SEE YOUR DOCTOR NOW ON FACETIME, WHATSAPP OR SKYPE!
Whether you realize it or not, you are becoming an expert in “remote living.” Video calls with your family and virtual meetings with work or school colleagues are part of your daily life. Now is the best time to take advantage of another newly expanded remote service: doctor visits.
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Did you know that many office-based providers think about half of their work with patients can be done remotely? Yet people are mistakenly postponing doctor visits during these uncertain times. Primary care offices reported a near fifty percent appointment decrease at the start of this pandemic. Traditional in-person visits have all but been eliminated due to virus transmission concerns plus the confusion around whether the closure of ‘non-essential businesses’ and the temporary halt on ‘elective medical procedures’ applies to outpatient medicine.
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Welcome to the important world of telemedicine.
(Quick clarification: the term telemedicine means providing clinical care remotely, while telehealth is a broader term including additional healthcare services, such as education, reminders, and monitoring.)
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In contrast to the extraordinary advancements made in diagnostic and therapeutic technologies, the medical community has been very slow to adopt information and communication technologies. At the latest survey in 2017 by the Center for Disease Control (CDC) National Center for Health Statistics, nearly 15% of office-based healthcare providers were still using paper charts. While medicine’s culture of tradition plays a role in technology acceptance, virtual visits have presented too many unanswered questions to be appropriately implemented.
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Working in a ski town, many of the people I saw either lived an hour away across a mountain pass or spent half the year in another state. One of my patients (let’s call her Cathy) e-mailed me last winter and said she wasn’t feeling well. There was a snowstorm blocking the pass and Cathy wished to schedule a virtual visit with me. She had a complicated medical history, filled with auto-immune and pulmonary diseases, and preferred seeing her trusted team of doctors. Unfortunately, my managers said, in a word, “No.” The risks around payment, privacy, documentation and legal liability were too great. So Cathy ended up in a local urgent care clinic.
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Today this pandemic has forced the healthcare industry to accept and offer telehealth services. Elderly patients are designated high risk and advised to remain home, yet they still require regular medical care. Thus the federal government announced a new emergency waiver that significantly broadens Medicare’s financial coverage of telemedicine services, making virtual visit payments equal to in-person visits. Many commercial insurance companies followed closely thereafter, either voluntarily or by state mandate. State-managed Medicaid programs have also been asked to expand virtual services.
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Healthcare providers everywhere are now receiving a crash course on how to provide medical care remotely. They are allowed in “good faith” to use commercial products that have reputably strong security measures in place, such as Skype or FaceTime, so long as usual privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA) are upheld. Some providers are using their own proprietary programs, while others are teaming up with telehealth companies.
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A significant amount of effective medical care can be provided remotely. Most preventative medicine requires counseling, including discussing healthy lifestyle habits, or applicability of certain cancer screens, such as mammograms for breast cancer or colonoscopies for colon cancer. These studies can be ordered during the visit. Mental health concerns and certain follow-ups, such as for high cholesterol, may also benefit from a virtual visit. Providers can still write prescriptions.
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Multiple aspects of a physical exam are also still feasible. Computer and phone cameras facilitate skin evaluations. Home thermometers and scales for temperature and weight data can be useful. Remote health monitoring devices, such as home blood pressure cuffs, glucometers for blood sugar levels, and wearable technologies, for example smartwatches that detect heart rate and abnormal heart rhythms, are increasingly used by providers to help make medical decisions.
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Telemedicine is not meant to fully replace in-person medicine, but rather to support and strengthen it. There are of course many health concerns that are not appropriate for a virtual visit. If you’re unsure if you can benefit from a virtual visit, call your healthcare provider and ask. If you don’t have your own provider, now is the time to get one. Many clinics are allowing virtual “establish care” visits, or you can connect with a doctor through a telehealth company (for example, Amwell, Doctor on Demand, Teladoc Health, and MDLive, to name a few without bias or recommendation). Your insurance company may also have a preferred telemedicine provider.
There are a few logistical warnings you should heed. Insurance coverage for telemedicine services vary by company, state and policy, so call your insurance before scheduling. Telemedicine is new for many providers and clinics, so please be patient. Also, the current financial coverage is largely temporary, lasting until the end of this pandemic crisis. That will affect what telemedicine services are offered in the future.
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Many of us hope that patients like you and the healthcare industry as a whole will realize the great benefit of telemedicine and that together we can make sure this valuable resource continues to be available in better times. Call your doctor and insurance company today and schedule your virtual appointment.
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Written by Jill A. Monteiro, MD, MBA
Published April 2020