Virtual urgent care gaining popularity as ER alternative, and LI providers are expanding options

Jasmine Vazquez knew she and her 1-year-old daughter Skye needed quick medical attention for their fevers and the strange bumps that had appeared on their skin, but the last thing she wanted to do was take her toddler to an urgent-care center or emergency room.

So she didn’t.

Shortly after midnight on a Sunday in August, Vazquez was searching online for urgent-care centers when she came across an ad for Northwell Health’s ER on Demand. The service offers 24/7 video consultations with board-certified emergency medicine doctors, including pediatricians.

When her daughter woke up, Vazquez called the service a little before 9 a.m. Within 20 minutes, she said, “I was on the phone with a doctor.” The doctor diagnosed the pair with coxsackie virus, a contagious childhood ailment that can cause a blister-like rash, and stayed on the phone for about a half-hour to give advice and answer questions.

The video call was better than an in-person visit, Vazquez said.

'If I don't have to go to the emergency room, I'd rather not, especially with my baby.'

-Jasmine Vazquez, 29, of Baldwin Harbor

Credit: Danielle Silverman

“If I don't have to go to the emergency room, I'd rather not, especially with my baby,” said Vazquez, 29, a patient care assistant who lives in Baldwin Harbor with her three children and her mother. “Why would I want to bring my baby to a facility and possibly get her sicker, or get sick with something else, when I can just do it virtually?”

Plus, she said, at an emergency room, “you can be there for hours, as opposed to a virtual call that could be… 15 to 20 minutes or less.”

Vazquez is among a growing number of patients on Long Island and across the country who have opted for a spur-of-the-moment video call with a doctor instead of a trip to an urgent-care facility or hospital emergency room. Such urgent-care video calls have become increasingly common as the federal government has required insurers to cover telehealth consultations during the COVID-19 pandemic, to help reduce crowding and keep patients and providers safe from contagion.

“We really see ourselves as a new way of accessing the system, accessing health care, and we want to make it accessible to all,” said Dr. Jonathan Berkowitz, medical director at Northwell’s Center for Emergency Medical Services in Syosset, which offers ER on Demand and other services, such as coordinating Northwell’s ambulance and helicopter transportation  for more than 120,000 patients a year.

In addition to New Hyde Park-based Northwell’s service, virtual urgent care is available 24/7 at the urgent-care chain CityMD, and during scheduled hours at NYU Langone Health, Mount Sinai Health System and NewYork-Presbyterian, among other health-care providers. Patients typically are billed for virtual office visits, rather than the often-higher charges for hospital emergency care.

“I definitely think it's an underutilized service,” said Dr. Dan Frogel, chief medical officer at CityMD. “At two o'clock in the morning, your child wakes up with severe ear pain…you don’t have to run out in the middle of the night.”

CityMD launched its virtual program in 2019, seeing about 20 to 30 patients a day. Use of the service “spiked” to 300 to 400 patients a day as the pandemic took hold in spring 2020, Frogel said. In-person visits still make up the vast majority of CityMD’s services, though, with “tens of thousands” of face-to-face visits a day, he said.

Virtual care can be helpful for infectious diseases such as flu, COVID monkeypox, as well as for stomach bugs, minor injuries, rashes and other conditions, doctors said. A video call can help answer questions such as whether a cut requires stitches, Frogel said: “Sometimes it's almost a consultation, ‘do I even need to bother to get seen physically or not?’” 

Video consultations also are making it easier to connect medical specialists with patients in hospital emergency rooms, and even in ambulances. Stony Brook Medicine’s hospitals in Suffolk County and Mount Sinai South Nassau in Oceanside are among the local facilities that offer video consultations with psychiatrists, neurologists and other specialists for patients in the ER who might otherwise have to wait for in-person consultations. The hospitals have carts equipped with high-resolution cameras and video monitors that can be wheeled to patients’ beds for virtual visits.

Stony Brook provides video consultations in its Mobile Stroke Unit ambulances, so neurologists can use high-resolution cameras to examine patients remotely, speeding up diagnosis and treatment.

“Every second in a stroke really matters in terms of long-term outcomes,” said Susan Wilner, assistant director of behavioral health services operations at Stony Brook Medicine. A video consultation with a neurologist, she said, allows a patient’s treatment to begin “long before they get to the hospital, which is the most important piece.”

The use of all telehealth services has increased dramatically during the pandemic, with 46% of patients having engaged in video calls with their providers, up from 11% in 2019, consulting firm McKinsey & Company reported. An analysis of claims data showed that about 20% of all ER visits could have been replaced by telehealth calls, McKinsey found. Virtual urgent-care visits had an average wait time of about nine minutes and an average cost of $49, compared with a nearly 71-minute wait and a cost of almost $143 for an in-person visit for the same condition, according to an analysis published last year by researchers at the University of North Carolina at Chapel Hill.

Some researchers have raised concerns about whether virtual urgent care actually reduces health-care spending and delivers the same quality of care as in-person treatment. A study of nearly 29,000 virtual visits and more than 57,000 in-person visits for acute respiratory infections from 2016 through 2019 found that about 10% of virtual patients had in-person visits within a week, compared with about 6% of in-person patients who required additional care.

Virtual care "may yield immediate savings by diverting health care from higher-cost settings," but those savings could be offset by additional spending on follow-up care, the researchers wrote last year in the journal Health Affairs.

Doctors who specialize in urgent care say sometimes follow-up care is needed – whether for lab tests or X-rays, or for other in-person treatment – but very often patients' concerns can be addressed on a call. "A lot of problems we really can solve virtually," Frogel said. But, he said, some conditions "might require a higher level of care." 

Despite its spike in popularity during the pandemic, the future of insurance coverage for virtual urgent care remains unclear. The federal COVID-19 public health emergency declaration that mandates telehealth coverage during the pandemic is due to expire in mid-October, though health industry leaders expect the government to grant another 90-day extension.

UnitedHealthcare, the nation’s largest health insurer, has covered virtual urgent care since 2016, and the insurer announced last year it would continue to cover virtual care even after the pandemic ends. UHC members' use of virtual care has skyrocketed by more than 2500% during the pandemic, the insurer said. For patients covered by UHC, virtual care generally costs $49, much less than the cost of care in a hospital emergency department or even a walk-in clinic, said Dr. Donna O’Shea, chief medical officer of population health at the insurer.

“You go to one of those urgent cares down the road, oftentimes, let's face it, you don't know what you're going to get charged, right?” she said. “When we do it virtually, you know exactly what it is.”

Virtual urgent care can even be used for dental emergencies, if a patient needs an antibiotic or a painkiller until they can see a dentist in person, and UHC offers such visits free to its members with dental coverage, O’Shea said.

It remains to be seen whether all private insurers, and the government-sponsored Medicare and Medicaid programs that cover millions of older and low-income Americans, respectively, will continue to offer coverage for virtual health care once the public health emergency declaration eventually expires.

But despite the uncertain future of insurance coverage for telehealth visits, some Long Island hospital networks and other health care providers are expanding their virtual urgent-care options.

Northwell’s ER on Demand program began in late 2020 as an in-house service for employees. It is now open to all callers, regardless of whether they're already Northwell patients, and it serves about 80 to 100 patients a week on average, Northwell said. A review of more than 3,000 calls showed that 92% of patients were able to get the care they needed on the call, with the other 8% being referred to hospital emergency departments, Northwell said. 

The  health system is expanding the service by offering it as an after-hours option when its affiliated doctors’ offices are closed. The service can help reduce burnout among doctors by relieving them of some after-hours duties, said Sarah Healey Herod, an assistant vice president for operations at Northwell. 

Callers to ER on Demand speak first to a paramedic. For the most urgent calls – say, a potential stroke or heart attack – the paramedic will send an ambulance. For less time-sensitive matters, they’ll route the call to a doctor. Doctors can call in prescriptions, order lab tests and schedule imaging such as X-rays. 

ER on Demand “is really about getting the patient to the right level of care,” Northwell’s Berkowitz said. “If you get the patient the right level of care, the patient’s going to be happier, the care is more effective, and that is a win for everyone.”

Eugenia Domingo, 78, a retired accountant who lives in East Meadow, contacted ER on Demand last month, when she developed a headache and a painful cough in the early stages of a COVID-19 infection.

She spoke with a doctor who recommended over-the-counter pain relievers and cough syrup, among other treatments. Soon after, another doctor called from the service to check on her. Hearing she was still in distress, the doctor called her pharmacy with a prescription for Paxlovid, an antiviral COVID medication.

'I felt good after that…knowing I will get that medication.'

-Eugenia Domingo, 78, of East Meadow

Credit: Eugenia Domingo

“I felt good after that…knowing I will get that medication,” she recalled. She felt, she said, that she was “in good hands.” She has since recovered from the infection, she said.

Virtual urgent-care can also be a boon for people who get sick when they’re away from home.

Mark Brink, 61, a retired government worker who lives in New Jersey, was driving to a house he and his wife Carolyn had rented in East Hampton in May when he started to feel ill. Soon after, he tested positive for COVID. On a hastily arranged video call, he got a prescription for Paxlovid from a doctor with Manhattan-based Summit Health, which runs primary and specialty care offices as well as CityMD.

Brink said if he hadn’t been able to get virtual care, he probably would have had to wait hours at a hospital emergency room, since COVID-positive patients can’t be seen at many in-person facilities. Virtual care “is the way of the future,” Brink said.

In addition, as the demand for mental health care continues to exceed the supply, virtual urgent care can help fill the gap, said Dr. Payal Sud, associate chair in emergency medicine at Glen Cove Hospital. For patients whose psychiatric emergencies bring them to a hospital emergency department, she said, “If it's a matter of [waiting] for 10 days for someone to see you in person or [waiting] for an hour to see somebody on video, I think most people would probably want to pick the latter option to seek care in a more timely fashion.”

Of course, in some cases, a video call is not enough. Anyone experiencing chest pain, symptoms of a stroke or another emergency should call 911 or go to a hospital, doctors said. 

If a caller might have appendicitis, a telehealth urgent-care doctor will advise going to a hospital emergency department, said Dr. Paul Testa, an emergency medicine physician and chief medical information officer at NYU Langone Health.

For patients going to an NYU Langone hospital, Testa said, he can add a note to their electronic medical records, and “make sure that the triage arrival team knows why I'm suggesting that they go in and what my recommendations are, and then the workup continues in the ER.”

At Mount Sinai South Nassau, psychiatrists and neurologists work at the hospital during the day, but telehealth allows them to treat patients remotely at night, said Dr. Jay Itzkowitz, chair of the hospital’s emergency department. “Not everyone is in the hospital 24/7, but we do have the capability of having the specialists, the services provided to the patient pretty much 24/7 when the need arises,” Itzkowitz said. “Before we had telehealth services, we'd have to wait for that provider, if it was the middle of the night they’d have to get up and they'd have to drive over here.”

Now, he said, “within a matter of minutes, we can actually have the provider on the telehealth equipment, evaluating the patient.”

By Maura McDermott

maura.mcdermott@newsday.commauramcdermott

Maura McDermott is a reporter on the investigations desk. Since starting at Newsday in 2012, she has also covered real estate and the business of health care.