Telemedicine and COVID-19: What You Need to Know
What Is telehealth?
By now you are probably familiar with the latest way to see your doc: telemedicine and telehealth are rapidly becoming available for patients in the U.S., especially in this time of COVID-19. What is telehealth?
- It’s a remote live and interactive communication, usually a type of online video chat, with a healthcare provider. It could be your doctor, nurse or your pharmacist.
- For certain types of illnesses or questions patients can be seen remotely using modern technology. This has become more common when social distancing was needed during COVID.
- Healthcare providers can often complete an exam, make a diagnosis, and even write a prescription for you, all from the comfort and safety of your home.
- However, telemedicine is not appropriate for many health care issues, when you might need a physical exam to pin down your symptoms to a diagnosis.
Telemedicine (or telehealth) is often used to treat patients with chronic diseases such as high blood pressure, urgent care visits for coughs and colds, and to connect primary care physicians with medical specialists. During the COVID-19 pandemic, telehealth has rapidly grown in the U.S. to help protect patients, providers and the larger community. The use of telehealth during the coronavirus outbreak has been widely adopted and most insurance companies, including Medicare, will reimburse for it.
Telehealth, often used interchangeably with the word telemedicine, can also cover a broader scope of remote healthcare services, such as remote non-clinical services, provider training, administrative meetings, and continuing medical education, in addition to clinical services.
Not every office visit is amenable to telemedicine, but for minor ailments or routine follow-ups, telemedicine is a reasonable, affordable, and often preferable option. But access is not always possible.
Researchers from Harvard reported that over 30% percent of all visits during the pandemic were provided via telemedicine, and there was a 23-fold increase in the weekly number of visits compared with the prepandemic period. Access was lower among insurance enrollees in disadvantaged areas and areas of higher poverty.
Does insurance pay for a telehealth visit?
During the COVID-19 pandemic, most health insurance companies, including Medicare, will now pay a provider for a remote telemedicine healthcare visit at the same rate as a visit in the clinic. Laws and rules are often set at the state level, so check with your doctor's office first.
As telemedicine is evolving, many private insurers are adopting rules to provide guidelines around how services are distributed and paid for. Providers regularly use telehealth to visit with patients, often via call centers specifically for that purpose. However, they might also meet with you electronically via their office, hospital, home or nursing facility
- During a telemedicine consult, a healthcare provider such as a doctor, physician's assistant, nurse, or pharmacist meets with the patient via video conferencing to provide healthcare services.
- The visit may include the transmission of still images, use of electronic medical records, and patient portals, vital sign monitoring, health education, remote device monitoring, call center consults, and medication therapy management (MTM).
- The consult might take place on a computer, laptop, smart phone or wireless tablet. Special secure telemedicine software might be used in the session to gather vital data.
- During COVID-19, many insurance companies are waiving copays, coinsurance or deductibles for use of telehealth.
Common ailments you have that could easily be treated via telemedicine include:
- back pain or problems
- colds or sinus congestion
- eye problems
- eye infections
- minor COVID symptoms
- rash or other skin condition
- certain mental health counseling and follow-up
How can a telehealth appointment help me?
Education is a great use of telehealth, especially for chronic, ongoing conditions. This could include: patient-directed health education such as proper use of an asthma inhaler device, group sessions aimed at smoking cessation, or a follow-up visit with a new diabetes patient.
Health data, such as vital signs or still images, may be collected and forwarded for later review. Vital signs could include blood glucose levels, blood pressure, heart ECG, or other lab work. Still images might include an unusual mole, a picture of the inner ear, or even a sore throat screen shot.
Primary care doctors, such as pediatricians or family medicine doctors, can use telemedicine to provide a consult with a patient or another specialist doctor, like a board certified dermatologist, to help render a diagnosis. This may involve live, interactive video conferencing, still screen shots, or can be used in conjunction with a nurse-assisted visit. When needed, a patient may be immediately directed to schedule in-office care.
For COVID-19, telemedicine allows providers to safely assess a patient's condition and determine their need for testing or further evaluation and treatment. This allows the patient to avoid the clinic or hospital setting and help to prevent further viral spread. In addition, patients with limited mobility or transportation, who live in rural areas, or with scheduling conflicts can get access to care more quickly.
Examples of telehealth companies include the following, but there are many more options. Check with your insurance provider for covered options:
- Doctor On Demand
- HIMS / HERS
- LiveHealth Online
What is telepharmacy?
Pharmacists are in a highly visible and patient-accessible role and are being integrated into telehealth solutions. Telepharmacy solutions are state-specific often determined via legislature rules. Much of the backlog in pharmacists covering these roles surrounds the legal and payment issues of gaining provider status. Pharmacist-provided remote services serve an important role in healthcare.
Studies have shown that access to a licensed pharmacist who provides pharmaceutical care can boost proper medication use, patient safety, and patient satisfaction. Over 125,000 patients die each year due to medication non-adherence. This non-adherence -- not taking a medication correctly, or simply not taking it at all -- has led to excess health care costs in the billions.
Telepharmacy, a branch of telemedicine conducted by a pharmacist, can help to address these costly, and often dangerous, outcomes. This is often referred to a Medication Therapy Management Program (or MTM). MTM services may be covered under Medicare, Medicaid or private insurance.
In telepharmacy, a patient might conference with a pharmacist to have a full overview of their medications two weeks after being discharged from the hospital. Side effects, dosing, cost, and other issues that lead to side effects or non-adherence can be reviewed. Medication therapy management (MTM) can prevent hospital readmission, dangerous side effects, and drug interactions.
What are telehealth pros and cons?
The major benefits of telehealth seem obvious, but there are some hidden ones, too:
- Increased access to healthcare: Telemedicine can vastly increase the reach of healthcare providers. Rural areas, underserved populations, elderly patients or those without transportation can be helped. In addition, non-specialist healthcare providers can utilize telemedicine technology to consult with top specialists around the nation, or even the world. Overall, telemedicine can offer better scheduling options for increasingly busy doctors. Bad weather no longer becomes a factor if patients can access a healthcare provider online.
- Cost savings: Creating efficiencies in the use of time is essential in healthcare. This allows more patients to be seen. As noted by the ATA, telemedicine can reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays. One study conducted in New York showed that telemedicine is a cost-effective way to replace more than a quarter of all visits to the emergency department. The group with access to telemedicine had 24 percent fewer ER visits, which cost about seven times the cost of a clinic or telemedicine visit.
- Improved Quality: Research has demonstrated that health care delivered via telemedicine has equal benefit to those visits conducted within a provider’s office. In fact, some specialties exceed the quality of an in-office visit, like mental health and ICU care. A medical home, where a team of healthcare providers work together to care for a patient, is an area where telemedicine has great benefit, too, especially if these healthcare providers do not work in the same medical office. Medical specialists can be accessed for consultation and recommendations for serious conditions, such as stroke.
- Better Patient Engagement: An important initiative within healthcare is increased patient engagement and having patients learn to take ownership for their acute, chronic and preventive healthcare. Telehealth allows additional follow-up visits to be scheduled to encourage long-term engagement.
- Patient Demand: Patients want telemedicine; studies over the last 15 years have shown high rates of patient satisfaction. Using a smartphone, teleconferencing, and going wireless are everyday occurrences for the public today. Patients want to save driving time when possible, avoid sitting in a clinic of other sick patients, prevent work loss, and get themselves -- and their families - healthy.
Even though telemedicine is an advanced healthcare option, but there are some major roadblocks that can come into play:
- Privacy and security: This may be the top concern that patients and healthcare providers have with telemedicine.
- As health groups choose vendors for telemedicine implementation, they must be sure to work with those that have a track record of HIPAA security.
- HIPAA guidelines need to be developed:
- 1. For healthcare providers who are involved with telemedicine.
- 2. For security surrounding video/audio recordings, and any EHR data, particularly when shared.
- 3. Added staff education on HIPAA laws should be instituted.
- Unavailability of services: While telehealth is expanding, it’s not available everywhere yet.
- With telemedicine services there has been concern as to how to handle state licensure issues when medicine is being shared between states through telecommunications.
- In addition, telemedicine reimbursement may or may not be covered. Patients should discuss with their insurance if telehealth services are available as covered benefit. Most states now require that private insurers cover telehealth the same as they cover in-person services.
- Some telehealth services are now covered under Medicare Part B. Coverage for these services have been widely expanded during COVID-19.
- Concerns over increased utilization: There have been concerns that telemedicine could result in overutilization and overprescribing.
- Coordination of care will be essential to be sure the patient does not receive conflicting advice should they engage multiple doctors via telehealth.
- Controlled substances prescribing and potential “doctor shopping” for abusable prescription drugs are other areas where increased utilization may come into play.
- Pharmacist provider status: Pharmacists are also seeking provider status in many states to allow adequate compensation for their highly accessible pharmaceutical care skills.
- Factors that would enable a broader reimbursement of pharmacists’ services include passage of national legislation which recognizes pharmacists and their services in private and government-sponsored healthcare insurance, especially in underserved rural areas.
- Telemedicine reimbursement and other regulatory issues: While many healthcare insurers are adopting telemedicine with payment parity (paying healthcare providers equal to what they would receive with an in-office visit) reimbursements are still a debated area. Government agencies will want to see cost-savings studies, although Medicaid and Medicare now cover at least some telehealth services.
Telemedicine can never replace the human touch of your physician, nurse or pharmacist. In fact, telemedicine works best when used in conjunction with an established clinical provider relationship. But telemedicine makes good sense for many reasons, especially in this time of COVID-19 when a highly communicable disease is in the community.
Now that greater access to telehealth is available, significant cost savings and patient satisfaction are likely to be a bonus in the more widespread adoption of telemedicine.
- Patel, S, et al. Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States. Health Affairs 2021 40:2, 349-358. Accessed April 13, 2021 at https://doi.org/10.1377/hlthaff.2020.01786
- Telemedicine Use Increased Considerably During COVID-19. Drugs.com News. Accessed May 1, 2021.
- Herman B. Virtual reality: More insurers are embracing telehealth. Modern Healthcare. February 20, 2016. Accessed April 13, 2021 at https://www.modernhealthcare.com/article/20160220/MAGAZINE/302209980/virtual-reality-more-insurers-are-embracing-telehealth
- Medicare.gov. Telehealth. Accessed May 1, 2021 at https://www.medicare.gov/coverage/telehealth
- Sweeny E. How Partners Healthcare is using virtual care. FierceHealthcare. Accessed April 13, 2021 at https://www.fiercehealthcare.com/it/3-ways-brigham-and-women-s-hospital-using-virtual-care
- Meidl T, Woller T, Iglar A, et al. Implementation of pharmacy services in a telemedicine intensive care unit. American Journal of Health-System Pharmacy. August 1, 2008;65:1464-69. Accessed April 13, 2021 at doi:10.2146/ajhp070682
- Margolis KL, Asche SE, Bergdall AR, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46–56. Accessed April 13, 2021 at doi:10.1001/jama.2013.6549
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.