Telemedicine On the Rise During COVID-19 Pandemic
Prior to COVID-19 there had been some concerns about the feasibility of wider use of telemedicine, but people have had to take a leap, Dr. Megan Mahoney, chief of staff at Stanford Health Care and Clinical Professor in the Division of Primary Care and Population Health at Stanford University, told MedTruth.
“A lot of us have gotten over that hump and now we all can appreciate the vast benefits of having it as another option – not replacing in-person care – but as another way to provide care when appropriate,” Mahoney, also a practicing internal medicine physician at Stanford, said.
So what counts as appropriate? Where does telemedicine fall short? Here’s what to know before trying it.
What is Telemedicine?
Telemedicine refers to the remote delivery of clinical health care services. It’s a type of “telehealth,” which also includes things like public health efforts and health education that include technology.
General medical direct-to-consumer apps such as Teladoc and Doctor on Demand connect patients with clinicians for a wide-range of virtual appointments, usually with much more availability than your personal doctor. Niche apps like PRJKT RUBY and Hims specialize in more limited, particular products and services such as birth control, erectile dysfunction drugs, or home testing kits that can be sent to patients after patient information is reviewed by a physician.
Virtual visits with established health care providers have been around in some settings for awhile. However, before the pandemic, insurers and publicly-funded payers like Medicare had tighter rules around what types of telemedicine services they would reimburse for, which limited the use of telemedicine. Under the current expanded guidelines, providers can also offer patient care via telephone, secure telemedicine platforms, and other video conferencing tools such as Zoom.
Those expanded guidelines are what has enabled Boston-based freelance writer Hannah Bernstein, 22, the continuity of online sessions with the same psychologist she’d been seeing in person for several years.
“It’s nice to be in my own bed, able to chat with my therapist in my own space, and a space I feel comfortable in,” she told MedTruth.
But it’s far from perfect. Bernstein and her therapist occasionally talk over one another. And Bernstein has multiple roommates.
“My apartment has thin walls,” she said. “It still feels weird to be talking about mental health topics in my apartment filled with people.”
Regardless, Bernstein said she would absolutely do it again. With telemedicine, the appointments were much easier to fit into her schedule.
She also recently saw an allergist via telemedicine as well. The appointment took less than 20 minutes and the doctor prescribed the medications Bernstein needed.
It’s nice to be in my own bed, able to chat with my therapist in my own space, and a space I feel comfortable in.
When Does Telemedicine Make Sense? When to Seek In-Person Care?
The appropriateness of telemedicine depends on a lot of factors, Dr. Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center, told MedTruth. Mehrotra researches innovations in health care delivery, including telemedicine models.
Mehrotra likens “telemedicine” to “prescription drugs.” You wouldn’t make a blanket statement that they’re all good or bad – most prescription drugs have big benefits when used at the right time for the right reason, he said.
For telemedicine visits with your regular doctor with whom you have an established relationship, the obvious benefit is reducing coronavirus exposure by moving care to the safety of online interaction, Mehrotra said.
To determine if a telemedicine app is safe for you, think about what type of patient you are and what you’re using the app for. If you’re young, generally healthy, and have a seemingly straightforward medical question or issue to take care, the care you get on an app might be wholly sufficient, Mehrotra said.
If you’re taking several medications or have underlying conditions that might complicate how other issues are addressed, you probably want to seek care from a doctor who’s more familiar with medical history, Mehrotra said.
When medically appropriate, telemedicine can potentially work well for relatively straightforward care that doesn’t require an in-person exam, Mahoney said, such as:
- Check ups for managing chronic conditions like diabetes, hypertension, heart disease, and COPD
- Diagnosing acute conditions like urinary tract infections with straightforward symptoms (e.g. burning urination), colds, gastrointestinal problems such as heartburn, and skin conditions
- Post-surgery follow up
- Prescription refills
- Some mental health care
- Telemonitoring of vital signs from scales, blood pressure cuffs, and glucometers that are automatically added to patient records via tracking apps and programs
Telemedicine apps can also be useful for obtaining second opinions, when care is straightforward and there’s some form of time pressure, and in the current health crisis to determine who needs in-person care versus what issues can be addressed virtually, Dr. Mia Finkelston, medical director for Amwell telemedicine app, told MedTruth.
On the other hand, you can’t perform lab tests via telemedicine, you can’t fix a broken bone, and it’s not appropriate for medical emergencies, Finkelston said.
And an app cannot be a substitute for a doctor with whom you have an established relationship, who knows your medical history, and can take a comprehensive look at your health when making a diagnosis or care recommendation, Dr. Gary LeRoy, Dayton, Ohio-based family physician and president of the American Academy of Family Physicians.
“There are a lot of intangibles that your (primary care provider) brings to your care that can’t be replaced with an app,” LeRoy told MedTruth. For instance, doctors are trained in medical school to catch potentially serious diagnoses first, before landing on whatever the problem most likely is. It’s unclear if apps can replicate that, he said.
LeRoy recommends talking with your doctor about telemedicine services you’re considering trying to help decide what’s appropriate or not. And remember that your doctor’s office probably has a physician “on call” to address urgent needs after hours and on weekends, too, he said.
If you do use a direct-to-consumer app to get medical care: Share that information with your primary care provider. Some apps send you a summary “visit” report, but you still need to send it to your doctor’s office or bring it to your next appointment, Mehrotra said.
Is My Health Information Secure with Telemedicine?
Before the COVID-19 pandemic, federal law required that health care rendered virtually needed to use encrypted software compliant with the U.S. Health Insurance Portability and Accountability Act of 1996, also known as HIPAA. That regulation covered telemedicine services via your doctor or a direct-to-consumer app.
Currently that regulation is not being enforced to allow providers to quickly move to telehealth. That’s why, at least for now, some providers are able to do visits via video conferencing tools such as Zoom, which may not be as secure as HIPPA-compliant platforms (though Zoom, for example, has rolled out a more secure version of its platform designed for telemedicine). Mehrotra advised patients to contact their providers with any concerns about the provider’s telemedicine platform.
It’s worth noting that newer niche apps such as PRJKT RUBY and Hims may not be subject to certain federal consumer protection regulations, such as those prohibiting the marketing of off-label drug use directly to patients, according to a 2019 editorial co-written by Mehrotra.
Is Telemedicine More Affordable?
The short answer is, it depends.
Insurance policies vary widely. Your out-of-pocket costs may vary depending on whether or not you’ve met your deductible, any special waivers your insurer has enacted because of COVID-19, or whether you connect with your doctor via phone or video.
If time and health status allow, be sure to review the details of your policy and contact your insurer with any questions or concerns, as insurance policies are often notoriously difficult for consumers to decipher.
When it comes to direct-to-consumer apps, some do take insurance – and some insurance plans provide coverage for specific telemedicine app(s). Other apps charge a flat fee per service, which can sometimes be significantly less than in-person care charges according to a 2017 study.
Telemedicine Apps: 3 Top-Rated Picks
Telemedicine apps offer a wide range of care options for everything from respiratory infections to mysterious rashes and mental health care without leaving the comfort of your home. MedTruth took a closer look at three top-rated comprehensive telemedicine apps—at press time each app had an average user rating of 4.8 or higher in the iPhone App Store—to give you an idea of what to expect.
Each app is compliant with national and international laws and regulations, including the U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA), and accredited by the National Committee for Quality Assurance, a nonprofit health care organization accreditation group. Your health information cannot be shared without your consent, although the apps are, however, allowed to use your anonymized data for their research.
Each app also offers an option for you to share a visit summary with your regular health care provider.
How It Works: Select your state, preferred time between 7 a.m. and 9 p.m., and whether your visit is “general” care, behavioral health, or dermatology. All providers are board-certified and licensed in your state. Aside from mental health care, you’ll need certain insurance plans in order to choose your provider, otherwise you’ll get whoever is available.
- With insurance, your cost may be as low as $0 per visit, depending on your policy.
- Without insurance:
“Everyday Care:” $75
Mental health care: $99
Dermatology review: $95.
- There’s no time limit or minimum per visit, but average length is 15 minutes for “everyday care” and 45 minutes for mental health visits.
- STD testing available, although you’ll need to go to a lab in-person to give a specimen.
- iPhone App Store: 4.8 based on 234,386 reviews
- Google Play Store: 4.7 based on 32,045 reviews
DOCTOR ON DEMAND
How It Works: Enter information about your issue and then you can choose to see the next available provider (estimated wait time is noted) or schedule with a provider of your choice. For mental health visits, you must choose your provider and appointment time.
- Medical doctor consultation: $75 for 15-minutes. After 13 minutes you have the option to extend for an additional 15 minutes for the same fee.
- Mental health consultation:
Length of mental health visits depend on what type of provider you see and which type of appointment you schedule.
Psychology: $129 for 25-minute consultation, $179 for 50 minutes.
Psychiatry: $299 for 45-minutes, $129 for 15-minute follow-up appointments.
Option to extend mental health and psychiatry visits for an additional fee.
- Some insurance plans are accepted (including Medicare Part B), which could lower costs.
- iPhone App Store: 4.9 based on 61,562 reviews
- Google Play Store: 4.9 based on 35,370 reviews
AMWELL APP: DOCTOR VISITS 24/7
How It Works: First, choose what type of appointment you need, such as urgent care, women’s care, child health, and so on. You can choose to see the next available provider—they’re available 24 hours a day, seven days a week. Or, you can choose a provider from a list of clinicians. You’ll be able to see a bio that notes where each provider has trained, how long they’ve practiced, and a user rating.
You’ll be prompted to answer some questions about your health; and then you’re either sent to the virtual waiting room (if you choose the next available physician option) or you can set up an appointment with your selected provider at a time that works for you.
- Urgent care visits: $79. Average appointment time 10 minutes.
- Online therapy: $99 to $110 per 45-minute session (depending on the level of degree of your provider).
- Psychiatry: $269 for 45-minute initial consultation. 15-minute follow-up appointments $99.
- Dietician: $70 for 30 minutes.
- Lactation consultation: $129 for 50 minutes. 25-minutes follow-up appointments for $75.
Costs may be lower with insurance coverage. Be sure to check with your insurer upfront about your particular policy BEFORE getting started.
- iPhone App Store: 4.9 based on 15,938 reviews
- Google Play Store: 4.2 based on 7,439 reviews