Once You Try Telemedicine, There’s No Going Back
It’s the best way to stay in touch with health care providers during a period of social distancing — and probably in the future, too
If you haven’t yet hopped on for a video chat with your doctor, chances are good in this Covid-19 era you will. Many doctor’s offices are now switching to telemedicine services for both well and sick visits to protect patients from potential Covid-19 exposure. The Trump administration and the Department of Health and Human Services (HHS) announced earlier this month they would essentially be removing red tape for telehealth services, lowering the cost for many patients, and making it easier for doctors to provide this service.
That means that in the coming weeks and months (and beyond), you might have appointments — whether for suspected Covid-19, annual visits, or health problems — on your phone or computer. These can be done with a doctor over video, phone call, or texting, and can be accessed a few ways: via your current doctor, hospital system, or insurance company; with a specialized telehealth provider, like Doctor on Demand; or via a clinic like CVS Minute Clinic’s Video Visit or Walgreens’ MDLIVE doctor video call.
“Doctors can carry out a physical exam just looking at you.”
What is telemedicine, and is it really effective?
Telehealth can be provided over the phone, through texting, or videoconferencing. It’s basically Skyping with your doctor. Your provider will talk to you about your medical history and current problems, and this information, coupled with what they can hear and see over a computer screen is surprisingly telling. “Doctors can carry out a physical exam just looking at you,” says Tania Elliott, MD, a telemedicine and immunology expert in New York City who has seen over 8,000 patients via telehealth in her career. She says that the first thing your doctor is looking for when they see you — in person or on a screen — is whether or not you appear ill (sweating, pale skin, bluish lips, glassy eyes) as well as your respiratory rate (Are you speaking in full sentences? Can you take a deep breath?).
Your doc may ask you to take your temperature with a thermometer or record your pulse with your Apple Watch or a home blood pressure cuff, if you have one. (If you don’t and a reading is absolutely needed, your provider can also teach you how to calculate your pulse by showing the spot on your neck to place two fingers, she says.) They might ask you to open really wide so they can look in the back of your throat for pus or lesions. If needed, your doctor will send you for follow-up testing (lab work, imaging scans). The mode you choose — video or messaging/text — depends on what you need at the time. For instance, you might be able to handle a follow-up question about, say, medication, over a messaging service.
What can’t you use telemedicine for?
Logically, anything you’ll need a procedure for, says Elliott. That could include well-child visits where vaccines are needed, getting stitches, putting a broken bone into a cast, or going in for a pap smear/HPV test. As for potentially awkward images: “I’ve had patients upload photos of a sensitive area,” she says. For those cases, you’ll ideally want to use a platform with HIPAA-compliant software (in other words, not FaceTime or Skype), since the video and images that come through are never recorded, adds Elliott. (Efforts from the HHS to open regulations means that you may be using a more familiar video chatting platform rather than this software. If your problem is of a private nature, talk to your doctor about what they recommend that will both protect your privacy while still addressing your concerns.)
What if you think you have Covid-19?
Telemedicine is actually perfect for this. In some parts of the country with outbreaks, urgent care centers and hospitals are jammed with patients. Being evaluated at home protects both you and others. “When you see predictions for the percentage of the U.S. population that will be affected, it’s clear that the regular health care system won’t have the capacity to deal with the amount of need,” says Nathan Favini, MD, the medical lead at Forward, a company that provides both in-person care and telehealth services. (Forward is a membership service; it charges a monthly fee.) The company has a Covid-19 symptom assessment tool in its app, which also evaluates a patient’s risk of suffering a severe case. “Based on the results, we make a recommendation on whether you should isolate at home or come in for testing,” he says. After, their doctors will monitor patients as they recover at home and watch for possible complications. (This is just one example of how telehealth can serve this need.)
Can you use it if I have a chronic condition?
Yes. Telemedicine is not just for problems like why am I coughing, is this a bad rash, or what’s up with my eye problems — it also can be used to manage care for chronic conditions. It’s especially important right now when primary care and specialty practices may be canceling routine visits or limiting office hours. “I worry that there will be a spike in complications from chronic diseases, like diabetes and high blood pressure, because the health care system has become overwhelmed [by Covid-19],” says Elliott. Hopefully your doctor will tell you they can see you through a telemedicine appointment rather than pushing off your next visit indefinitely. What’s more, telemedicine providers are generally not seeing a disruption in their service, says Favini.
It’s a pretty exciting sea change in medicine, even if it did take a pandemic to get us here.
How do you know if your doctor offers it?
Ask! Before the HHS’s declaration, there were lots of barriers to care, says Elliott. But rules about HIPAA-compliant software, treating out-of-state patients, reimbursement, and tight regulations about how doctors could connect with patients are now gone. “All the regulations that were behind the times were waived,” she says. These new rules apply to any health care provider (doctors, nurses, hospitals, dentists, pharmacists), says the HHS. (This does not apply if you access telehealth specifically through your insurance company.) It makes sense then, that more doctors will be willing to see patients through telemedicine now. Thanks to these expanded regulations, you are now legally permitted to talk to your doctor across any platform considered “nonpublic facing,” says the HHS. This includes video or texting through FaceTime, Facebook Messenger, Google Hangouts, WhatsApp, or Skype.
Is it covered under insurance?
If you’re telecommunicating with your existing provider, then yes, insurance should cover this appointment, says Elliott. You should also see your copay waived, she says, though there “may be a lag as commercial plans update their policies,” she says. Ask your employer or insurer about current coverage. Telehealth will also be covered through Medicare.
That said, not every service will be free. There are many telehealth companies that charge a membership to access care or are set up as a pay-per-visit. In some instances, your insurance might reimburse you, but, again, ask before assuming.
If you haven’t used telemedicine, it may feel different at first. But imagine not having to schlep yourself to a doctor’s office, worry about who was just sick in the waiting room, and then spend forever hanging around for your appointment to start. In some ways, it’s a pretty exciting sea change in medicine, even if it did take a pandemic to get us here. “The world has changed. Once you try telemedicine, you won’t want to go back to the doctor’s office,” says Elliott.
