Telehealth companies have seen barriers to service lifted overnight due to an overwhelming demand for online visits, with doctors and patients alike fearing infection during the pandemic. Two major federal changes involve ﹘ temporarily ﹘ Medicare patients and state medical licenses. Providers are now able to get reimbursement for serving Medicare patients, and doctors are able to practice telemedicine across state lines. “The temporary waiver allowing practitioners to deliver care across state borders, and allowing Medicare reimbursement has enabled us to respond quickly to this crisis,” said Miles Kramer, vice president at Aligned Telehealth Inc. in Woodland Hills. “There’s a physician shortage and a high demand for care, and in many communities care is difficult or impossible to access. The current regulatory environment is helping break down some of the barriers limiting the ability to match a patient in need with a provider.” Amwell, parent company of telepsychiatry-focused Aligned, has seen a surge of 2,000 percent in usage compared to what the Boston telemedicine company had expected pre-COVID. “We were very well positioned prior to this crisis, and obviously in the last six to eight weeks there has been a tremendous overall increase in using telemedicine. … Today Americans are more convinced in the care and delivery that can be provided through telemedicine and our current crisis has only highlighted this,” said Dr. Nitin Nanda, chief executive officer at Aligned Telehealth. For physicians, the shift from preferred in-person visits to virtual calls comes with multiple tiers of training and patience while techs bring platforms online. Valley Community Healthcare, for one, has begun a one-two punch up of available telehealth options, starting with a phone service linked to a physician’s computer to the rollout of Colorado-based OTTO Health, a virtual visit platform that was in the works pre-virus and quickly fast tracked. “We were planning it and making all the preparations for it, and when this happened the state allowed billing to be completed for telemedicine and telehealth visits. We definitely jumped on that because it’s a strategy to protect our patients from exposure,” said Dr. David Luna, chief medical officer at Valley Community Healthcare in North Hollywood. Prior to the outbreak, one member of each department had been trained to use OTTO; now the rest of the system’s providers are getting a crash course in the program. “There is a significant training portion we need to do for our providers before we start that. (The doctor is) expected to be present, provide emotional feedback, be empathic to the patient,” added Luna. “The setting needs enough lighting, no window behind you, and a certain level of training ﹘ people don’t realize how much is required to launch that. It’s easy to just say, ‘Let’s set up a camera and communicate,’ but it won’t be the right product if you don’t think of all the details.” A skeleton crew mans each department at Valley Community when a patient has no choice but to physically come in. Luna expects physical visits to involve vaccines and immunizations, mostly, as well as late-stage treatment for a patient that has already had telehealth visits. “Things like rashes or moles, those kind of findings that are more visual we could potentially diagnose by the telemedicine platform and determine if they need further biopsy, monitoring or medical treatment,” explained Luna.