's a lot about asking questions and I think many are doing that. In our own delivery system we now have a software program where people can text or dial in and go through an algorithm with a computer to see if they need to be triaged to get a COVID test or not. And, of course, we have human backup, doctors and nurses, backing that up, but the first step is simply interacting with a piece of software. 

[00:16:57] So the screening for the virus in many cases can be done this way. And then if people have contracted the virus, but if they're, say convalescing at home and have mild symptoms, a lot of that follow up can easily be done this way as well because it's about calling an individual and doing a series of questions.

[00:17:17] The way I've framed it for my clinician colleagues who've been asking about this is to think about the times when you've interacted with a patient, when in order to get the information you need to make a clear decision, you didn't have to touch the patient. And I think that opens up people's thought processes. 

[00:17:42] In terms of preparing for such a visit, I think a couple of things. Don't be afraid of the technology. These days if you're comfortable with FaceTime because you FaceTime with your family members, ask your doctor's office if they're willing to do FaceTime. Be proactive. Again, we can always revert to telephone for 90 percent of what we need to do.

[00:18:06] And the real prep is gathering information about your health. Whether you realize it or not, when you visit a doctor in the office, your clinician is doing all kinds of observations about your health when they're talking to you, when they're looking at you, etc. And it will be easier for them to, again, collect that information and make a good decision about your care if you are prepared.

[00:18:34] So if you're following your blood pressure, make sure you have your readings. If you're following your blood sugar, make sure you have your readings. Any symptoms that you're following, keep a diary. If you're doing something about food, keep a diary. It may sound like common sense, but when you go into the office, a lot of people expect the clinician to draw that information out of them, and it's just going to be easier in this kind of an environment of you are prepared with that ahead of time. 

[00:19:05]Jean Setzfand:  Great. That's terrific. And I think to the point that you raised Dr. Kvedar and also Dr. Gettinger, there are pieces of information out there. I want to reinforce that. On hhs.gov there's new information available to those providers, as well as patients, on telemedicine. And also I want to direct your attention to resources that AARP has available to consumers at aarp.org/coronavirus. We have highlighted a special section around telehealth, telemedicine, in the middle of the aarp.org/coronavirus today. So I invite you to take a look at that information so that you can be prepared and know the beginning steps of just how to access this type of service.

[00:19:55] Dr. Neuman, are you back on? No? Okay. We will continue to try and get Dr. Neuman back on. But we have lots of live calls. So now it's time to really address the calls that have already come in. I want to turn to those questions and see if we can have Dr. Gettinger and Dr. Kvedar address those.

[00:20:19] So please press star three at any time on your telephone keypad to be connected with AARP staff to share your question. And it's my pleasure to be joined today with my colleague Jesse Salinas, AARP vice president of programs. Jesse's going to be organizing all of our live calls today. So welcome, Jesse.

[00:20:36]Jesse Salinas:  Thanks Jean. I'm happy to be here for this important conversation. 

[00:20:39]Jean Setzfand:  Wonderful. So who do we have online today? 

[00:20:43]Jesse Salinas:  Jean our question today is from Patricia in Georgia. 

[00:20:48]Jean Setzfand:  Wonderful. Welcome Patricia. What question do you have for us today? 

[00:20:52]Patricia:  I'm concerned with all of the discussion about disparities and minorities. How will this teleconferencing really get to those communities? And are there any protocols that have been set up that specifically explain when we can use this new technology? When is it appropriate? Is it a supplement or is it replacing what one is expecting from the health care system?

[00:21:26]Jean Setzfand:  Thank you, Patricia. Great question. Let me turn to Dr. Kvedar first. And I'll also have Dr. Gettinger comment on as well. Dr. Kvedar, what do you think about that question? 

[00:21:36]Joe Kvedar:  Well, I'm so glad you called in and asked because we're very concerned about that. I think I would just underscore as a first response, and I appreciate this, no one response solves everything you asked, right? It's a very complicated matter. I would say the good news is it's on everyone's mind and we want very much to have an equitable response that includes as many participants in our health care system as we can. So the first response is that we now have, as was said, the access to the opportunity to take care of you by telephone. And that should help with any digital divide for the most part. Again, there's going to be some people that are always fall off, unfortunately, so that's I think the main answer I would have to that. And just to also say that if it's any solace to you, there's a lot of people that are very concerned about making sure that our response to this is equitable and that we don't make create a digital divide where one doesn't exist.

[00:22:43] I don't know, Andrew, if you have other thoughts.

[00:22:49]Jean Setzfand:  Dr. Gettinger, do you have any additional comments to add here? 

[00:22:53]Andrew Gettinger:  Yeah, I think it is something that the federal government is very focused on. A lot of our support in that space goes through state Medicaid programs. There's also one other thing that was done as part of the congressional appropriations. They appropriated $200 million for the Federal Communications Commission to spend to foster telemedicine, including some of the devices that Dr. Kvedar mentioned before. And some of those are targeted for communities that don't necessarily have access on their own. 

[00:23:41]Jean Setzfand:  That's great. Thank you for letting us know about the expansion. Let me just check in again. Dr. Neuman, have you been able to rejoin us? Not yet. Okay. All right. We'll continue to check. All right Jesse, who else is online? 

[00:23:59]Jesse Salinas:  Our next question is from Sandy in Maryland. 

[00:24:03]Jean Setzfand:  Thank you, Sandy. You can go ahead with your question.

[00:24:06]Sandy:  Hi. I have a question. I'm really concerned about this next month. I had to cancel my appointment to have my eyes dilated. And as you know, there are some things you cannot do by teleconference, you know. But how do you weigh what's more important? Going to the doctor for a test like that or staying home and being safer from the virus because you take a risk going to the doctor. But which is more important, to not go to the doctor or go to the doctor? 

[00:24:52]Jean Setzfand:  That’s right. Thank you so much, Sandy. I think that's a question that's weighing on all of our minds today. Dr. Kvedar, I'm going to start with you on that question again. How should we consider that? Dr. Kvedar?

[00:25:15]Joe Kvedar:  That's something I deal with every day myself. I am having these barriers….

[00:25:25]Jean Setzfand:  I think we're losing you again Dr. Kvedar. Can you hear us? OK, Dr. Gettinger, can you hear me?

[00:25:43]Andrew Gettinger:  I can. 

[00:25:45]Jean Setzfand:  Can you help us with Sandy's question? How do you weigh the options of actually going to see a doctor? Let me get you to opine on that question.

[00:26:03]Andrew Gettinger:  It is a difficult question. What are the actual risks of going into the office versus the risks of not getting timely care? What I would suggest is that the best way to figure out what the best course for an individual is to be in touch with your physician or other care provider, express the concern you have and see how that trained professional helps you evaluate the right course of action for you.

[00:26:42]Jean Setzfand:  Great, thank you for that. Is Dr. Kvedar back on? 

[00:26:50]Joe Kvedar:  I think so. Can you hear me all right?

[00:26:52]Jean Setzfand:  I can hear you. Perfect. Thank you. All right, I'm also going do another sound check for Dr. Neuman. Dr. Neuman, are you with us? 

[00:27:01]Tricia Neuman:  I am here. Can you hear me? 

[00:27:02]Jean Setzfand:  Oh, wonderful. We can hear you. Thank you. We are really putting our technology lines on a test today as we talk about telehealth. I actually want to turn to Dr. Neuman for a second right now. 

[00:27:14] We talked a lot about the changes and the relaxation of the rules, particularly with Medicare. I'd like to turn to you to talk a little bit about that. What are some of these adjustments, particularly from a time standpoint? We understand that there's an end date to some of these adjustments. Can you tell us a little bit more about that? 

[00:27:33]Tricia Neuman:  Well, I think we don't really know because this is really a transition during an emergency period. And so for the period of this emergency, Medicare has waived a number of rules to make it easier for people to be in communication with their health care providers via telehealth and various devices. My understanding is that once we are over the emergency period, then Medicare rules will revert back to the way they were prior to the current virus crisis. Now, that said, I do suspect there could be a fair amount of pressure to change the rules if it turns out that patients and their doctors recognize that there may be some benefits to having broader use of telehealth, particularly in certain circumstances for people who have difficulties getting to the doctor or when maybe the trip is more onerous than necessary, but that all emerges after the emergency period is over. At that point, it goes back to sort of business as usual for Medicare, which had a much more restrictive set of rules for how telehealth can be used.

[00:28:48]Jean Setzfand:  That's really helpful. Thank you for that. And I know you've been studying this all along too, so you've been looking at sort of the possibilities, as well as the limits of telehealth, for the older adults. What have you seen? Can you give us some insights on that front? 

[00:29:04]Tricia Neuman:  Yes. We've seen both a broadening of availability of devices and access to telehealth, at least through Medicare Advantage plans. And what we've also seen is that more and more older people are able to connect through the internet with devices in their own homes. That's a change. That's been gradually changing over the years, which at least puts many older people in a position to try telehealth services now that they are allowed.

[00:29:35] We did a recent survey and found that nearly 7 in 10 adults 65 and older said they have a computer or smartphone or tablet at home. And so that's really good news in terms of being able to reach out and communicate with their health care providers. Yes, there are real differences by income. There are differences by race and ethnicity, and I did hear the conversation before and there is a real digital divide. But the overall numbers are ticking upward and that's, I think, promising for changing the way in which doctors and patients and others communicate. 

[00:30:10] But what we don't know is whether older adults will feel comfortable using these devices and talking to health care providers. That will be a real change. We are seeing actually very few people with experience with telehealth. Across the board just about a little bit more than 10 percent of people of any age say they've talked to a medical provider in the past few weeks via video or some other kind of device. So I think people of all ages are trying to get used to the new world in which we are living and becoming comfortable, as are their doctors.

[00:30:47] But it's not clear yet whether older adults will want to use these devices to talk with their doctors. We know that today they are much less likely to do video chatting with their friends and families than younger folks. So it's a bit too soon to tell. There's at least an infrastructure in place so that people may learn to use these devices, may develop a higher comfort level. But for now, not many people are doing that. So we'll just see over time. And as doctors and patients become more comfortable and more familiar with this form of communication, it may become more common and we may learn how best people communicate via video chatting and telephones, and if that works or not. So in some ways, this is a both an opportunity and an experiment. 

[00:31:39]Jean Setzfand:  Right. Makes sense. Wonderful. All right, we're going to turn to the phone lines. I’ll invite Jesse back into the conversation. Jesse, who do we have on the line? 

[00:32:02]Jesse Salinas:  Our next call is going to be from Facebook. This is from Judy, and she's asking if she goes to the doctor once a year for a wellness check, is it really safe to do at telehealth visit remotely?

[00:32:16]Jean Setzfand:  Great. All right. Let me again begin with Dr. Kvedar. What do you think about that question from Facebook? 

[00:32:25]Joe Kvedar:  Well, I think that's stretching it. So much happens in that once a year checkup. Usually, if you have a high-quality doctor, you're having a conversation about everything from your family members to your chronic illnesses, your health prevention, the things that are needed next, whether it's your colonoscopy or a Pap smear or what have you.

[00:32:48] And then there's that physical exam in the office, and probably some lab tests get drawn. Again, I think it's a bit of a stretch to try to do all that via telehealth. It's probably possible in extreme circumstances to do most of it without some of the physical exam part, but it really isn't ideal.

[00:33:09] I think more likely that, and I think before I got cut off before I was saying that, if you have something routine like that, it's probably OK to put it off a month or two rather than expose yourself to a health care environment right now. The telehealth should really be mostly for follow-ups, mostly for tracking things that you already have a care plan for, those kinds of things as opposed to a yearly checkup, I think. 

[00:33:39]Jean Setzfand:  Great. That's really a clear guidance. Thank you for that, Dr. Kvedar. Again, as Dr. Neuman said before, there is an interesting environment for us to really get better accustomed to telehealth. So let's take some more questions to try to help people get greater guidance on us. Jesse, who else is online for us? 

[00:33:58]Jesse Salinas:  Your next question is from Cheryl in Ohio. 

[00:34:02]Jean Setzfand:  Great. Welcome, Cheryl, what's your question?

[00:34:05]Cheryl:  This is Cheryl. I’m wondering, because I just used this virtual [method] , which was wonderful for a dermatology problem, which I've had removed because it was squamous cell … is this going to be covered by Medicare, by our insurances, since it is something that's up and coming? And rather than have to drive, which I would have had to a distance, where are we going with this as far as the coverage? 

[00:34:34]Jean Setzfand:  Thanks for that question, Cheryl. Dr. Neuman, let me turn to you first. What are your thoughts on that?

[00:34:41]Tricia Neuman:  Well, I hate to say it, but it depends. At the moment this is a covered service, but it's not clear what will happen in the future. And it depends on where you get your coverage. If you’re covered by a Medicare advantage plan, which is a Medicare HMO or PPO, these plans have the flexibility to cover telehealth services, so it would be covered if you happen to be in one of those plans. If you're in traditional Medicare, and at the moment the majority of people covered by Medicare are in the traditional Medicare program, then it may not be covered, particularly if you don't live in a rural area, which is the part of the country where Medicare does allow for this coverage. And that's why I've been saying I think that after this period of time there may be more pressure to make changes to Medicare. If patients and physicians are comfortable with telehealth, at least in certain circumstances, there may be more pressure to make this a covered benefit, much as it is for Medicare Advantage plans.

[00:35:56]Jean Setzfand:  That makes a lot of sense. Is there any guidance, Dr. Neuman, for Cheryl? Is there a number that she can call to check in to see if that's covered or not? 

[00:36:04]Tricia Neuman:  I think, again, it would depend on the plan that you're in. If you're in traditional Medicare, you can always call 1-800-MEDICARE to confirm, or you can ask your doctor because I'm sure your doctor has access to that information. If you happen to be among the people enrolled in a Medicare Advantage plan, then you would want to call that plan to find out what they do and do not cover. 

[00:36:30]Jean Setzfand:  Great. Thank you for that. All right, let's turn to another call online. 

[00:36:36]Jesse Salinas:  Our next question is going to be from Gilda in Oregon. 

[00:36:40]Jean Setzfand:  Gilda, welcome. What's your question? 

[00:36:43]Gilda:  Hello. I have an iPad Air 2. My question is, what devices are better appropriated for a virtual or a screen time with my primary care provider?

[00:37:03]Jean Setzfand:  Great. Thank you for that. So a question around devices. Let me begin with Dr. Gettinger. What's your advice on that? Computer, iPad or smartphone? 

[00:37:12]Andrew Gettinger:  I think it really depends on how you're communicating with your doctor. If you are using your computer or your iPad just for a voice call, it doesn't matter. If you are using it for video resolution and a face-to-face telemedicine call, then it's whatever device has the best resolution.

[00:37:45] Some of the newer iPads have incredible resolution. Some of the other devices have incredible resolution. I think I just saw last week a comment that some of the smartphones don't have as good a resolution. So it's really about the resolution of the device more than the actual device.

[00:38:07] By the way, it's not just looking at you. It's also the ability to see something that most clinicians don't get to see routinely … the environment in which you live. And that can tell a lot about you as well. 

[00:38:26]Jean Setzfand:  That's really great guidance. Thank you so much, Dr. Gettinger. All right, Jesse, who else do we have online there?

[00:38:32]Jesse Salinas:  Our next questioner is Mary from Massachusetts. 

[00:38:37]Jean Setzfand:  Welcome, Mary, what's your question?

[00:38:39]Mary:  Hi. Yes, I think that it's wonderful that we've been using telemedicine for all those uses that the doctor described previously. But what about for older adults who do need to have tests for procedures during this emergency time? Do you have any advice about if it’s safe for them to visit their doctor's offices or go to have blood drawn? 

[00:39:17]Jean Setzfand:  Great question, Mary. Thank you for that. Dr. Kvedar, what do you think about that? I think we heard that before, but I think some more guidance from you would be helpful.

[00:39:26]Joe Kvedar:  Well, I would say follow your doctor's advice. Those of us that provide care are all acutely aware of the risk-reward ratio of deciding to ask someone to come into a facility. But if you need a blood test, if you need a X-ray, if you need to be examined in person, we're going to take every precaution. Every facility that I know of around where I live, there's someone to greet you at the door, they ask you your screening questions, they make you use Purell, they make you wash your hands, they give you a mask. Then when you're in a waiting area, you're always six feet from anyone else in the waiting area.

[00:40:09] So I think we do our best. We wipe rooms down, we clean them with Clorox, we do all kinds of things now to minimize your risk. The most minimal risk is staying at home. But if someone who's taking care of you says, “We think you should have X, Y, Z test or X, Y, Z exam,” I would follow their advice. 

[00:40:31]Jean Setzfand:  Great. Thank you for that guidance. All right, Jesse, who else do we have online today? 

[00:40:36]Jesse Salinas:  Our next question is from Virginia in Georgia.

[00:40:40]Jean Setzfand:  Welcome Virginia. What’s your question?

[00:40:42]Virginia:  Hi. My question is kind of a two-part question — how would you address the challenges of reimbursement and coverage for telehealth services from a provider side? And then the second part of the question is how to bridge the telehealth gap between insurance companies and medical centers for quality, telehealth services, locations?

[00:41:08]Jean Setzfand:  Great. Thank you for that question, Dr. Neuman, how would you address that question for Virginia? 

[00:41:16]Tricia Neuman:  Well, I think I want to hear the second question again, but on the first question, providers are being paid by Medicare as they would be paid for a visit during this period of time. So this allows providers to continue to charge for a visit and get paid for a visit even if it is happening electronically.

[00:41:43] Your second question, I would love for someone to repeat that. 

[00:41:48]Jean Setzfand:  Sure. I think Virginia was also asking about the two sides of the coin. The patient and provider also have in this time a need to understand the reimbursement process. So any guidance around getting to close that gap, as well.

[00:42:11]Tricia Neuman:  Well, that's a great question. I think we've been talking a lot about the learning curve for patients. But honestly, I think there's also a huge learning curve that has taken place with providers. Some providers are far more comfortable and familiar with the processes of telehealth than others. And that is primarily around patient care, but also around billing. And I think for that, providers really need to work with the payers that reimburse them for their services normally. So whether it's Medicare, then it should be Medicare, if it's private insurers then private insurers. Because in a system like ours with multiple payers, the rules pertaining to payment and the amount of payments vary from payer to payer, and that would include Medicaid, as well. 

[00:43:03]Jean Setzfand:  Wonderful. Thank you for that. All right, let's turn to another call. Jesse, who else do we have online? 

[00:43:10]Jesse Salinas:  Let's bring on Diane from Florida.

[00:43:12]Jean Setzfand:  Welcome Diane. What is your question?

[00:43:18]Diane:  OK. I'm wondering about dental. How do you facilitate, or is it possible to do a dental visit through telehealth? You know, I'm thinking I’ve got a little bit of pain and I'm thinking it may be the start of an abscess. How do I deal with that or with dental in general?

[00:43:42]Jean Setzfand:  Great. Thank you for that question, Diane. Dr. Kvedar I can turn to you for that question? 

[00:43:48]Joe Kvedar:  You can although my knowledge is probably not perfect. I know that there are a number of tele-dentistry organizations, companies. I believe most of their efforts are around more chronic follow-up, as we talked about before. Something that's acute like that, where there's tooth pain and a possible abscess, I think has to be seen in person. I know around where I live, most of the dentist offices are taking calls for emergencies and handling them, so that would be my advice on that. 

[00:44:25]Jean Setzfand:  Great. Thank you so much for that. I want to highlight a resource that AARP has available. Sometimes it’s really nice to have a friendly voice help you through these challenging times. AARP’s Community Connection is a toll-free service for all adults 18 and We have trained volunteers standing by to provide a friendly call just to help, maybe connect with a person to have an informal conversation during these trying times.

[00:44:59] If you'd like to speak to someone Monday through Friday from 9:00 to 5:00 p.m. Eastern time, feel free to call this number, [888] 281-0145, and leave us your information. A volunteer will be getting back to you. And you can even set up a recurring call like every Wednesday at 2:00 for a check-in.

[00:45:21] Again, it's a free service, AARP Community Connections for all adults, regardless of your membership, and we do also have bilingual capabilities, including Spanish. And if you stay online to the end of this call, we'll also be providing an option for you to connect directly to AARP Community Connections.

[00:45:47] All right, let's hear some more from our experts. Dr. Neuman, we talked a little bit about this before. In what ways have the regulations been relaxed and coverage expanded for Medicare? And how do, particularly, private insurers align with these coverage changes?

[00:46:10]Tricia Neuman:  Well, prior to the coronavirus pandemic, Medicare really had a pretty restrictive definition for what it would cover. Generally it restricted full telehealth coverage to people living in rural areas and then only if individuals had a long-standing relationship with their provider and with certain devices.

[00:46:36] So this is very much of a new world for Medicare and for Medicare beneficiaries. Medicare Advantage, the private plans, have had more flexibility. So over this period of time, Medicare Advantage plans, most of them, actually do offer some telehealth services and it will be interesting to see how much they have expanded the services that they cover and whether they continue to do that after the emergency. 

[00:47:06] Medicare has also allowed more providers to do telehealth services. And this may have come up when I wasn't on the call, but I'm thinking of federally qualified health centers, rural health clinics that can provide these services directly. There's more opportunity for home health agencies and hospice providers. The whole idea is to protect patients and protect providers and to allow people to stay at home, to shelter in place, to minimize their risk of getting infected, helping both patients and the caregivers who take care of them. The changes in the rules that have been made for the emergency period could have profound implications in the future for how coverage is treated. But in the meantime, it's really helpful for people because now people have the opportunity, they can call their doctor, they can talk about a problem, they can use just a plain old telephone and make life much easier during this period of time when they're just staying home.

[00:48:11] And I think it's also an opportunity for people to reach out to others who may be less comfortable with technology and to help neighbors and family members become more comfortable so that they, too, can use the various devices that are available to them. And ask for help. If you have the technology but you don't know how to use it, this is a great time to try to learn so there are ways to reach out to more people, medical providers and family members and friends. 

[00:48:44] Medicare also, by the way, has made a few other really important changes beyond telehealth. For example, Medicare, like private insurers, has waived cost sharing for testing, which is a significant financial help to people who need to be tested.

[00:49:04] It also has required part D plans to provide a 90-day supply of medications, which allows people to stay at home for a longer period of time rather than go to the pharmacy. And that too is enormously helpful for people, particularly if they're at greater risk of infection. And it’s said that if a future vaccine comes to market, it will be covered with no cost sharing. So for people who may be concerned about what will be the cost of a vaccine if it comes along, that should not be an issue. 

[00:49:40]Jean Setzfand:  Great. Thank you for that. Thank you for highlighting those changes and also reminding us this is a way that if you don't know how to get connected through telehealth, telemedicine services, maybe reach out to others to ask for some help as well. Again, let me remind folks that you can go to aarp.org/coronavirus and there is a special section around telehealth, the one, two, three beginning steps of how to get connected. 

[00:50:05] Thank you for that, Dr. Neuman. Dr. Kvedar, obviously with the trying times, I think more and more folks are experiencing new or heightened anxiety or depression and other psychological issues. You mentioned this before, but how can telehealth help folks in these circumstances? 

[00:50:27]Joe Kvedar:  Well, it's a wonderful solution. In some ways we tend to think that it may be better than a face-to-face interaction simply because as an individual has anxiety or depression, it's a big challenge to leave your house and travel to a facility to see someone. So we can see you right now in your own home. And I think it was one of my colleagues mentioned earlier that we get to see what's around you in the home and that's very important for us in terms of understanding your environment and how that impacts your mental health. 

[00:51:03] Before the pandemic, approximately 48 percent of mental health professionals had used some sort of telehealth in their practice. So most of them are well equipped. Another thing to just mention is that the physical exam in a mental health visit is talking to the patient, so it's ideal from that perspective as well. 

[00:51:26] There is one caveat I have to mention, which is that even before this public health emergency there was a backlog of need for mental health services, and now it's even more acute. So there's not enough mental health practitioners to go around, unfortunately. But the technology allows us to connect with people very well and is a great solution for that problem. 

[00:51:58]Jean Setzfand:  Great. Thank you for that reminder and also sharing your thoughts on telehealth and mental health support.

[00:52:15] Before we turn back to your live questions, I do want to provide a quick AARP Fraud Watch Network coronavirus alert. Scammers, unfortunately, are still trying to get your money and personal information by pitching fake cures and even constructing fake testing centers in some communities.

[00:52:32] They are offering bogus investments, impersonating medical professionals to collect payments, posing as global health authorities, conducting phishing campaigns designed to trick recipients with malware or ransomware. This week, coronavirus stimulus payments are beginning to hit bank accounts, and the scammers are trying to get a piece of that action, unfortunately.

[00:52:57] Scammers are calling, emailing or texting saying that they need money or bank account information to deposit or speed up your stimulus check payments. It's important to know that the federal government will not be calling to ask for information before processing any of the stimulus payments.

[00:53:17] For official information on economic impact payments, please visit the corona tax relief page at irs.gov. If you suspect a scam, please visit aarp.org/fraudwatchnetwork. You can search scams in your area or actually report a scam. Take action and fight against scammers, or you can call our help line. The fraud watch network helpline is at [877] 908-3360. We have volunteers on staff to answer your calls at [877] 908-3360, the fraud watch network helpline. 

[00:54:07] All right, let's take more of your questions, and we'll get Dr. Kvedar, Dr. Neuman, and Dr. Gettinger to respond to them. Jesse, who else do we have online? 

[00:54:44]Jesse Salinas:  We're going to bring on Ken from Michigan. 

[00:54:48]Jean Setzfand:  Hello Ken.

[00:54:50]Ken:  Hi. How are you? So my question is are there any potential medical malpractice issues specifically related to providers of telehealth? 

[00:55:04]Jean Setzfand:  Thank you for your question, Ken. Let me begin with Dr. Gettinger, what do you think about that?

[00:55:10]Andrew Gettinger:  I think it's a great question to ask. I think many physicians and other clinicians have asked similar questions. I think if you provide effective care, you do all the things via a telemedicine visit that you do in the office absent the obvious physical exam, it's unlikely that the fact that it's a telemedicine visit would increase your risk in the liability space. I say that with the caveat that I am not an attorney and not necessarily an expert. But certainly in 30 years of practice, I didn't practice being worried about those things. I just wanted to take good care of my patients, and that's what telemedicine allows us to do during these very difficult times. 

[00:56:08]Jean Setzfand:  Thank you so much for that, Dr. Gettinger. Jesse, who else do we have online today? 

[00:56:13]Jesse Salinas:  Yeah, we're going to bring on Queenie from New York.

[00:56:18]Jean Setzfand:  Hello? 

[00:56:19]Queenie:  Hello. Hi. I am a high-risk patient, and I'm very concerned about the experience that I had at the hospital when I went because I'm an asthmatic and my doctor advised me to go to the hospital. On my first visit there I was given a chest X -ray and a flu shot … and they sent me home with some asthma medication and told me to stay in for 14 days.

[00:56:55] Fourteen days afterwards, I called my primary doctor and I was still feeling not well, so he told me he wanted me to return. I returned to the same hospital, and when I got there they took a CAT scan, did another X-ray, did the virus test and told me that I had an infection of the chest. The doctor said that she was, you know, concentrating on having me admitted. But she said there was no room at the hospital that I was at, so she was going to have me admitted to one of their sister hospitals. And so I asked her, was it a designated virus hospital? She said yes. So I informed her that I had been tested and I had a negative test. 

[00:57:56] And I asked her, would I be in a private room? She said no, that I would be sharing a room with someone else who has the virus. And I was just very, very concerned because if I don't have the virus, then why am I going to be sharing a room with patients that do have the virus?

[00:58:19]Jean Setzfand:  Thank you, Queenie. Thank you for that. Dr. Kvedar, in the circumstance like this, would telemedicine be helpful in any way given the circumstances that we just heard from Queenie. 

[00:58:30]Joe Kvedar:  No, sadly, I don't think so. I think the need for the testing that she described, the fact that she has asthma, I think, from what I'm understanding, that the doctors are very, very, very concerned about making sure she was well taken care of.

[00:58:51] The last part is hard to know without having been there. I don't think anyone would knowingly put you in the same room with someone who had coronavirus. I think that's unlikely. I know hospitals are stretched right now for capacity, but people are getting sick with things other than the virus, and an asthma attack or a chest infection made worse by asthma is a serious thing.

[00:59:23] But again, I don't think telemedicine is going to play a role in sorting that out, unfortunately. 

[00:59:29]Jean Setzfand:  Well, thank you for that guidance, Dr. Kvedar. All right Jesse, who else do we have online? 

[00:59:35]Jesse Salinas:  Our next question is from Facebook. We have Monica and she's been asking weather copays and deductibles are waived for telehealth and specifically around chronic care management and things like that.

[00:59:48]Jean Setzfand:  Great. Thank you for that. Dr. Neuman, what do you think about that question? 

[00:59:53]Tricia Neuman:  Well, I think it's going to vary across different insurers. So I don't think there is a single answer to that question as far as I know. So yes, it's covered, but cost sharing is not routinely waived. Cost sharing is waived, as I think I mentioned before, if it's a physician’s visit associated with a test, but not consistently so. 

[01:00:21]Jean Setzfand:  So probably some legwork and some extra research is needed to figure that out. Great. Thank you so much for that. Jesse, who else do we have up next for our calls? 

[01:00:56]Jesse Salinas:  Let's bring online Jean from Massachusetts. 

[01:01:01]Jean:  Hello, everyone. This is Jean from Massachusetts. I run a council on aging and, while we are not physically open, we're making a tremendous number of care calls out to our patrons. 

[01:01:15] And we are dealing with a high degree of social isolation, and we know who these folks are and we can talk to them at length. However, because we are a community-based services organization and not a clinical organization, we can't really intervene to let their physician know what we're finding out. So my question is, are physicians who have profiles of patients that are seniors that are prone to mental health issues, are you proactively calling and reaching out through telehealth to these patients? And if so, is this covered? And what are the various physicians doing regarding the fact that, you know, on a typical day I had 150 to 160 seniors coming through for a range of activity, one being connectivity to other human beings. And now they cannot, but we are making care calls out to them.

[01:02:11] So what is the health care system doing proactively through things like telehealth to connect with these older adults?

[01:02:19]Jean Setzfand:  Great. Thank you for that question. Dr. Gettinger, I think I'm going to start with you. Do you have any thoughts on that? 

[01:02:27]Andrew Gettinger:  Well it's, again, a great question. I don't have any particular insight into what community clinicians are doing.

[01:02:37] What I did hear yesterday, which was a bit surprising but really happy news, was from the secretary of the VA who described, that in these circumstances, again an older population with a lot of medical needs, that in this window of time, that population was actually doing much better than expected.

[01:03:02] In a variety of ways, not the least of which, they've seen a dramatic reduction in veterans who've hurt themselves. He attributed that to the increased communication that was going on via telemedicine-type encounters. Again, that's the VA population. I'll let others comment more generally on the community.

[01:03:30]Jean Setzfand:  Dr. Kvedar or Dr. Neuman, do you have any thoughts on the last question? 

[01:03:36]Joe Kvedar:  I would just say our clinicians are pretty stretched right now. So it may not be happening to the degree that we would like, and I completely would just endorse the knowing the impact that social isolation has, and it's a significant one.

[01:03:57] But that said, I think, as I said earlier, our mental health professionals are sort of dealing with as much incoming and, sadly, may not have the capacity to do a lot of proactive outbound outreach. 

[01:04:12]Jean Setzfand:  And Dr. Neuman. 

[01:04:14]Tricia Neuman:  The only thing I'd add is I'm hearing, and this is really word of mouth, this varies by medical profession and practice. Some physicians and mental health providers specifically are reaching out to offer their patients the opportunity to get treated, which is not to say that there aren't capacity issues. Of course there are. But I am hearing of some outreach from providers, and I'm just wondering if the caller might want to think about encouraging the clients that you see who are dealing with depression or other concerns related to social isolation, to reach out directly to their physicians or other providers in order to get help. Either to maintain some kind of connection in an ongoing way with a mental health provider or to find someone else who might be able to provide support during this period.

[01:05:16]Jean Setzfand:  Great. Thank you for that. All right, Jesse, who else do we have on the line? 

[01:05:22]Jesse Salinas:  We've got Tony from Washington on the line.

[01:05:26]Toni:  Yes. I would like to know in terms of the security and privacy of utilizing Zoom and telehealth. My provider is about 16 miles from where I live in Port Angeles. I take paratransit, ADA transportation, to get there and I only have that transportation. I would like to know about this because I understand the provider and the provider’s clinic only uses Zoom for telehealth if I ever needed to see or talk to my doctor. What do I do? How do I approach this?

[01:06:28]Jean Setzfand:  Thank you for that question. Dr. Kvedar and Dr. Gettinger, I know you both talked about this. Let me begin with Dr. Kvedar. What are your thoughts around the various forms of video connections, for example with Zoom and everything that we're hearing about privacy concerns there?

[01:06:46]Joe Kvedar:  Thanks. Thank you. It's a wonderful question. I think the news is good. There have been news stories about people breaking into Zoom meetings. And as far as I know all of the ones that I'm aware of were times when people posted a Zoom link on some kind of a public forum, such as Facebook or Twitter. Again, most of the ones I heard about were Alcoholics Anonymous meetings or Narcotics Anonymous meetings. Although I think those were very sad stories because of the meanness and nefarious intent of the person who dialed in, I wouldn't call it hacking because the link was out there in public. 

[01:07:29] I think if your doctor wants to use Zoom, make sure that they share that Zoom link with you in a very private way, maybe over a patient portal, something like that. And I think the likelihood that you'll have your privacy interfered with is extremely low. The other thing I would say is that the real important part of the privacy conversation is how your visit is documented in the electronic record. And again, that's not changed. We have as private as possible systems for our electronic records. So I would just close by saying, I think the chance of having your privacy invaded in a telehealth interaction is extremely low, and I wouldn't let that get in your way of having a conversation with your doctor in this way.

[01:08:22]Jean Setzfand:  Right. Thank you for that. Dr. Gettinger, anything to add to that?

[01:08:27]Andrew Gettinger:  No, I completely agree. The only thing I would add is the FBI has put out some guidance for Zoom gatherings generally. And some of that guidance involves always using a password, in addition to making sure that the link is private. Then there are actually, and I'm not sure which version your physician uses, but there's the free version, which has been a little bit more susceptible. The professional version or the version that you pay for has more security options available within it. 

[01:09:14]Jean Setzfand:  Great. Thank you for that guidance. So I think we have a few more calls online. Jesse, who else do we have online? 

[01:09:22]Jesse Salinas:  Our next question is going to come from Reed in Wisconsin.

[01:09:27]Reed:  Hi, this is Reed. I have concerns about the digital divide. I know here in Wisconsin, the governor this year had gotten funding for access to broadband for more of the state. And what the intent there is, is that a lot of this sophisticated telehealth takes place with the bandwidth that would be very useful to diagnosticians. You pretty much have to have broadband for some of those things. It seems to me that it tends to be a geographic divide where the rural areas, the companies that provide it don't seem to have the economic wherewithal or impetus to provide it. I just wondered what the thoughts are there?

[01:10:29]Jean Setzfand:  Great. Thank you for that question. Dr. Gettinger, I'm going to start with you. 

[01:10:35]Andrew Gettinger:  Yeah, I think that's a real issue and I can assure you that a number of us in the government are talking about it. At least historically just to go back many years when the only way we communicated in rural areas was with landlines. Folks who were providing clinical care or available on call would get priority. The FCC, when it was regulating in a different way, ensured that telecommunication providers did that for clinicians. I'm imagining a future state where telecommunications for clinical purposes would be equally supported, and we completely recognize that that's not the case now. 

[01:11:27] And the bad news is as so much of digital connectivity moves to 5G, and fiber and copper lines are not how things get to people, especially in urban areas, in rural areas 5G just doesn't have the distance penetration that will be necessary. So I think this is not going to go away as an issue. I'm in rural New Hampshire currently, and I've seen local communities recognize that their vitality and future depends on doing broadband so that broadband is becoming a service that’s not just telecommunication companies, but is a service by the local community as well. 

[01:12:26]Jean Setzfand:  Great. Thank you for that. Dr. Kvedar, do you have any thoughts to add to that from the Telemedicine Association perspective? 

[01:12:33]Joe Kvedar:  Well, we advocate for more broadband for more people. It's a real issue. I'll go back to saying that all is not lost given that during the public health emergency we can use telephone, and I mentioned that earlier. But it doesn't take away from my enthusiasm for having more broadband for more citizens, especially in rural areas. I completely agree. It needs to be done. 

[01:12:57]Jean Setzfand:  Great. Thank you. All right, I think we have time for just one last question. Jesse, who's our last question?

[01:13:04]Joe Kvedar:  The next question comes from Facebook. It's Jim from Colorado, and Jim is asking whether there's any relief for Medicare premium payments during this pandemic? They say they pay a lot for insurance and they really could use some help right now. 

[01:13:18]Jean Setzfand:  Great question. Dr. Neuman, can you help us with that question?

[01:13:22]Tricia Neuman:  Well, that is a great question. I have heard discussion about providing relief on cost sharing, particularly for COVID-related treatments. I have not heard anything about providing relief to people with premiums. I mean it is a serious concern that many people on Medicare, not exclusively Medicare, but many people on Medicare struggle with health expenses. I think what this situation is bringing to light is that it's premiums, it's cost sharing. It's the whole package together that could consume a fairly large share of people's retirement income. I'm just sorry to say I haven't heard any discussion about premium relief. 

[01:14:13]Jean Setzfand:  Thank you for highlighting that for us. We are running out of time, so let me ask our esteemed panelists to give us some closing thoughts. Beginning with Dr. Gettinger, moving to Dr. Kvedar and Dr. Neuman, any thoughts that you have for our members, our listeners today? What are some last thoughts you'd like to leave us with? Dr. Gettinger, do you want to kick us off? 

[01:14:38]Andrew Gettinger:  Absolutely. You know, just as we experienced on the call today, a little bit of bumpiness here, a little bit of bumpiness there. Stepping away, I would say the call was very successful. I would say, being tolerant, being patient, telemedicine for many clinicians and for many patients is a new mode of care, and I believe it's one that is here to stay. But it's going to take us a little while to work out all the kinks, figure out what best practices are for individual clinicians, as well as for patients. So I continue to be very optimistic and enthusiastic. Thanks for asking. 

[01:15:26]Jean Setzfand:  Thank you, Dr. Kvedar.

[01:15:29]Joe Kvedar:  Well, actually my colleague’s enthusiasm and thanking you for inviting me to this. What I've been reminding folks like your listeners, so this is the plea, if you have a good experience, tell your congressman or senator that you don't want to go back to having only one channel if health care delivery, which is having to go into the office.

[01:15:54] As we said, not everything is going to be ideal for telehealth. But I would say the flip side is if we can't emerge from this crisis with more than one channel for health care delivery, then it's a sad day for our country that we have to go back to what is really 20th century style of delivering a service. You have to come see me in a physical location, and that's the only way to get something done. So speak up, talk to your politicians. Make sure they know that you don't want to go back. 

[01:16:29]Jean Setzfand:  Thank you so much. And Dr. Neuman. 

[01:16:33]Tricia Neuman:  Yeah, I agree it's going to be very hard to put the genie back in the bottle. And I also agree that patients and doctors are at a steep learning curve right now. This is a time when people are working out the kinks, who want to use this time to learn how well telehealth works, when it works, when it doesn't work and how to make it work better. This is an opportunity to use a new technology or an old technology in a new way to help us all stay safer.

[01:17:10] It's an opportunity for people who are not so familiar with this type of technology or communicating in this way with their doctors to become more comfortable with it, if they choose to, and help us all figure out when this is the right line of communication and how to make it work in the best possible way to improve our safety and to improve the communication that we have with each other. 

[01:17:36] So I think this is a great opportunity. And I think it's highly unlikely that we'll go back to business as usual without so much reliance on telehealth. But how we use it, when we use it, is still an open question.

[01:17:52]Jean Setzfand:  Great. Thank you for that. Again, thank you so much for your patience with us today. I think we were modeling the beginning of the future of telehealth with our technical difficulties. But thank you so much for your optimism. Thank you so much for your practical guidance. I think we hopefully have allayed some questions and concerns from our listeners today, and it's been such an informative discussion.

[01:18:14] I want to thank each of you for joining our call. And I want to thank all of our listeners, our AARP members, volunteers, for participating in this discussion. Again, let me just tell you that we do have the ability to provide you a friendly voice through our AARP Community Connections. We have trained volunteers standing by, as I said before. This is a free service for all adults regardless of your membership, and we do offer some bilingual capabilities, including Spanish. To be connected right now to AARP Community Connections, you can just press star zero on your telephone keypad and your call will be rerouted to the service. 

[01:18:55] AARP is a nonprofit, non-partisan membership organization and we've been working hard to promote the health and well-being of older Americans for more than 60 years. In the face of this crisis, we're providing information and resources to help older adults and those caring for them to protect themselves from the virus, prevent it's spread to others while taking care of yourself. All the resources referenced, including a recording of today's Q&A event, can be found aarp.org/coronavirus by April 17th. Please visit that website if your question was not answered. You'll find the latest updates, as well as information created specifically for older adults and family caregivers. 

[01:20:08] We hope you’ve learned something that can help keep you and your loved ones healthy. Be sure to tune in next week for our next AARP tele-town hall. We are in fact offering two Q&A events next Thursday, April 23. The first will be at the same time, 1:00 p.m. Eastern time, where we're going to be focused on caring for your loved ones and facilities such as nursing homes and long-term care facilities. And we'll also be offering a separate topic for a conversation at 7:00 p.m. Eastern time focused on the unfortunate disparate impact of coronavirus. 

[01:20:44] But I want to thank you again for joining us today. Have a good day.

[01:20:47] And this concludes our call.

[01:20:51]

 

CORONAVIRUS  Tele-Town Hall 4/16/20

JEAN SETZFAND: Hola. Soy la vicepresidenta sénior de AARP, Jean Setzfand, y quiero darles la bienvenida a esta importante discusión sobre el coronavirus.

AARP, una organización compuesta de socios sin fines de lucro y no partidista, ha estado trabajando para promover la salud y el bienestar de los adultos mayores durante más de 60 años.

Ante la pandemia de coronavirus, AARP proporciona información y recursos para ayudar a los adultos mayores y a quienes cuidan de sus seres queridos.

Hoy hablaremos con expertos sobre las opciones de telesalud y discutiremos cómo Medicare, Medicaid y el seguro privado han ajustado las regulaciones para expandir el acceso a la telesalud durante la pandemia global.

Si ha asistido a una de nuestras teleasambleas informativas, sabe que es muy similar a un programa de entrevistas de radio, y tendrá la oportunidad de hacer preguntas en vivo. Si desea hacer una pregunta sobre el uso de la telemedicina durante esta pandemia global, presione * 3 en su teléfono para conectarse con un miembro del personal de AARP que anotará su nombre, su pregunta y lo pondrá en la lista para hacer esa pregunta en vivo. Nuevamente, si desea hacer una pregunta, presione * 3.

Hola. Si recién se une a nosotros, nuevamente, soy Jean Setzfand de AARP, y quiero darle la bienvenida a esta importante discusión sobre el impacto de la pandemia mundial de coronavirus. Hablaremos con expertos y responderemos sus preguntas en vivo.

Permítanme presentarles a algunos de nuestros invitados de hoy. Hoy tenemos a Andrew

Gettinger, M.D., director clínico, Office of the National Coordinator for the Health Information Technology de EEUU. Departamento de Salud y Servicios Humanos.

En segundo lugar, tenemos a Tricia Neuman, doctora en ciencias, vicepresidenta senior de la Henry J Kaiser Family Foundation.

Por último, tenemos a Joseph Kvedar, M.D., presidente electo de la American Telemedicine Association.

AARP está convocando esta teleasamblea para garantizar que tenga acceso a la información durante el coronavirus. Si bien vemos un papel importante para AARP en el suministro de información y defensa relacionada con el coronavirus, debe tener en cuenta el hecho de que la mejor fuente de información sobre información médica y de salud proviene de los Centros para el Control y la Prevención de Enfermedades, los CDC. Puede acceder a más información en www.cdc.gov/coronavirus.

Para que lo sepan, este evento está siendo grabando, y pueden acceder a la grabación desde www.aarp.org/coronavirus 24 horas aproximadamente después del evento.

Nuevamente, hoy estamos hablando con expertos sobre cómo mantenerse a salvo, saludables y conectados durante la pandemia mundial de coronavirus. Para hacer preguntas, presione * 3.

Estos son tiempos muy difíciles para muchas personas. Y AARP está trabajando incansablemente, abogando por los miembros y todas las personas mayores de 50 años durante esta pandemia. Permítanme compartir con ustedes algunos de los esfuerzos que se están realizando.

Primero, AARP ha luchado para garantizar que las personas en el país cuya principal fuente de ingresos es el Seguro Social también reciban pagos de hasta $1,200 en el reciente paquete de estímulo económico.

También hemos impulsado la ampliación de los beneficios del seguro de desempleo, así como la licencia por enfermedad paga y la licencia familiar para las personas que se toman un tiempo para cuidar de sí mismos y de sus seres queridos.

Si bien hemos estado trabajando duro en Washington, DC, los representantes de AARP en todo el país también están luchando por usted al trabajar con los encargados de formular políticas estatales en una variedad de temas, desde visitas virtuales a hogares de ancianos, telesalud, licencias pagas y prevención de desalojos, ejecuciones hipotecarias, y desconexión de servicios.

Quiero compartir algunos de estos con ustedes. AARP ha abogado con éxito para expandir los servicios de telesalud para los residentes de Alaska, Idaho, Illinois, Indiana, Michigan, Nueva York, Tennessee y Virginia Occidental para ayudar a las personas a obtener la atención médica que necesitan durante estos tiempos.

Las oficinas estatales de AARP están muy involucradas en abogar por la seguridad de las personas en hogares de ancianos, centros de atención a largo plazo y en luchar para garantizar que los miembros de la familia reciban información y puedan mantenerse en contacto con sus seres queridos en estas instalaciones.

Todas estas son victorias importantes para los adultos mayores, y no hubieran sido posibles sin las llamadas telefónicas, los correos electrónicos, las acciones de todos ustedes al teléfono, socios de AARP, voluntarios, adultos mayores en todo el país. Realmente queremos agradecerles.

Ahora, déjenme volver a presentar a nuestros distinguidos invitados. Nos acompañan hoy tres individuos realmente distinguidos.

Primero, tenemos al Dr. Andy Gettinger. Después de más de 30 años de práctica clínica tanto en el quirófano como en la UCI, el Dr. Andy Gettinger hizo la transición a la política de atención médica. Actualmente, el Dr. Gettinger es el Director Clínico de Office of the National Coordinator of Health, Information Technology, ubicado dentro del Departamento de Salud y Servicios Humanos de EE. UU. El Dr. Gettinger tiene una amplia experiencia en el campo de la tecnología de información de salud y ha liderado el desarrollo de sistemas electrónicos de registros de salud. Es anestesiólogo certificado por la junta y también es médico de cuidados críticos.

En segundo lugar, tenemos a la Dra. Tricia Neuman. Como vicepresidenta sénior, la Dra. Tricia Neuman supervisa el análisis de políticas y la investigación de la Henry J. Kaiser Family Foundation relacionada con Medicare y la cobertura de atención médica y la atención para los adultos mayores y las personas con discapacidades del país.

También es directora ejecutiva del Programa de Kaiser Family Foundation sobre las políticas de Medicare. Su trabajo se centra en la salud y la seguridad económica de los adultos mayores, los costos de los medicamentos recetados, la reforma del sistema de pagos y entregas y las opciones de políticas que fortalecen a Medicare para el futuro. Por último, tenemos un líder reconocido internacionalmente, el Dr. Joe Kvedar, en el campo de la salud conectada. El Dr. Kvedar es Vicepresidente de Connected Health Partners HealthCare y profesor de la Facultad de Medicina de Harvard. Y también copreside el Grupo Asesor de Pago de Medicina Digital de la Asociación Médica Americana. Y a partir del próximo mes, comenzará su mandato como presidente de la American Telemedicine Association, una organización dedicada a acelerar la adopción de la telesalud.

Nuevamente, muchas gracias a nuestros distinguidos invitados por acompañarnos hoy. Vamos a comenzar con nuestra discusión. Y para los oyentes, si desea hacer una pregunta, recuerde presionar * 3 para conectarse con uno de los miembros de nuestro personal.

Dr. Gettinger, déjeme comenzar con usted. Durante las últimas dos semanas, el coronavirus ha cambiado las vidas que navegamos en nuestra vida diaria. Una visita al hospital, el consultorio del médico ahora es intimidante. Y estamos escuchando y viendo a más expertos hablar más sobre telesalud. Comencemos por ahí. ¿Qué es exactamente la telesalud?

ANDREW GETTINGER: Gracias, Jean. Y esta es una entrada perfecta. Las dificultades técnicas son el tipo de cosas que enfrentan los médicos, otros clínicos y pacientes a medida que pasan de la típica visita cara a cara al consultorio o al hospital, a lo que voy a definir como telesalud, que es sincrónico, lo que significa que sucede con las personas simultáneamente, no cara a cara, lo que requiere aprovechar alguna tecnología para brindar atención. Y hay una variedad de formas en que puede suceder.

Cualquier cosa desde una llamada telefónica normal, similar a lo que estamos haciendo hoy, hasta una videoconferencia de alta definición y alta resolución, que históricamente era así como se llevaba a cabo mucha telemedicina. La telemedicina no es nada nuevo. Hemos tenido esta gran transición en el último mes. Pero ha existido por bastante tiempo. Y voy a dejar de lado un par de cosas.

No voy a hablar de teleradiología, donde los radiólogos buscan e interpretan imágenes de manera remota desde hospitales de todo el mundo, en realidad. No voy a hablar de tele-UCI. Tiene casi 20 años, donde los especialistas en cuidados críticos han podido extender su alcance a los hospitales comunitarios que no tienen médicos de cuidados críticos certificados por la junta.

Esa ha sido una forma muy exitosa de telesalud. De lo que realmente voy a hablar es del tipo de telesalud en el que creo que muchos de los oyentes están interesados.

Ayer tuvimos una audiencia pública y escuchamos en varios de los grandes sistemas cuán extensamente han cambiado las cosas. El CIO de la Universidad de Michigan describió el increíble compromiso de sus médicos. Sin embargo, una de las cosas que señaló es que cada disciplina clínica tiene una capacidad diferente para participar en telesalud

Un médico de medicina familiar, un internista, su práctica es mucho más adecuada que algunas de las otras prácticas. La oftalmología es un buen ejemplo de una práctica que realmente depende de la tecnología y la medición en la oficina, por lo que es mucho más difícil para el oftalmólogo.

La telemedicina no es un solo tipo de cosa. Y el Gobierno de Estados Unidos, vamos a hablar un poco más sobre eso en un momento, pero sí quiero compartir con la audiencia, el Gobierno de EE. UU., el Departamento de Salud y Servicios Humanos lanzará, en el siguiente día o dos, el sitio web www.telemedicine.hhs.gov  con mucha información realmente buena, tanto para pacientes y también para médicos que no estaban haciendo esto antes, pero se encuentran en transición hacia este nuevo espacio.

JEAN SETZFAND: Eso es genial. Gracias por eso. Y gracias por ser tan amable y decir que los fallos tecnológicos fueron planeados. No lo fueron, pero efectivamente, en los días que vivimos hoy, la flexibilidad es definitivamente necesaria. Así que, realmente lo aprecio. Y creo que hizo alusión a esto antes, así que hablemos un poco sobre los cambios.

Los Centros de Servicios de Medicare y Medicaid,  también conocidos como CMS, y las aseguradoras privadas, realmente han relajado las regulaciones y ampliado la cobertura como resultado del distanciamiento social y la permanencia en el hogar.

Hable un poco sobre algunos de los cambios más significativos. Y ya ha aludido a esto, en términos de los diferentes tipos de atención. ¿Estos cambios solo están disponibles para la atención vinculada al coronavirus en este momento? ¿O es más amplio que eso?

ANDREW GETTINGER: No, es completamente más amplio que eso. Toda la atención clínica se puede facturar mediante telemedicina en este momento. Y algunos de los requisitos históricamente se han expandido, como usted ha mencionado, incluida la expansión de la capacidad de usar el teléfono como medio para llevar a cabo la telemedicina.

Eso es particularmente importante en las zonas rurales donde la banda ancha no está disponible, ni para los médicos ni para sus pacientes. Ese es un elemento importante. El otro elemento importante es que la Oficina de Derechos Civiles ha permitido mitigar algunas de las reglas de HIPAA: esas son las reglas de privacidad y seguridad, para que los médicos puedan usar una variedad de medios, como FaceTime, Zoom, una especie de formas regulares de interactuar con pacientes que normalmente no usarían debido a preocupaciones sobre seguridad y privacidad.

Señalaré que hay algunos desafíos para que los médicos puedan hacer eso. Deben comprender cómo documentar esos encuentros en el registro, cómo vincularlos con sus sistemas administrativos, como la programación. Y, por lo general, los médicos dependen de un equipo en la oficina. Y cuando lo hace desde casa, uno mismo constituye todo el equipo, por lo que asegurarse de que todo el contenido sea registrado y se cubra adecuadamente requiere algunos ajustes en todas las partes.

JEAN SETZFAND: Eso es genial. Gracias. Es tan importante tener en cuenta que no es que necesite computadoras o no, se han hecho excepciones en las reglas para disponer de las conexiones telefónicas, pero es importante que los médicos también tengan en cuenta todos los cambios y desafíos.

Bueno, creo que quiero volver a comprobar que estamos teniendo, desafortunadamente, algunas dificultades técnicas.

Y Dra. Neuman, ¿está en la línea o no?

Muy bien, no creo haber escuchado a la Dra. Neuman todavía. Intentaremos recuperarla para poder conversar con ella sobre algunos de estos cambios. Bien, vamos a cambiar para conversar rápidamente con el Dr. Kvedar.

Dr. Kvedar, hablamos un poco sobre los diferentes tipos de atención. El Dr. Gettinger acaba de mencionar que, por ejemplo, la telemedicina puede ser útil para los internistas, mientras que para la oftalmología puede no serlo. ¿Puede contarnos un poco más sobre los términos apropiados de atención clínica para la telesalud? Y cuando lo piensa desde la perspectiva del paciente, ¿hay cosas que debemos hacer de manera diferente al prepararnos para estas citas?

JOE KVEDAR: Sí, gracias por preguntar. Me alegro de participar hoy. Y estoy completamente de acuerdo con todo lo que Andy dijo. Supongo que recalcaría un par de cosas. Una, probablemente la mejor, creo, la utilización [INAUDIBLE] en salud mental.

Incluso antes de la pandemia, la salud mental comenzó a ser el usuario principal. Eso es algo maravilloso porque la necesidad de salud mental es muy aguda en este momento. Muchos proveedores de salud mental se sienten muy cómodos interactuando con sus pacientes a través de un enlace, y lo han estado haciendo.

Nuevamente, en el otro extremo del espectro, como se señaló, cualquier cosa que sea procesal, realmente no se puede hacer de esta manera. Pero luego está este término medio con cosas como el manejo de enfermedades crónicas.

Si tiene presión arterial alta o diabetes tipo B o insuficiencia cardíaca congestiva, las enfermedades como esas, realmente requieren el control del paciente y asegurarse de que esté siguiendo ciertos parámetros de salud, y que esos parámetros sean estables, como su peso diario si se trata de un paciente con insuficiencia cardíaca, o la presión arterial, nuevamente.

Si usted es tipo B, tal vez esté comenzando un nuevo medicamento para la presión arterial. Con las herramientas adecuadas en el hogar, como un esfigmomanómetro o una báscula, esas condiciones se pueden manejar muy bien de esta manera.

Y nuevamente, gracias a Dios porque muchas de esas personas tienen un mayor riesgo de contraer el virus. La detección de virus, en muchos casos, podemos hacerla por teléfono.

Se trata mucho de hacer preguntas. De hecho, y creo que muchos lo están haciendo en nuestro sistema de entrega. Ahora tenemos un programa de software donde las personas pueden enviar mensajes de texto o marcar y pasar por un algoritmo con una computadora para ver si necesitan ser evaluados para realizarse una prueba de COVID-19 o no Y, por supuesto, tenemos respaldo humano, médicos y enfermeras que lo respaldan.

Pero el primer paso es simplemente interactuar con una pieza de software. La detección del virus, en muchos casos, se puede hacer de esta manera. Y luego, si las personas han contraído el virus, pero si, por ejemplo, están convalecientes en casa y tienen síntomas leves, gran parte de ese seguimiento también se puede hacer fácilmente de esta manera porque se trata de llamar a un individuo y hacerle un serie de preguntas.

La forma en que lo formulé para mis médicos y colegas que han estado preguntando es que piensen en los momentos en que han interactuado con un paciente cuando, para obtener la información que necesitaban para tomar una decisión clara, no tenían que tocar al paciente.

Y creo que eso abre el proceso de pensamiento de las personas. En términos de... Y lo dejaré aquí, porque fue lo último que me ha preguntado.

En términos de preparación para tal visita, creo que hay un par de cosas.

No le tengas miedo a la tecnología si estás... En estos días, si te sientes cómodo con FaceTime porque usas FaceTime con los miembros de tu familia, pregúntale al consultorio de tu médico si están dispuestos a hacer FaceTime. Sé proactivo.

Una vez más, siempre podemos volver al teléfono para el 90% de lo que necesitamos hacer. Y la verdadera preparación es recopilar información sobre tu salud. Ya sea que te des cuenta o no, cuando visitas a un médico en el consultorio, tu médico hace todo tipo de observaciones sobre tu salud mientras te están hablando, cuando te están mirando, etc.

Y sería más fácil que, nuevamente, recopilen esa información y tomen una buena decisión sobre si está preparado para ser atendido. Si está controlando su presión arterial, asegúrese de tener las lecturas. Si controla su sangre, asegúrese de tener las lecturas. Cualquier síntoma que esté controlando, lleve un diario. Si está haciendo algo con la comida, lleve un diario. Puede parecer sentido común, pero cuando va al consultorio, mucha gente espera que el médico les extraiga esa información.

Y será más fácil en este tipo de entorno si se prepara con anticipación.

JEAN SETZFAND: Genial. Eso es fantástico. Y creo que, hasta el punto que plantea usted, Dr. Kvedar, y también el Dr. Gettinger, hay información disponible. Quiero reforzar eso.

En www.hhs.gov, hay nueva información disponible para esos proveedores, así como para los pacientes que reciben telemedicina. Y también, quiero dirigir su atención a los recursos que AARP tiene disponibles para los consumidores. En www.aarp.org/coronavirus, hemos destacado una sección especial sobre telesalud, telemedicina en el medio de www.aarp.org/coronavirus hoy.

Los invito a que echen un vistazo a esa información para que puedan estar preparados, conozcan los pasos iniciales de cómo acceder a este tipo de servicio.

Muy bien, creo que es hora de volver a verificar si la Dra. Neuman está nuevamente en línea. Dra. Neuman, ¿ha vuelto?

JESSE SALINAS: No, no ha vuelto.

JEAN SETZFAND: De acuerdo. Seguiremos tratando de recuperar a la Dra. Neuman. Pero tenemos muchas llamadas en vivo. Ahora es el momento de abordar las llamadas que ya han entrado. Quiero pasar a esas preguntas y ver si podemos hacer que el Dr. Gettinger y el Dr. Kvedar respondan a esas preguntas. Presione * 3 en cualquier momento en el teclado de su teléfono para conectarse con el personal de AARP para compartir su pregunta.

Y es un placer para mí, estar hoy con mi colega, Jesse Salinas, vicepresidente de Programas de AARP. Jesse organizará todas nuestras llamadas en vivo hoy. Bienvenido Jesse.

JESSE SALINAS: Gracias, Jean. Estoy feliz de estar aquí para esta importante conversación.

JEAN SETZFAND: Maravilloso. ¿A quién tenemos en línea hoy?

JESSE SALINAS: Sí, Jean. Nuestra primera pregunta hoy es de Patricia en Georgia.

JEAN SETZFAND: Maravilloso. Bienvenida, Patricia. ¿Qué pregunta tiene para nosotros hoy?

PATRICIA: Me preocupa toda la discusión sobre las disparidades en las minorías. ¿Cómo llegará realmente esta teleconferencia a esas comunidades? ¿Y hay algún protocolo que se haya establecido que explique específicamente cuándo podemos usar esta nueva tecnología? ¿Cuándo es apropiado? ¿Es un suplemento? ¿O está reemplazando lo que uno espera del sistema de salud?

JEAN SETZFAND: Gracias, Patricia. Buena pregunta. Permítanme recurrir al Dr. Kvedar primero. Y también haré que el Dr. Gettinger comente algo. Dr. Kvedar, ¿qué le parece esa pregunta?

JOE KVEDAR: Bueno, me alegra que haya llamado y preguntado porque estamos muy preocupados por eso. Creo que solo destacaría como primera respuesta, y aprecio esto, ninguna respuesta resuelve todo lo que ha preguntado, ¿verdad? Es un asunto muy complicado.

Diría que la buena noticia es que está en la mente de todos. Y queremos tener una respuesta equitativa que incluya tantos participantes en nuestro sistema de salud como podamos.

La primera respuesta es que ahora tenemos, como hemos dicho, acceso a la oportunidad de cuidarlos por teléfono, y eso debería ayudar con cualquier brecha digital en su mayor parte.

Nuevamente, habrá algunas personas que siempre se caen, desafortunadamente. Esa es, creo, la respuesta principal que tendría para eso. Y solo decir que si le sirve de consuelo, hay muchas personas que se están ocupando de asegurarse de que nuestra respuesta a esto sea equitativa y que no creemos una brecha digital donde no la hay.

No sé, Andrew, si tienes otra cosa que decir.

JEAN SETZFAND: Dr. Gettinger, ¿tiene algún comentario adicional para agregar aquí?

ANDREW GETTINGER: Sí. Creo que es algo en lo que el Gobierno federal está muy enfocado. Gran parte de nuestro apoyo en ese espacio pasa por los programas estatales de Medicaid. También hay otra cosa que se hizo como parte de las asignaciones del Congreso. Asignaron $200 millones para que la Comisión Federal de Comunicación invierta para fomentar la telemedicina, incluidos algunos de los dispositivos que el Dr. Kvedar mencionó anteriormente. Y algunos de ellos están destinados a comunidades que no necesariamente tienen acceso por su cuenta.

JEAN SETZFAND: Eso es genial. Gracias. Gracias por informarnos sobre la expansión. Permítanme controlar nuevamente. Dr. Neuman, ¿ha podido reunirse con nosotros? Todavía no, bueno.

Muy bien, continuaremos comprobando. Muy bien, Jessie, ¿quién más está en línea?

JESSE SALINAS: Sí, nuestra próxima pregunta es de Sandy en Maryland.

JEAN SETZFAND: Gracias. Sandy. Puede hacer su pregunta.

SANDY: Hola. Tengo una pregunta. Esto me preocupa realmente. El mes que viene... Bueno, tuve que cancelar mi cita para dilatar mis ojos. Y como saben, hay algunas cosas que no puedes hacer por teleconferencia.

Pero, ¿cómo sopesan lo que es más importante, ir al médico para una prueba como esa o quedarse en casa y estar más a salvo del virus? Porque corres el riesgo con el virus al ir al médico.

Pero, ¿qué es más importante, que no vayas o que te quedes en casa? Quiero decir, ¿no ir al médico o ir al médico?

JEAN SETZFAND: Correcto. Muchas gracias, Sandy. Creo que esa es una pregunta que existe en todas nuestras mentes hoy.

Dr. Kvedar, voy a comenzar con usted con esa pregunta nuevamente. ¿Cómo deberíamos considerar eso? ¿Dr. Kvedar?

JOE KVEDAR: ¿Hola?

JEAN SETZFAND: Sí, hola.

JOE KVEDAR: ¿Puede oírme?

JEAN SETZFAND: Sí, puedo.

JOE KVEDAR: ¿Puede oírme bien? Bien. Eso es algo con lo que trato todos los días. Estoy teniendo estos diversos [INAUDIBLE]

JEAN SETZFAND: Creo que lo estamos perdiendo nuevamente, Dr. Kvedar. ¿Puede oírnos? Muy bien, déjenme... Bueno, Dr. Gettinger, ¿puede oírme?

ANDREW GETTINGER: Sí, puedo.

JEAN SETZFAND: ¿Puede ayudarnos con la pregunta de Sandy? Nuevamente, ¿cómo evalúa las opciones de ir a ver a un médico? Nuevamente, creo que probablemente es una razón perfecta por la cual podemos usar la telemedicina en este momento.

Cuéntenos su opinión al respecto.

ANDREW GETTINGER: Creo que es una pregunta difícil. ¿Cuáles son los riesgos reales de ir al consultorio, frente a los riesgos de no recibir atención a tiempo?

Lo que sugeriría es que la mejor manera de descubrir cuál es el mejor camino a seguir para una persona, es ponerse en contacto con su médico u otro proveedor de atención, expresar la preocupación que tiene y ver cómo ese profesional capacitado lo ayuda a evaluar el curso de acción correcto para usted.

JEAN SETZFAND: Eso es genial. Gracias por eso. Muy bien, voy a controlar rápidamente. ¿Está de vuelta el Dr. Kvedar?

JOE KVEDAR: Creo que sí. ¿Lo estoy? ¿Me oyen bien?

JEAN SETZFAND: Puedo oírte. Perfecto. Gracias.

JOE KVEDAR: Cielos.

JEAN SETZFAND: Muy bien, también voy a hacer otra prueba de sonido para la Dra. Neuman.

Dra. Neuman, ¿está con nosotros?

TRICIA NEUMAN: Aquí estoy. ¿Puede escucharme?

JEAN SETZFAND: Oh, maravilloso. Podemos escucharla. Gracias. Muy bien, realmente estamos poniendo a prueba nuestras líneas tecnológicas hoy mientras hablamos de telesalud.

 De hecho, quiero recurrir a la Dra. Neuman por un segundo en este momento. Hablamos mucho sobre los cambios y la mitigación de las reglas, particularmente con Medicare.

Me gustaría recurrir a usted para que hable un poco sobre eso. ¿Cuáles son algunos de estos ajustes, particularmente desde el punto de vista del tiempo? Entendemos que hay una fecha de finalización para algunos de estos ajustes. ¿Puede contarnos un poco más sobre eso?

TRICIA NEUMAN: Bueno, creo que realmente no lo sabemos porque esto es realmente una transición durante un período de emergencia. Durante el período de esta emergencia, Medicare ha renunciado a una serie de reglas para facilitar a las personas comunicarse con sus proveedores de atención médica a través de telesalud y varios dispositivos.

Según tengo entendido, una vez que hayamos pasado el período de emergencia, las reglas de Medicare volverán al estado anterior a la crisis del coronavirus. Dicho esto, sospecho que podría haber una gran presión para cambiar las reglas si resulta que los pacientes y sus médicos reconocen que puede haber algunos beneficios al tener un uso más amplio de la telesalud, particularmente en ciertas circunstancias para las personas que tienen dificultades para ir al médico, o cuando tal vez el viaje sea más costoso de lo necesario.

Pero todo eso surge después de que termine el período de emergencia. En ese momento, se remontará al tipo de negocio habitual de Medicare, que tenía un conjunto de reglas mucho más restrictivas sobre cómo se puede utilizar la telesalud.

JEAN SETZFAND: Eso es realmente útil. Gracias por eso. Y sé que también ha estado estudiando esto todo el tiempo. Así que, ha estado analizando las posibilidades, así como los límites de la telesalud para los adultos mayores. ¿Qué han visto? ¿Puede darnos algunas ideas en ese sentido?

TRICIA NEUMAN: Sí. Hemos visto una ampliación de la disponibilidad de dispositivos y acceso a telesalud, al menos a través de los planes Medicare Advantage. Y lo que también hemos visto es que cada vez más personas mayores pueden conectarse a través de Internet con dispositivos en sus propios hogares. Y eso es un cambio.

Eso ha ido cambiando gradualmente a lo largo de los años, lo que al menos coloca a muchas personas mayores en condiciones de probar los servicios de telesalud ahora que están permitidos. Hicimos una encuesta reciente y descubrimos que casi 7 de cada 10 adultos mayores de 65 años dijeron que tenían una computadora o teléfono inteligente o tableta en casa.

Y esa es una muy buena noticia en términos de poder comunicarse con sus proveedores de atención médica. Sí, habrá diferencias por ingresos. Hay diferencias por raza y etnia. Y escuché la conversación antes, y hay una verdadera brecha digital. Pero los números generales están subiendo.

Y creo que es prometedor para cambiar la forma en que los médicos, los pacientes y otras personas se comunican. Pero lo que no sabemos es si los adultos mayores se sentirán cómodos usando estos dispositivos y hablando con los proveedores de atención médica.

Eso será un cambio real. En realidad, estamos viendo muy pocas personas con experiencia en telesalud. En general, casi un poco más del 10% de las personas de cualquier edad dicen que han hablado con un proveedor médico en las últimas semanas a través de video o algún otro tipo de dispositivo.

Creo que personas de todas las edades están tratando de acostumbrarse al nuevo mundo en el que vivimos, y se están sintiendo cómodos, al igual que sus médicos. Pero aún no está claro si los adultos mayores querrán usar estos dispositivos para hablar con sus médicos.

Sabemos que hoy en día es mucho menos probable que hagan videollamadas con sus amigos y familiares que los más jóvenes. Entonces es demasiado pronto para saberlo. Existe al menos una infraestructura para que las personas puedan aprender a usar estos dispositivos y puedan desarrollar un mayor nivel de comodidad.

Pero por ahora, no mucha gente está haciendo eso. Solo veremos con el tiempo. Y a medida que los médicos y los pacientes se sientan más cómodos y más familiarizados con esta forma de comunicación, puede volverse más común y podemos aprender cómo es que las personas se comunican por videollamada y teléfono, y si eso funciona o no. Entonces, de alguna manera, esto es tanto una oportunidad como un experimento.

JEAN SETZFAND: Gracias. Eso tiene sentido. Maravilloso. Bueno, vamos a más de nuestras llamadas en vivo. Nuevamente, permítanme recordarles, si desean hacer una pregunta, presionen * 3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP para compartir su pregunta.

Muy bien, vamos a pasar a las líneas telefónicas. Invitaré a Jesse a volver a la conversación. Jesse, ¿a quién tenemos en la línea?

JESSE SALINAS: Sí. Nuestra próxima pregunta es de Facebook. Es de Judy y ella pregunta, si va al médico una vez al año para una revisión general, ¿es realmente seguro hacer una visita de telesalud de forma remota?

JEAN SETZFAND: Genial. Muy bien, esa pregunta. Permítanme comenzar de nuevo con el Dr. Kvedar. ¿Qué opinas sobre esa pregunta de Facebook?

JOE KVEDAR: Bueno, creo que eso es demasiado. Sucede tanto en ese chequeo anual. Por lo general, si tiene un médico de alta calidad, tiene una conversación completa, desde los miembros de su familia hasta las enfermedades crónicas y la prevención de su salud, las cosas que se necesitan a continuación, ya sea una colonoscopía o una citología vaginal, o lo que sea.

Y luego, está ese examen físico en el consultorio y probablemente se hagan exámenes de laboratorio. Nuevamente, creo que es un poco demasiado tratar de hacer todo eso a través de la telesalud. Probablemente sea posible en circunstancias extremas hacer la mayor parte sin la parte del examen físico. Pero realmente no es lo ideal.

Creo que es más probable que, y creo que antes de que se me cortara hace un rato, estaba diciendo que, si tienes algo rutinario como eso, probablemente esté bien posponerlo durante un mes o dos en lugar de exponerte a un entorno de atención médica en este momento.

La telesalud realmente debería ser principalmente para seguimientos, principalmente para rastrear cosas para las que ya tiene un plan de atención, ese tipo de cosas, en vez de un chequeo anual, creo.

JEAN SETZFAND: Genial. Esas son instrucciones realmente claras. Gracias por eso, Dr. Kvedar. Nuevamente, como dijo el Dr. Neuman antes, hay un ambiente interesante para que nos acostumbremos realmente a la telesalud.

Respondamos algunas preguntas más para tratar de ayudar a las personas a obtener una mayor orientación sobre esto. Jesse, ¿a quién más tenemos en la línea?

JESSE SALINAS: Bien. La próxima pregunta es de Cheryl en Ohio.

JEAN SETZFAND: Qué bien. Bienvenida Cheryl. ¿Cuál es su pregunta?

SHERYL: Hola, soy Sheryl. Me pregunto, porque acabo de usar este sistema virtual, que fue maravilloso, para un problema de dermatología que me había quitado porque era una célula escamosa. ¿Va a estar cubierto por Medicare, por nuestros seguros, ya que es algo novedoso?

Y en lugar de tener que conducir, que hubiese tenido que distanciarme, ¿cómo viene esto en cuanto a cobertura?

JEAN SETZFAND: Gracias por esa pregunta, Sheryl. Dra. Neuman, déjeme recurrir a usted primero. ¿Qué piensas sobre eso?

TRICIA NEUMAN: Bueno, odio decirlo, pero depende. Por el momento, este es un servicio cubierto. Pero no está claro qué sucederá en el futuro, y depende de dónde obtenga su cobertura. Si está cubierto por un plan Medicare Advantage, que es una HMO o PPO de Medicare, tienen flexibilidad.

Estos planes tienen flexibilidad para cubrir los servicios de telesalud. Y entonces estaría cubierto si usted está en uno de esos planes. Si está en Medicare tradicional, y en este momento, la mayoría de las personas cubiertas por Medicare están en el programa tradicional de Medicare, entonces es posible que no esté cubierto, especialmente si usted no vive en un área rural, que es donde Medicare permite la cobertura.

Y es por eso que he estado diciendo, creo que después de este período de tiempo, puede haber más presión para realizar cambios en Medicare si los pacientes y los médicos se sienten cómodos con la telesalud, al menos en ciertas circunstancias.

Puede haber más presión para hacer de esto un beneficio cubierto, como lo es para los planes Medicare Advantage.

JEAN SETZFAND: Eso tiene mucho sentido. ¿Tiene alguna instrucción, Dra. Neuman, para Cheryl? ¿Hay algún número al que pueda llamar para verificar si está cubierta o no?

TRICIA NEUMAN: Bueno, creo que nuevamente dependería del plan en el que se encuentre. Si tiene Medicare tradicional, siempre puede llamar al 1-800-MEDICARE para confirmar. O puede preguntarle a su médico porque estoy segura de que su médico tiene acceso a esa información.

Y si se encuentra entre las personas inscritas en un plan Medicare Advantage, entonces le conviene llamar a ese plan para averiguar qué cubren y qué no.

JEAN SETZFAND: Genial, gracias por eso. Muy bien, pasemos a otra llamada. ¿Quién más está en línea?

JESSE SALINAS: Nuestra próxima pregunta será de Gilda en Oregón.

JEAN SETZFAND: Gilda, bienvenida. ¿Cuál es su pregunta?

GILDA: Hola. Tengo un iPad Air 2. Mi pregunta es, ¿qué dispositivos son los más apropiados para contactar a mi proveedor de atención primaria?

JEAN SETZFAND: Bien. Gracias por eso. Pregunta sobre dispositivos. Déjenme comenzar con el Dr. Gettinger. ¿Cuál es su consejo con respecto a eso? ¿Computadora, iPad o teléfono inteligente?

ANDREW GETTINGER: Creo que realmente depende de cómo se esté comunicando con su médico. Si está utilizando su computadora o iPad solo para una llamada de voz, no importa.

Si lo está utilizando para resolución de video y una llamada de telemedicina cara a cara, entonces es el dispositivo que tenga la mejor resolución. Algunos de los iPads más nuevos tienen una resolución increíble. Algunos de los otros dispositivos tienen una resolución increíble.

Creo que vi la semana pasada un comentario de que algunos de los teléfonos inteligentes no tienen una resolución tan buena. Realmente se trata de la resolución del dispositivo más que del dispositivo en sí. Por cierto, no se trata solo de verla, también se presenta la capacidad de ver algo que la mayoría de los médicos no ven generalmente, el entorno en el que vives.

Y eso también puede decir mucho sobre usted.

JEAN SETZFAND: Ese es un buen consejo. Muchas gracias, Dr. Gettinger. Muy bien, Jesse, ¿a quién más tenemos en línea?

JESSE SALINAS: Sí. Nuestra próxima pregunta será Mary de Massachusetts.

JEAN SETZFAND: Bienvenida, Mary. ¿Cuál es su pregunta?

MARY: Hola. Si. Creo que es maravilloso que hayamos estado usando la telemedicina para todos los usos que el médico describió anteriormente. Pero, ¿qué hay de los adultos mayores que sí necesitan hacerse pruebas para procedimientos durante este tiempo de emergencia?

¿Tiene algún consejo? ¿Es seguro para ellos visitar los consultorios de su médico o ir a que les extraigan sangre?

JEAN SETZFAND: Buena pregunta, Mary. Gracias. Dr. Kvedar, ¿qué piensa al respecto? Creo que hemos escuchado eso antes. Pero creo que un poco más de orientación de su parte sería útil.

JOE KVEDAR: Bueno, yo diría, sigue los consejos de tu médico. Aquellos de nosotros que brindamos atención somos muy conscientes de los riesgos y el nivel de beneficio de decidir pedirle a alguien que se acerque a un centro.

Pero si necesita un análisis de sangre, si necesita una radiografía si necesita ser examinado en persona, tomaremos todas las precauciones.

En cada instalación que conozco alrededor de donde vivo, hay alguien que te recibe en la puerta, te hacen preguntas de control, te hacen Purell, te hacen lavarte las manos, te dan una máscara.

Y luego, cuando estás en un área de espera, siempre estás a seis pies de cualquier otra persona en el área de espera. Creo que hacemos nuestro mejor esfuerzo.

Limpiamos las habitaciones. Los limpiamos con Clorox. Hacemos todo tipo de cosas ahora para minimizar su riesgo. Corres menor riesgo al quedarte en casa. Pero si alguien que te está cuidando te dice "Creemos que deberías hacerte tal o cual examen", seguiría sus consejos.

JEAN SETZFAND: Genial. Gracias por esa orientación. Muy bien, Jesse, ¿a quién más tenemos en línea hoy?

JESSE SALINAS: Sí, nuestra próxima pregunta es de Virginia en Georgia.

JEAN SETZFAND: Bienvenida, Virginia. ¿Cuál es su pregunta?

VIRGINIA: Hola. Sí. Mi pregunta tiene dos partes. ¿Cómo abordaría los desafíos del reembolso y la cobertura de los servicios de telesalud desde el punto de vista de un proveedor? Y luego, la segunda parte, la pregunta es ¿cómo cerrar la brecha de telesalud entre empresas de seguro y centros médicos para servicios de telesalud de calidad para pacientes?

JEAN SETZFAND: Genial. Gracias por esa pregunta. Dra. Neuman, ¿cómo respondería la pregunta de Virginia?

TRICIA NEUMAN: Bueno, creo que quiero escuchar la segunda pregunta nuevamente, pero en la primera pregunta, Medicare les paga a los proveedores así como se les pagaría por una visita durante este período de tiempo.

Esto permite a los proveedores continuar cobrando por una visita y recibir un pago por una visita, incluso si está sucediendo electrónicamente. Su segunda pregunta, me gustaría que alguien la repitiese.

JEAN SETZFAND: Claro. Creo que Virginia también estaba preguntando sobre algo así como las dos caras de la moneda, el paciente y el proveedor. Un proveedor también tiene, en este momento, la necesidad de comprender el proceso de reembolso. ¿Algún consejo sobre cómo cerrar esa brecha también?

TRICIA NEUMAN: Bueno, esa es una buena pregunta. Creo que hemos estado hablando mucho sobre la curva de aprendizaje para los pacientes, pero sinceramente, creo que también se ha producido una gran curva de aprendizaje con los proveedores.

Y algunos proveedores están mucho más cómodos y familiarizados con los procesos de telesalud que otros. Y eso se trata principalmente de la atención al paciente, pero también de la facturación. Y creo que para eso, realmente hace falta que los proveedores trabajen con los pagadores que normalmente reembolsan por sus servicios.

Si era Medicare, entonces debería ser Medicare. Si se trata de aseguradoras privadas, entonces las aseguradoras privadas, porque en un sistema como el nuestro, con múltiples pagadores, las reglas relativas al pago y la cantidad de pagos varían de pagador a pagador. Y eso también incluiría Medicaid.

JEAN SETZFAND: Maravilloso. Gracias por eso. Muy bien, pasemos a otra llamada. Jesse, ¿a quién más

tenemos en línea?

JESSE SALINAS: Sí, traigamos a Diane de Florida.

JEAN SETZFAND: Bienvenida, Diane. ¿Cuál es tu pregunta? Hola.

DIANE: Hola. ¿Pueden escucharme?

JEAN SETZFAND: Sí.

DIANE: De acuerdo. Me pregunto sobre lo dental. ¿Cómo se facilita, o es posible hacer una visita dental a través de telesalud?

Estoy pensando, tengo un poco de dolor, y estoy pensando que puede ser el comienzo de un absceso. ¿Cómo manejo eso, o lo dental, en general?

JEAN SETZFAND: Genial. Gracias por esa pregunta, Diane. Dr. Kvedar, ¿puedo recurrir a usted para esa pregunta?

JOE KVEDAR: Puede, aunque mi conocimiento probablemente no sea perfecto. Sé que hay una serie de organizaciones de teledentista, compañías, etc. Creo que la mayoría de sus esfuerzos se centran en un seguimiento más crónico, como hemos mencionado antes.

Algo que es agudo como eso, donde hay dolor de dientes y un posible absceso, creo, tiene que verse en persona. Y sé que, una vez más, donde yo vivo, la mayoría de las oficinas de dentistas están atendiendo llamadas de emergencia y manejándolas. Ese sería mi consejo al respecto.

JEAN SETZFAND: Genial. Muchas gracias por eso. Permítanme recordar a todos los oyentes también que estas son excelentes preguntas. Y si usted mismo tiene alguna, presione * 3. Y también, quería destacar un recurso que AARP tiene disponible.

A veces es realmente agradable tener una voz amigable que te ayude en estos tiempos difíciles. Mi Comunidad con AARP es un servicio gratuito para todos los adultos mayores de 18 años. Contamos con voluntarios capacitados que están listos para brindar una llamada amistosa, y tan solo para ayudar a que tal vez se conecte con una persona para tener una conversación informal durante estos tiempos difíciles.

Si desea hablar con alguien, de lunes a viernes de 9:00 a 5:00 p.m., hora del este, no dude en llamar a este número: 888-281-0145. Y déjenos su información. Un voluntario se pondrá en contacto con usted.

E incluso puede configurar una llamada periódica, como todos los miércoles a las 2:00 p.m. para saber cómo está. Una vez más, es un servicio gratuito, Mi Comunidad con AARP para todos los adultos, independientemente de su membresía.

Y también tenemos capacidades bilingües, incluido el español. Una vez más, ese número para Mi Comunidad con AARP es 888-281-0145. Y si permanece en línea hasta el final de esta llamada, también le proporcionaremos una opción para que se conecte directamente a Mi Comunidad con AARP.

Muy bien, escuchemos algo más de nuestros expertos. Dra. Neuman, ya hablamos un poco sobre esto antes. ¿De qué manera se mitigaron las regulaciones y se amplió la cobertura de Medicare?

¿Y cómo se alinean particularmente las aseguradoras privadas con estos cambios de cobertura?

TRICIA NEUMAN: Bueno, Medicare, antes de la pandemia de coronavirus, Medicare realmente tenía una definición bastante restrictiva de lo que cubría. Y en general, restringió la cobertura total de telesalud para las personas que viven en áreas rurales, y luego, solo si las personas tenían una relación de hace tiempo con su proveedor y con ciertos dispositivos.

Este es un mundo muy nuevo para Medicare y para los beneficiarios de Medicare. Medicare Advantage, los planes privados, han tenido más flexibilidad. Durante este período de tiempo, los planes Medicare Advantage, la mayoría de ellos ofrecen algunos servicios de telesalud. Y será interesante ver cuánto han ampliado los servicios que cubren y si continúan haciéndolo después de la emergencia.

Medicare también permitió que más proveedores presten servicios de telesalud. Y esto puede haber surgido cuando yo no estaba en la llamada.

Pero estoy pensando en centros de salud calificados a nivel federal, clínicas de salud rurales que pueden proporcionar estos servicios directamente. Hay más oportunidades para las agencias de atención médica a domicilio y los proveedores de cuidados paliativos. La idea es proteger a los pacientes y proteger a los proveedores y permitir que las personas se queden en casa, se refugien en ese lugar, para minimizar el riesgo de infectarse, ayudando tanto a los pacientes como a los cuidadores que los cuidan.

Y los cambios que se han hecho en las reglas para el período de emergencia podría tener profundas implicaciones en el futuro sobre cómo se trata la cobertura de salud. Pero mientras tanto, es realmente útil para las personas porque ahora las personas tienen la oportunidad, pueden llamar a su médico, pueden hablar sobre un problema, pueden usar un teléfono viejo y simple y hacer la vida mucho más fácil durante este período en que simplemente se quedan en casa.

Y creo que también es una oportunidad para que las personas se acerquen a otras personas que pueden sentirse menos cómodas con la tecnología, y para ayudar a los vecinos y a los miembros de la familia a sentirse más cómodos para que ellos también puedan usar los diversos dispositivos que tienen a su disposición. Y pide ayuda.

Si, a decir verdad, tienes la tecnología, pero no sabe cómo usarla, este es un buen momento para tratar de aprender, de modo que haya formas de llegar a más personas, proveedores médicos, familiares y amigos.

Medicare también, por cierto, ha realizado algunos otros cambios realmente importantes más allá de la telesalud. Por ejemplo, Medicare, al igual que las aseguradoras privadas, ha renunciado a los costos compartidos para las pruebas, lo cual es una ayuda financiera significativa para las personas que necesitan hacerse la prueba.

También ha requerido que los planes de la Parte D proporcionen un suministro de medicamentos para 90 días, lo que permite a las personas quedarse en casa por un período de tiempo más largo, en lugar de ir a la farmacia.

Y eso también es enormemente útil para las personas, especialmente si tienen un mayor riesgo de infección. Y ha dicho que, si una futura vacuna llega al mercado, estará cubierta sin costos compartidos.

Para las personas que pueden estar preocupadas por: "Oh, ¿cuál será el costo de una vacuna si aparece?" eso no debería ser un problema.

JEAN SETZFAND: Genial, gracias. Gracias por resaltar esos cambios y también por recordarnos que si no sabe cómo conectarse a través de la telesalud, el servicio de telemedicina, quizás pueda comunicarse con otros para pedir ayuda.

Nuevamente, permítanme recordarle a las personas que pueden visitar www.aarp.org/elcoronavirus. Y hay una sección especial sobre telesalud, realmente los pasos básicos sobre cómo conectarse. Muy bien, gracias Dra. Neuman.

Dr. Kvedar, obviamente, con este tipo de tiempos difíciles, creo que cada vez más personas experimentan ansiedad o depresión y otros problemas psicológicos nuevos o intensificados.

Mencionaste esto antes, pero ¿cómo puede la telesalud ayudar a la gente en estas circunstancias?

JOE KVEDAR: Bueno, es una solución maravillosa. De alguna manera, tendemos a pensar que puede ser mejor que una interacción cara a cara, simplemente porque, como una persona que tiene ansiedad o depresión, es un gran desafío salir de su casa y viajar a un establecimiento para ver a alguien.

Entonces, ahora podemos atenderte ya y en tu propia casa. Uno de mis colegas mencionó anteriormente que podemos ver qué hay a su alrededor en el hogar, y eso es muy importante para nosotros, en términos de comprender su entorno y cómo eso afecta su salud mental.

Antes de la pandemia, aproximadamente el 48% de los profesionales de la salud mental habían usado algún tipo de telesalud en su práctica. Así que la mayoría de ellos están bien equipados. Otra cosa que solo debo mencionar es que el examen físico en una visita de salud mental es hablar con el paciente, por lo que también es ideal desde esa perspectiva.

Hay una advertencia que debo mencionar, que es que, incluso antes de esta emergencia de salud pública, había una acumulación de necesidad de servicios de salud mental. Y ahora es aún más agudo.

Desafortunadamente, no hay suficientes profesionales de la salud mental para todos. Pero la tecnología nos permite conectarnos muy bien con las personas y es una excelente solución para ese problema.

JEAN SETZFAND: Genial. Gracias por ese recordatorio y también por compartir sus pensamientos sobre telesalud en el apoyo de salud mental.

Permítanme recordarles a las personas que si tienen una pregunta, por favor presionen * 3 en cualquier momento en su teclado telefónico para conectarse con el personal de AARP para compartir su pregunta

Antes de volver a sus preguntas en vivo, quiero proporcionar una alerta de coronavirus rápida de la Red de vigilancia contra el Fraude, de AARP. Los estafadores, desafortunadamente, todavía están tratando de obtener su dinero e información personal alegando curas que son falsas e incluso construyendo centros de pruebas falsas en algunas comunidades.

Todos ofrecen inversiones falsas, se hacen pasar por profesionales médicos para cobrar pagos, se hacen pasar por autoridades de salud mundial, realizan campañas de "phishing" en línea para engañar a los destinatarios con software malicioso.

Esta semana, los pagos de estímulo de coronavirus están comenzando a llegar las cuentas bancarias, y los estafadores están tratando de sacarle el jugo, desafortunadamente. Los estafadores están llamando, enviando correos electrónicos o enviando mensajes de texto, diciendo que necesitan dinero o información de la cuenta bancaria para depositar o acelerar sus pagos de cheques de estímulo.

Es importante saber que el Gobierno federal no llamará para solicitar información antes de procesar cualquiera de los pagos de estímulo. Para obtener información oficial sobre los pagos de impacto económico, visite Corona Tax Relief, en la página www.irs.gov. Nuevamente, visite la página Corona Tax Relief en www.irs.gov.

Y si sospecha de una estafa, visite www.aarp.org/fraude.  Puede buscar estafas en su área, o informar una estafa, tomar medidas y luchar contra los estafadores. O puede llamar a nuestra línea de ayuda, la línea de ayuda de la Red contra el Fraude, al 877-908-3360. Nuevamente, tenemos voluntarios en el personal para responder sus llamadas al 877-908-3360 en la línea de ayuda de la Red contra el Fraude, de AARP.

Muy bien, recibamos más de sus preguntas. Y haremos que el Dr. Kvedar, la Dra. Neuman y el Dr. Gettinger respondan a ellas. Recuerde, presione * 3 en cualquier momento en el teclado de su teléfono para conectarse con el personal de AARP y compartir su pregunta.

Y nuevamente, para obtener más información, como dije antes, puede visitar www.aarp.org/elcoronavirus. Allí, puedes ver más información sobre el coronavirus. Y si sus preguntas no son respondidas, hay muchos recursos allí.

Muy bien, volviendo a sus preguntas. Jesse, ¿a quién más tenemos en línea?

JESSE SALINAS: Sí, vamos a traer a Ken de Míchigan.

JEAN SETZFAND: Hola, Ken.

KEN: Hola, ¿cómo está? Mi pregunta es, ¿hay algún problema potencial de negligencia médica específicamente relacionado con los proveedores de telesalud?

JEAN SETZFAND: Gracias por su pregunta, Ken. Déjeme comenzar con el Dr. Gettinger. ¿Qué piensa sobre eso?

ANDREW GETTINGER: Creo que es una gran pregunta para hacer. Creo que muchos médicos y otros clínicos han hecho preguntas similares. Creo que si brinda una atención eficaz, si a través de una visita de telemedicina hace todas las cosas que haría en el consultorio, sin el examen físico obvio, es poco probable que el hecho de que sea una visita de telemedicina aumentaría su riesgo con respecto a negligencia.

Lo digo con la advertencia de que no soy un abogado y no necesariamente un experto. Pero, ciertamente, en 30 años de práctica, no me preocupé por esas cosas. Solo quería cuidar bien a mis pacientes. Y eso es lo que la telemedicina nos permite hacer durante estos tiempos muy difíciles.

JEAN SETZFAND: Muchas gracias por eso, Dr. Gettinger. Jesse, ¿a quién más tenemos en línea hoy?

JESSE SALINAS: Sí, vamos a traer a Queenie de Nueva York.

JEAN SETZFAND: Hola.

QUEENIE: Hola. Soy una paciente de alto riesgo y estoy muy preocupada por la experiencia que tuve en el hospital cuando fui porque soy asmática, y mi médica me aconsejó que fuera al hospital.

Y en mi primera visita allí, me hicieron una radiografía de tórax, una vacuna contra la gripe y el virus. Y me enviaron a casa con algunos medicamentos para el asma y me dijeron que me quedara 14 días.

14 días después, llamé a mi médica de atención primaria y todavía no me sentía bien, así que me dijo que quería que volviera. Regresé al mismo hospital.

Y luego, cuando llegué allí, me hicieron una tomografía computarizada, hicieron otra radiografía e hicieron otra, también, prueba del virus y me dijeron que tenía una infección en el pecho. Y la doctora dijo que se estaba concentrando en que me admitieran. Y ella dijo que no había habitación en el hospital en el que yo estaba. Ella iba a hacerme ingresar a uno de sus hospitales hermanos.

Le pregunté si era un hospital designado al virus. Ella dijo que sí. Entonces, le informé que me habían hecho la prueba y que tenía un resultado negativo. Y le pregunté, ¿estaría en una habitación privada? Ella dijo que no, que compartiría una habitación con otra persona que tiene el virus. Y estaba muy, muy preocupada porque, si no tengo el virus, ¿por qué voy a compartir una habitación con pacientes que sí lo tienen?

JEAN SETZFAND: Gracias, Queenie. Gracias. Dr. Kvedar, en una situación como esta, ¿sería útil la telemedicina de alguna manera, dadas las circunstancias que acabamos de escuchar de Queenie?

JOE KVEDAR: No. Lamentablemente, no lo creo. Creo que la necesidad de realizarse la prueba que describió, el hecho de que tiene asma, creo, por lo que entiendo, que los médicos estaban muy, muy, muy preocupados por asegurarse de que la cuidaran bien.

La última parte es difícil de saber sin haber estado allí. No creo que nadie te ponga a sabiendas en la misma habitación con alguien que tenga coronavirus. Creo que es poco probable. Sé que los hospitales están cortos, en este momento, de capacidad.

Pero las personas se enferman de otras cosas además del virus, y un ataque de asma, o una infección en el pecho empeorada por el asma, es algo grave.

Pero, una vez más, no creo que la telemedicina vaya a desempeñar un papel en resolver eso, desafortunadamente.

JEAN SETZFAND: Bien. Bueno, gracias por su orientación, Dr. Kvedar. Muy bien, Jesse, ¿a quién más tenemos en línea?

JESSE SALINAS: Sí, nuestra próxima pregunta es de Facebook. Tenemos a Mónica, y ella pregunta si no se aplican excepciones a copagos y deducibles para la telesalud, y específicamente en relación con el manejo de la atención crónica y cosas así.

JEAN SETZFAND: Gracias. Dra. Neuman, ¿qué le parece esa pregunta?

TRICIA NEUMAN: Bueno, creo que variará según las diferentes aseguradoras, por lo que no creo que haya una sola respuesta a esa pregunta, que yo sepa. Entonces, sí, está cubierto, pero generalmente no hay excepciones para el costo compartido.

El costo compartido no se aplica, como creo que mencioné antes, si se trata de una visita al médico asociada con una prueba, pero no de manera consistente.

JEAN SETZFAND: Entonces, probablemente se necesite algo de trabajo preliminar y algo de investigación adicional para resolverlo. Excelente. Muchas gracias por eso.

Jesse, ¿a quién más tenemos a continuación para nuestras llamadas?

JESSE SALINAS: Sí, creo que tenemos una pregunta similar de Tom en Pensilvania.

JEAN SETZFAND: Hola, Tom. ¿Hola, Tom? Muy bien, creo que hemos perdido a Tom.

Muy bien, ¿a quién más tenemos en línea, Jesse?

JESSE SALINAS: Traigamos a Jean de Massachusetts.

JEAN: Hola a todos. Soy Jean de Massachusetts. Dirijo un Consejo sobre el Envejecimiento, y aunque no estamos físicamente abiertos, estamos haciendo un gran número de llamadas de atención a nuestros clientes.

Y estamos lidiando con un alto grado de aislamiento social, y sabemos quiénes son estas personas, y podemos hablar con ellos extensamente. Sin embargo, debido a que somos una organización de servicios basada en la comunidad, y no una organización clínica, realmente no podemos intervenir para que su médico sepa lo que estamos descubriendo.

Mi pregunta es: ¿los médicos, que tienen perfiles de pacientes que son personas mayores, que son propensos a problemas de salud mental, están llamando de manera proactiva y llegando a través de telesalud a estos pacientes? Y si es así, ¿está cubierto? ¿Qué están haciendo los diversos médicos con respecto al hecho de que, en un día típico, yo tenía entre 150 y 160 adultos mayores que venían a realizar una variedad de actividades, una de ellas conectividad con otros seres humanos, y ahora no pueden?

Pero nosotros estamos realizando llamadas de atención para ellos. ¿Qué está haciendo el sistema de salud de manera proactiva, a través de cosas como la telesalud, para conectarse con estos adultos mayores?

JEAN SETZFAND: Genial. Gracias por esa pregunta. Dr. Gettinger, creo que voy a comenzar con usted. ¿Tiene alguna idea sobre eso?

ANDREW GETTINGER: Bueno, nuevamente es una gran pregunta, y no tengo una idea particular de lo que están haciendo los médicos de la comunidad. Lo que escuché ayer, que fue un poco sorprendente, pero una noticia realmente feliz, fue del Secretario de VA, quien describió que, en estas circunstancias, nuevamente, una población de edad avanzada con muchas necesidades médicas, que, en esta ventana de tiempo, esa población en realidad estaba mucho mejor de lo esperado en una variedad de formas, no menos importante, han visto una reducción dramática en los veteranos que atentan contra sí mismos.

Y lo atribuyó a la creciente comunicación que se estaba produciendo a través de encuentros tipo telemedicina. De nuevo, esa es la población de VA. Dejaré que otros comenten de manera más general sobre la comunidad.

JEAN SETZFAND: Dr. Kvedar o Dra. Neuman, ¿tienen algo que compartir sobre la última pregunta?

JOE KVEDAR: Solo diría que nuestros médicos están bastante atareados en este momento, por lo que puede que no esté sucediendo en la medida en que nos gustaría. Y respaldaría por completo que conocer el impacto que tiene el aislamiento social, que es significativo.

Pero dicho eso, creo que, como dije antes, nuestros profesionales de la salud mental están lidiando con la mayor cantidad de entrantes y, lamentablemente, es posible que no tengan la capacidad de realizar una gran cantidad de actividades de difusión proactiva.

JEAN SETZFAND: ¿Dra. Neuman?

TRICIA NEUMAN: Lo único que agregaría es que estuve escuchando, y esto es realmente de boca en boca, esto varía según la profesión y la práctica médica, algunos médicos y proveedores de salud mental, específicamente, se están comunicando para ofrecer a sus pacientes la oportunidad de recibir tratamiento, lo que no quiere decir que no haya problemas de capacidad.

Por supuesto que los hay. Pero estuve escuchando acerca de algún alcance de los proveedores. Y me pregunto si la persona que llama podría pensar en alentar a los clientes que ve, que están lidiando con depresión u otras preocupaciones relacionadas con el aislamiento social, a comunicarse directamente con sus médicos u otros proveedores, para obtener ayuda, ya sea para mantener algún tipo de conexión de manera continua con un proveedor de salud mental o para encontrar a otra persona que pueda brindarle apoyo durante este período.

JEAN SETZFAND: Muy bien. Gracias. Muy bien, Jesse, ¿a quién más tenemos en la línea?

JESSE SALINAS: Sí, tenemos a Toni de Washington en la línea.

TONI: Sí. Me gustaría saber, en términos de seguridad y privacidad de la utilización de Zoom y telesalud. Mi proveedor está en Sequim, Washington, a unas 16 millas de donde vivo en Port Angeles. Tomo...

[TOS]

Disculpe, tragué mal.

Tomo transporte público, transporte ADA para llegar allí. Y solo tengo ese medio de transporte. Me gustaría saber sobre esto porque entiendo que el proveedor y la clínica del proveedor solo usan Zoom para telesalud, si alguna vez necesitara ver o hablar con mi médico. ¿Qué debo hacer? ¿Cómo abordo esto?

JEAN SETZFAND: Gracias por esa pregunta, Toni. Dr. Kvedar, Dr. Gettinger, sé que ambos hablaron sobre esto. Permítanme comenzar con el Dr. Kvedar. ¿Qué piensa sobre las diversas formas de conexiones de video, por ejemplo, con Zoom y todo lo que estamos escuchando sobre preocupaciones de privacidad?

JOE KVEDAR: Bien. Gracias. Es una pregunta maravillosa. Creo que la noticia es buena. Ha habido noticias sobre personas que irrumpieron en reuniones de Zoom. Y hasta donde yo sé, todos los casos que conozco fueron veces en que las personas publicaron un enlace de Zoom en algún tipo de foro público, como Facebook o Twitter.

Nuevamente, la mayoría de los que escuché fueron reuniones de Alcohólicos Anónimos o reuniones de Narcóticos Anónimos. Y aunque creo que esas fueron historias muy tristes, debido a la maldad y la intención nefasta de la persona que llamó, no lo llamaría piratería, porque el enlace era público.

Creo que si su médico quiere usar Zoom, asegúrese de que comparta ese enlace de Zoom con usted de una manera muy privada, tal vez a través de un portal para pacientes, algo así. Y creo que la probabilidad de que interfieran con su privacidad es extremadamente baja.

La otra cosa que diría es que la parte realmente importante de la conversación de privacidad es cómo se documenta su visita en el registro electrónico. Y de nuevo, eso no ha cambiado.

Tenemos sistemas lo más privados posibles para registros electrónicos. Solo terminaría diciendo que creo que la posibilidad de que su privacidad sea invadida en una interacción de telesalud es extremadamente baja. Y no dejaría que eso se interpusiera en tener una conversación con su médico por este medio.

JEAN SETZFAND: Bien. Gracias. Dr. Gettinger, ¿tiene algo que añadir?

ANDREW GETTINGER: No. Estoy completamente de acuerdo. Lo único que agregaría es que, en general, el FBI ha brindado algo de orientación para las reuniones de Zoom. Y parte de esa guía implica siempre usar una contraseña, además de asegurarse de que el enlace sea privado.

Y de hecho, no estoy seguro de qué versión usa su médico, está la versión gratuita, que ha sido un poco más susceptible. La versión profesional, o la versión por la que paga, tiene más opciones de seguridad disponibles.

JEAN SETZFAND: Genial. Gracias por esa guía. Muy bien, en nuestros últimos minutos, creo que tenemos algunas llamadas más en línea. Jesse, ¿a quién más tenemos en línea?

JESSE SALINAS: Nuestra próxima pregunta vendrá de Reid en Wisconsin.

REID: Hola, soy Reid. Me preocupa la brecha digital. Sé que si estás en Wisconsin, el gobernador este año obtuvo fondos para acceder a la banda ancha para más parte del estado. Y la intención es que gran parte de la telesalud sofisticada ocurra con un ancho de banda que sería muy útil para los diagnósticos.

Prácticamente tienes que tener banda ancha para algunas de esas cosas. Y me parece que tiende a ser una brecha digital geográfica, ya que en las áreas rurales, las compañías que lo proveen, no parecen tener medios económicos o impulso para proporcionarlo.

Me preguntaba qué piensan de eso.

JEAN SETZFAND: Genial. Gracias por esa pregunta. Dr. Gettinger, voy a comenzar con usted.

ANDREW GETTINGER: Sí, creo que es un problema real. Y les puedo asegurar que algunos de nosotros en el Gobierno estamos hablando de eso. Es, al menos históricamente, solo para retroceder muchos años, cuando la única forma en que nos comunicábamos en las zonas rurales era con teléfonos fijos. Las personas que estaban brindando atención clínica o de guardia tendrían prioridad.

La FCC, cuando regulaba de una manera diferente, se aseguró de que los proveedores de telecomunicaciones hicieran eso para los médicos. Me estoy imaginando un estado futuro donde las telecomunicaciones con fines clínicos serían igualmente compatibles, y reconocemos completamente que ese no es el caso ahora.

Y la mala noticia es que, dado que gran parte de la conectividad digital se traslada a 5G y hoy en día las cosas le llegan a las personas a través de lineas de fibra y cobre, especialmente en áreas urbanas, en áreas rurales, 5G simplemente no tiene la penetración de distancia que será necesaria.

Entonces, creo que este problema no va a desaparecer. Y lo que he visto, estoy en la zona rural de Nuevo Hampshire actualmente, y he visto a las comunidades locales reconocer que su vitalidad y su futuro dependen de la banda ancha, por lo que la banda ancha se está convirtiendo en un servicio que no es solo empresas de telecomunicaciones, sino también es un servicio de la comunidad local.

JEAN SETZFAND: Gracias. Dr. Kvedar, ¿tiene alguna idea para agregar desde la perspectiva de

la Asociación de Telemedicina?

JOE KVEDAR: Bueno, abogamos por más banda ancha para más personas. Es un problema real. Volveré a decir que no todo está perdido, dado que durante la emergencia de salud pública, podemos usar el teléfono.

Y lo mencioné anteriormente, pero no quita mi entusiasmo por tener más banda ancha para más ciudadanos, especialmente en las zonas rurales. Estoy completamente de acuerdo, hay que hacerlo.

JEAN SETZFAND: Genial. Gracias. Muy bien, creo que tenemos tiempo para una última pregunta.

Jesse, ¿de quién es nuestra última pregunta?

JESSE SALINAS: Sí, la siguiente pregunta proviene de Facebook, Jean. Es Jim de Colorado. Y Jim pregunta si hay algún alivio para los pagos de Medicare Premium durante esta pandemia.

Dicen que pagan mucho por el seguro. Realmente les vendría bien algo de ayuda en este momento.

JEAN SETZFAND: Muy buena pregunta. Dra. Neuman, ¿puede ayudarnos con esa pregunta?

TRICIA NEUMAN: Bueno, esa es una buena pregunta. He escuchado discusiones acerca de proporcionar alivio en costos compartidos, particularmente para tratamientos relacionados con COVID. No he escuchado nada sobre brindar alivio a las personas con premium.

Es una preocupación seria que muchas personas con Medicare, no exclusivamente Medicare, sino muchas personas con Medicare, luchan con los gastos de salud. Y creo que lo que esta situación está sacando a la luz el asunto de las primas son los costos compartidos, el paquete completo que consume una parte bastante grande de los ingresos de jubilación de las personas. Lamento decir que no he escuchado ninguna discusión sobre el alivio con las primas.

JEAN SETZFAND: Gracias por destacar eso para nosotros. Nos estamos quedando sin tiempo, así que permítanme pedirles a nuestros estimados panelistas que nos otorguen algunos pensamientos finales. Comenzando con el Dr. Gettinger, siguiendo con el Dr. Kvedar, la Dra. Neuman, ¿alguna idea que tengan para nuestros miembros, nuestros oyentes de hoy?

¿Qué sería lo último que les gustaría compartir?

Una vez más, Dr. Gettinger, ¿quiere comenzar?

ANDREW GETTINGER: Absolutamente. Tal como lo experimentamos hoy en la llamada, un poco de inconvenientes aquí, un poco de inconvenientes allí, alejándome, diría que la llamada fue muy exitosa. Yo diría que ser tolerante, ser paciente; la telemedicina, para muchos médicos y para muchos pacientes, es un nuevo modo de atención. Y creo que ha llegado para quedarse.

Pero nos tomará un poco de tiempo resolver todos los problemas, descubrir cuáles son las mejores prácticas para un médico individual, así como para los pacientes. Sigo siendo muy optimista y entusiasta. Gracias por preguntar.

JEAN SETZFAND: ¿Dr. Kvedar?

JOE KVEDAR: Bueno, comparto el entusiasmo de mi colega y le agradezco por invitarme a esto. Lo que les he estado recordando a la gente como sus oyentes, así que esta es una súplica, si tiene una buena experiencia, dígale a su congresista o senador que no quiere volver a tener un solo canal para la prestación de atención médica, que es tener que ir al consultorio.

Como dijimos, no todo será ideal para la telesalud. Pero diría que la otra cara es que si no podemos salir de esta crisis con más de un canal para la prestación de atención médica, entonces es un día triste para nuestro país, tener que volver a lo que realmente es un estilo de distribución de servicio del siglo XX.

"Tiene que venir a verme a un lugar físico, y esa es la única forma de hacer algo". Entonces, hable. Hable con sus políticos. Y asegúrese de que sepan que no quieres volver.

JEAN SETZFAND: Muchas gracias. ¿Y Dra. Neuman?

TRICIA NEUMAN: Sí, estoy de acuerdo en que será muy difícil volver a meter al genio en la botella. Y también estoy de acuerdo en que los pacientes y los médicos están en una curva de aprendizaje empinada en este momento.

Y este es un momento en que la gente está resolviendo los problemas. Queremos aprovechar este tiempo para aprender qué tan bien funciona la telesalud, cuándo funciona, cuándo no funciona y cómo hacer que funcione mejor.

Esta es una oportunidad para utilizar una nueva tecnología, o una tecnología antigua de una manera nueva, para ayudarnos a todos a mantenernos más seguros. Es una oportunidad para que las personas que no están tan familiarizadas con este tipo de tecnología, o comunicarse de esta manera con sus médicos, se sientan más cómodas con ella, si así lo desean, y nos ayuden a todos a descubrir cuándo es la línea correcta de comunicación y cómo hacer que funcione de la mejor manera posible para mejorar nuestra seguridad y mejorar la comunicación que tenemos entre nosotros.

Creo que esta es una gran oportunidad, y creo que es muy poco probable que volvamos a los negocios como siempre sin depender tanto de la telesalud. Pero cómo lo usamos cuando lo usamos, sigue siendo una pregunta abierta.

JEAN SETZFAND: Muy bien. Gracias. Nuevamente, muchas gracias por su paciencia con nosotros hoy. Creo que modelamos el comienzo del futuro de la telesalud con nuestras dificultades técnicas. Pero muchas gracias por su optimismo. Muchas gracias por su orientación práctica.

Creo que hoy hemos disipado algunas preguntas y preocupaciones de nuestros oyentes. Y ha sido una discusión tan informativa. Quiero agradecer a cada uno de ustedes por unirse a nuestra llamada. Y quiero agradecer a todos nuestros oyentes, nuestros socios de AARP, y los voluntarios por participar en esta discusión.

Nuevamente, permítanme decirles que tenemos la capacidad de brindarles una voz amigable a través de nuestro Mi Comunidad con AARP. Tenemos voluntarios capacitados esperando, como dije antes.

Este es un servicio gratuito para todos los adultos, independientemente de su membresía. Y ofrecemos algunas capacidades bilingües, incluido el español.

Para conectarse ahora a Mi Comunidad con AARP, puede presionar * 0 en el teclado de su teléfono y su llamada será derivada al servicio.

Nuevamente, siéntase libre de presionar * 0 y puede, ser derivado al servicio gratuito en este momento. O puede llamar en cualquier momento al 888-281-0145. De nuevo, ese número es 888-281-0145.

AARP es una organización de membresía sin fines de lucro y no partidista, y hemos estado trabajando arduamente para promover la salud y el bienestar de los estadounidenses mayores durante, nuevamente, más de 60 años.

Ante esta crisis, estamos brindando información y recursos para ayudar a los adultos mayores y a aquellos que los cuidan a protegerse del virus, evitar su propagación a los demás y cuidarse a sí mismos.

Todos los recursos a los que se hace referencia, incluida una grabación del evento de preguntas y respuestas de hoy, se pueden encontrar en www.aarp.org/elcoronavirus a partir del 17 de abril.

Nuevamente, el sitio web en español es www.aarp.org/elcoronavirus. Por favor visite este sitio web. Si su pregunta no fue respondida, encontrará las últimas actualizaciones, así como información creada específicamente para adultos mayores y cuidadores familiares.

Esperamos que haya aprendido algo que pueda ayudarlo a mantenerse saludable usted y sus seres queridos. Asegúrese de sintonizar la próxima semana nuestra próxima teleasamblea de AARP. De hecho, estamos ofreciendo dos eventos de preguntas y respuestas el próximo jueves 23 de abril.

El primero, será nuevamente a la misma hora, 1:00 p. m., hora del este, donde nos centraremos en el cuidado de sus seres queridos en instalaciones, como hogares de ancianos y centros de atención a largo plazo. Y también ofreceremos un tema separado para conversar a las 7:00 p.m., hora del este, centrado en el desafortunado impacto dispar del coronavirus.

Pero quiero agradecerles nuevamente por acompañarnos hoy.

Tengan un buen día.

Y esto concluye nuestro llamado.

 

 


For the latest coronavirus news and advice, go to AARP.org/coronavirus.


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  • July 9 - Coronavirus: Your Most Frequently Asked Questions
  • June 18 and 20 - Strengthening Relationships Over Time and  LGBTQ Non-Discrimination Protections
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  • April 30 – Coronavirus: Caring for Parents, Kids & Grandkids
  • April 23 – Coronavirus: Supporting Loved Ones in Care Facilities and Disparate Impact on Communities
  • April 16 – Coronavirus: Telehealth
  • April 9 – Coronavirus: Coping and Maintaining Your Well-Being
  • April 2 – Coronavirus: Managing Your Money and Protecting Your Health
  • March 26 – Coronavirus: Protecting and Caring for Loved Ones
  • March 19  Coronavirus: Protect Your Health, Wealth and Loved Ones
  • March 10 – Coronavirus: Symptoms. How to Protect Yourself, and What It Means for Older Adults and Caregivers
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