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Virtual care: The alternative to a doctor’s office visit gains in popularity during pandemic

As COVID-19 became a reality, 

many people were 

concerned about

access to health care



I didn’t know what to expect. And I didn’t know how life was going to be. 


Michigan Medicine is

finding ways to help

all patients

during the pandemic



I was diagnosed with PCD around five years ago. It stands for primary ciliary dyskinesia. 



Michigan Medicine

The general strategy in managing this condition is seeing patients like her every three months. But for now, it’s very difficult both for families and for the health care professionals

to get people into clinic that frequently for that level of care. So what this young lady and I and her parents have agreed to is to do frequent virtual visits. 


Michigan Medicine

has conducted


video and phone visits

since the pandemic began


ELLY [name not displayed]

I like using virtual care because it’s easier to work around my school schedule, and it’s, like, a lot  healthier because of what’s going on right now. 

SABA [name not displayed]

I can see people relatively quickly, and much more frequently. Even though we still have these needs to do physical assessments with patients, this is a really nice tool for us to have to let patients know that we are always here for you. 


For patients

leaving the hospital

who still need care


Karen and her colleagues 

provide home monitoring kits



Michigan Medicine

We send them home from the hospital with a kit that contains a scale, a blood pressure cuff, a tablet, a pulse oximetry machine, thermometer, and a blood glucose machine. 


The readouts are

automatically sent

to a 24/7 care team


Pat was given a home kit

after a recent hospitalization


PATRICIA [name not displayed]

It was so easy to use, it was wonderful. And on one occasion when my numbers were not good, I got a call very early in the morning from a nurse, and that made me feel well cared for. 


And Michigan Medicine

continues to

conduct research 

on telemedicine


through its

Telehealth Research




Institute for Healthcare Policy and Innovation

at the University of Michigan


One of the key areas that we’re working on is disparities in care: identifying the areas where disparities exist the most, and then finding ways to fix those disparities and improve access for all populations. The ultimate goal here is to inform policymaking. 


Michigan Medicine has


ongoing telemedicine

research projects


and continues to

find ways to help

all patients


All the doctors are really good about figuring out 

what’s the best thing to do for me to get me feeling like myself again. 


PATRICIA [name not displayed]

I felt well cared for. I think that it’s a great advance in client care.

Video Produced by Jarrett Begick, Michigan Media All photos by Eric Bronson, Michigan Photography
By Jina Sawani and Kelly Malcom, Michigan Medicine

When the COVID-19 pandemic hit, many people were concerned about their access to health care. But 15-year-old Elly LeCursi knew that visits with her doctor would be business as usual.

She was diagnosed with PCD, or primary ciliary dyskinesia, five years ago and has been a virtual patient at Michigan Medicine since then. The cilia throughout her respiratory system does not function properly, making it difficult for her to produce mucus. LeCursi is immunocompromised and regularly sees a pediatric pulmonologist.

Elly LeCursi, a patient of Dr. Tom Saba, at her home in Saline, Michigan

Elly LeCursi, at her home in Saline

“My doctor, Thomas Saba, is really good about communicating with me through email when I can’t see him in person,” LeCursi said. “And during the quarantine, I got sick and we emailed back and forth to figure out the best way for me to get better.”

She says their email exchange eventually led to a video visit where Saba could determine the best path forward for her health.

“I’ve always liked using virtual care because it’s easier to work around my school schedule and extracurricular activities. I can also be home when I need to be home—I’ve even had visits with Dr. Saba from our car,” LeCursi said. “Also, it’s a lot healthier given everything that’s going on right now with the pandemic.”

“And with my virtual visits, I feel free to talk to someone if I have questions. I’m very impressed by how easy the setup is, it’s a great advance in client care and I feel very well cared for.”
– Pat Pooley, a Michigan Medicine patient.

According to Saba, when COVID-19 cases ramped up in March, Michigan Medicine’s doctors, nurses and other health care professionals were naturally focused on managing the disease. Personal protective equipment and logistics regarding a potential field hospital were top of mind.

There was also an incredible amount of effort around maintaining sufficient access to care for the academic medical center’s existing and future patients.

“We had a commitment to our patients and wanted to continue providing them with the level of care that they were used to,” Saba said. “That’s why a massive amount of work went into training thousands and thousands of our employees in telemedicine, a platform that has existed for many years.”

Tom Saba, a pediatric pulmonologist at Michigan Medicine

Tom Saba

Video visits have been available to Michigan Medicine patients in a slowly increasing number of ambulatory clinics since 2016, and e-visits have been offered to primary care patients since 2017. But it took several key policy shifts at the federal level in response to the pandemic to enable the recent rapid surge of telehealth.

“The No. 1 thing that made it possible was making people’s homes as a site where patients can connect and receive telemedicine,” said Chad Ellimoottil, assistant professor of urology and director of the U-M Institute for Healthcare Policy and Innovation’s Telehealth Research Incubator.

Up until March 2020, the Medicare program did not allow patients to connect using their smart phones from home. But as the pandemic began to unfold and shelter-in-place measures were instituted across the country, Medicare not only allowed patients to connect with clinicians from home, it allowed for the use of non-HIPAA-compliant equipment and the practice of medicine across state lines.

Before these moves, providers couldn’t be sure whether a patient would get stuck with a large bill for a telehealth visit, Ellimoottil says. Now, Medicare considers a video visit equivalent to an office visit.

Dr. Chad Ellimoottil at the North Campus Research Complex in Ann Arbor, Michigan. Ellimoottil is director of the Telehealth Research Incubator.

Chad Ellimoottil at the North Campus Research Complex

With these barriers removed, providers were able to respond to the rapidly growing interest in telehealth visits by streamlining operations and quickly training more providers. To date, Michigan Medicine has conducted more than 350,000 video and phone visits since the pandemic started.

For patients leaving the hospital that still need care, Karen Neeb, a nurse practitioner at Michigan Medicine, provides them with home monitoring kits. The readouts are automatically sent to a team that operates 24 hours a day, seven days a week.

“We treat people who have left the hospital but still need care, whether at a subacute rehab center or in their own homes,” Neeb said. “We also go to several nursing homes in the surrounding area to care for Michigan Medicine patients.”

Neeb says that when the pandemic started, the patient monitoring at-home service was created to serve as a bridge for individuals who needed closer monitoring upon leaving the hospital.

Michigan Medicine Nurse practitioner Karen Neeb provides home monitoring kits for discharged patients who still need care

Nurse practitioner Karen Neeb

“We give them a kit that contains a scale, blood pressure cuff, tablet, pulse oximetry machine, thermometer and blood glucose machine so that we can monitor them closely and track their health,” she said. “Especially now, with people staying home to remain safe, we’re able to help them feel connected to their health care teams in ways that simply wouldn’t be possible otherwise.”

Many patients are new to the video visit system, so Neeb and her team provide them with this extra level of care by tracking things like their vital signs and weight, which help inform their primary care providers and other relevant specialists.

Virtual care offerings currently in use at Michigan Medicine include:

  • E-visits, where a patient fills out a questionnaire and receives a written treatment plan
  • E-consults, where a primary care provider and another provider, typically a specialist, consult regarding a specific patient/condition
  • Tele-specialty consults, conducted between Michigan Medicine providers and affiliates/partners to coordinate patient care
  • Video visits, involving two-way audiovisual communication between a patient and a Michigan Medicine provider

The COVID-spurred move to telemedicine also provides an unexpected boost to ongoing research by Ellimoottil and his team to study the impact of telehealth on health outcomes, cost and quality of care.

“Not only is this pandemic period uncovering new knowledge gaps, it’s giving us the ability to assess the existing knowledge gaps in a more robust way,” Ellimoottil said.

Meanwhile, virtual care is offering patients peace of mind during a very challenging time.

“Sometimes when you’re not feeling well and you’re concerned about something, you would like to know what the doctor or the nurse has to say about your situation,” said Pat Pooley, who is a Michigan Medicine patient. “And with my virtual visits, I feel free to talk to someone if I have questions. I’m very impressed by how easy the setup is, it’s a great advance in client care and I feel very well cared for.”

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