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Are Virtual Doctor Visits Here to Stay?

Are Virtual Doctor Visits Here to Stay?

Learn how telemedicine actually works, including how to schedule, prepare and ‘go’ to an online appointment.

Updated on May 22, 2020 at 9:30am EST.

The COVID-19 pandemic has dramatically reshaped how people around the world live on a daily basis. We’ve changed how we shop, work, eat, exercise and interact. It’s also affecting how and when we seek medical attention—even for issues not related to the novel coronavirus.

The threat of exposure to SARS-CoV-2—the virus that causes COVID-19—has deterred many people from going to U.S. emergency rooms for chest pain and other warning signs of a heart attack. Even routine care has become a gray area for many who assume there is no harm in delaying checkups. But putting off an appointment could put your health at risk. This is particularly true if you have a chronic condition that should be well-managed, like diabetes or high blood pressure.

The good news is that most people with Wi-Fi and a smartphone, tablet or computer can “see” their doctor virtually for medical advice and keep follow up visits without leaving their home.

This concept, called telehealth, or telemedicine, isn’t new. It’s been around for years but the COVID-19 pandemic has transformed this underutilized approach to medicine into a vital resource for patients and doctors.  

Telemedicine supports social distancing by allowing people to receive care without leaving the safety of their home, says James R. Powell, MD, CEO and chief medical officer of Long Island Select Healthcare in Suffolk County, New York.

More people are taking advantage of telehealth
Between 2010 and 2017, the percentage of U.S. hospitals using telehealth jumped from 35 to 76 percent, according to the American Hospital Association. Nearly every state Medicaid program has some form of coverage for telehealth services. Private payers also cover many telehealth services.

In years past, however, the widespread use of telehealth was hindered by Medicare, which set limits on coverage and payment for many telehealth services.

COVID-19 has changed all that.

New, relaxed rules from the Centers for Medicare and Medicaid Services have expanded telemedicine coverage. Among the changes: Coverage has been extended to include dozens of new procedure codes and virtual sessions are reimbursed like an in-office visit. Some private insurers have also expanded telemedicine coverage as well.  

Nearly half of doctors are now using telehealth to treat their patients—up from 18 percent just two years ago, according to a survey of physicians across the country conducted for The Physicians Foundation.

As of April 14, 2020, telemedicine provider Teladoc Health reported an “unprecedented surge in demand” for its services in the United States. The company said that between the beginning of March and mid-April, virtual medical visits increased more than 100 percent, with more than 20,000 occurring daily during that period of time.

Analysts at Forrester Research predict that virtual care visits will continue to soar to more than one billion this year.

Whether these changes outlive the COVID-19 crisis is yet to be seen, but the genie might be out of the bottle, says Joseph C. Kvedar, MD, president-elect of the American Telemedicine Association, professor of dermatology at Harvard Medical School and senior advisor for virtual care at Partners HealthCare in Boston. Telehealth is now a “living room word” around the country and for the most part, people are enthused about it, he adds.

What doctors can—and can’t—do virtually
Online doctor visits are good options when in-person visits are unavailable or overly risky. But how much can a healthcare provider (HCP) really do virtually?

A lot, actually.

Telemedicine can be used to provide almost any type of service that doesn’t require the HCP to touch or smell the patient, advises Dr. Powell.

“I know if I can put eyes and ears on someone, I can address 60 to 70 percent of what the patient presents with,” he says, noting he has used telehealth to treat an entire group home for scabies, diagnose shingles and pneumonia and assess people after falls.

There are, however, some limitations, particularly when it comes to medical emergencies. Anything that would normally prompt you to head to the emergency room shouldn’t be treated virtually. This includes seeking medical advice for potentially life-threatening symptoms, such as chest pain, active bleeding and anaphylactic shock, cautions Tania Elliott, MD, associate attending physician at New York University Langone Health and national spokesperson for the American College of Allergy, Asthma and Immunology.

Preparing for your virtual visit
The first step in setting up a virtual medical appointment is to download the correct app. It's important to use the same app that your HCP uses, says David Stukus, MD, a pediatrician at Nationwide Children’s Hospital in Columbus, Ohio.

After you download the app, fill out all the information requested by your HCP before the visit. “We still need the same information regarding insurance and any forms normally filled out while sitting in the waiting room,” Dr. Stukus says.

Concerned about your Wi-Fi connection? If you can stream movies, you should have enough bandwidth to get through a telemedicine visit, Stukus notes. If your connection is too weak, however, a phone consultation can be arranged.

The next steps in preparing for your online appointment aren’t much different from how you’d get ready for an in-person visit.

Make a list of your symptoms and how long you’ve had them, Dr. Elliott advises. She also recommends doing the following:

  • If you think you have a fever, take your temperature with your home thermometer.
  • If you have a chronic condition and have a blood pressure cuff, scale or glucose monitor, take readings right before your visit and write them down or take a picture of them on your phone so you can show your HCP.
  • If you have a rash, take a photo of it in high resolution or portrait mode.
  • If you think you may have a urinary tract infection, buy over-the-counter test strips at your local pharmacy and test your urine before your online appointment.

It’s also important to have a list of your current medications and the dosages you are taking, Stukus says. Make sure you know the phone number for your local pharmacy if you need refills or a new prescription.

How to schedule and ‘go’ to your appointment 
Telehealth visits can be scheduled by calling your doctor’s office and requesting a virtual visit. Some HCPs also enable patients to schedule telehealth appointments online.

Before your online appointment, your HCP’s office will tell you how to connect with the doctor. Typically, you’ll receive a link that you will click on to be connected, Elliott says.

If you would like a checkup immediately, there are companies that provide “on demand” appointments. There are dozens of apps that are currently in use for telemedicine, including MDLIVE, Lemonaid, LiveHealth, Amwell and Doctor On Demand. You can also try Sharecare’s Virtual Care service.

Think of them as virtual “walk in” clinics,” says Elliott.

A few minutes before your appointment, take these steps:

  • Choose a well-lighted, private room
  • Turn off the TV or music
  • Make sure your camera and microphone are on
  • Use headphones if you have them 

Telehealth visits can be scheduled as needed or as directed by your doctor, particularly if you have a chronic condition.

What to expect during a virtual visit
Once you see the doctor appear on the screen, the appointment begins. Your HCP will be able to see and hear you as well. Just like a typical office visit, you’ll be asked about your symptoms and medical history.

Your HCP will likely walk you through a few steps in order to perform a physical exam. For example, you may be asked to tap on your sinuses or open your mouth in front of the camera on your device to reveal the back of your throat, Elliott says. What happens during your visit also depends on why you made the appointment. A visit for a sore throat may last about 10 minutes while a visit for a more complex issue could take longer, she adds.

Managing privacy concerns
Before the pandemic, HCPs were required to use platforms that comply with federal law to protect patients’ confidential health information.

During the COVID-19 crisis, rules have been relaxed to allow the use of consumer-friendly technologies like Zoom, Skype and FaceTime. “The value of having a telehealth visit far outweighs any privacy risk, in my opinion,” Dr. Kvedar says. 

It can be a lifeline for people with disabilities or those who have trouble getting to a doctor’s appointment. When telemedicine works well, Kvedar says, it combines access to care, quality and convenience. “When these three things come together, it’s a magical outcome.”

Medically reviewed in May 2020.

Sources:
Judd E. Hollander, MD, and Brendan G. Carr, MD. “Virtually Perfect? Telemedicine for Covid-19.” The New England Journal of Medicine. March 11, 2020.
Center for Connected Health Policy. “COVID-19 Telehealth Coverage Policies.”
U.S. Department of Health and Human Services. “Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency.”
American Hospital Association. “Fact Sheet: Telehealth.”
Teladoc Health. “Teladoc Health Previews First-Quarter 2020 Results.”

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