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A few days before a recent visit with a nurse practitioner to go over routine blood work, I called my doctor’s office. “Can I speak to her on the phone instead?” I asked, not wanting to sit in a waiting room full of sick patients in the age of the coronavirus.
“She does phone appointments once a week,” her assistant said. Her next available? Nearly two months later. I emailed the head of the practice asking him to loosen the rules given the emergency situation. The next day, I got a phone call. The nurse practitioner could talk to me in a few days, via a telehealth visit.
On the day of my appointment, I sat down in front of my laptop and clicked a link my doctor’s office sent. Then my nurse practitioner popped up on the screen, and we proceeded with my appointment just like we were sitting together in her office.
Telemedicine or telehealth visits have been around for years, with some doctors embracing them and others slow to adopt. Two major barriers holding back telehealth have been spotty access to providers and limited insurance coverage for care. Now, COVID-19 has propelled telehealth into the spotlight. There’s a push to make it more widely available — and quickly. Experts say virtual care has the potential to expedite medical attention while keeping healthcare providers safe. It also keeps healthy patients safe by isolating them from sick ones, and can improve access for patients in remote areas.
Earlier this month, the government took an emergency step to relax its rules for telehealth coverage for Medicare recipients, allowing someone on Medicare to have a telehealth visit at home as long as they’ve seen that provider, or another one in the same practice, at least once in the past three years. Medicare patients can also now have a telehealth visit with an out-of-state provider, and providers are allowed to use any video conferencing platform, including FaceTime. The policy change has helped open the floodgates, prompting more providers to offer telehealth visits to patients.
“Telehealth was always coming,” says Joseph Brennan, a telehealth consultant and founder of Moonshot Telehealth Consulting. “Patients wanted it more and more, but there was never a push to use it. What COVID-19 has done is that now, every provider has to consider this is something they’re going to do in the next three months. Everybody is rolling up their sleeves. With healthcare visits, there’s going to be a virtual component.”
To get the most out of a telehealth visit, you need to prepare. Especially now, with doctors pressed for time scrambling to care for both routine patients and those with coronavirus symptoms, it’s important to help make visits as efficient as possible.
Preparing for routine appointments and sick visits
The first step is to make sure your technology is set up for a telehealth visit. You’ll need a smartphone or a computer with a video camera and a reliable internet connection. Brennan, who helps healthcare systems across the country get set up with telehealth, says it’s important to find a quiet spot where you won’t be interrupted and where you can have an open and honest conversation with your provider.
Just like an in-person appointment, you should prepare a list of questions or concerns. If you’re going over bloodwork with your provider, print out the report from your patient portal so you have it in front of you during your visit. If you don’t have a copy, ask your doctor to send it to you ahead of time.
Dr. Jennifer Vazquez Bryan, a family doctor in Olympia, Washington, about an hour outside of Seattle, says patients should also have their current medications in front of them, or at least a list of what they’re taking. She’s currently getting virtual appointments up and running to see her mostly elderly patients. “I’m trying to limit the number of people coming into the office, because you just don’t know,” she says. The US isn’t doing enough coronavirus testing, she adds.
Chaunie Marie Brusie, 33, from southeast Michigan, has used a telehealth app on her phone for the last four years for doctor’s appointments for herself and her five children. Once, she scheduled a telehealth visit when she came down with a sinus infection. “They’re a great resource to have,” she says, “and especially now.”
Before joining calls with her doctor, Brusie gathers relevant information, like her temperature, any current symptoms, medicine she’s taken and when she took the last dose. When it comes to cost, Brusie pays her normal insurance co-pay for a telehealth visit. Brennan says that based on his own research, it’s common for patients not using insurance to pay on average $45 to $99 for a telehealth visit with their primary care provider.
In Columbus, Ohio, Amy Fortney, 45, has used her PC at home to do telehealth appointments for colds and sinus infections. “Make sure you have a good webcam,” she adds. She’s also done telemedicine visits without a video component, where she went online to describe symptoms to a doctor. Indeed, some specialties like dermatology have their own telehealth policies and practices. Some dermatologists interact with their patients via live video while others review images and other data their patients send them. (Here’s a primer on teledermatology.)
Virtual mental healthcare
David Stern, a psychiatrist in private practice in Houston, conducts all of his patient appointments online, seeing almost 100 patients a week. Patients who connect with him see Stern in his home office surrounded by potted plants. “It’s super convenient, and it’s much easier to schedule people,” he says.
The most successful calls are those for which the patient makes sure they have the time and space to focus on the virtual visit, he says. He asks patients to think about any symptoms they’re still having or any side effects from their medications and be prepared to talk about them during the call.
“When you go into a doctor’s office, all you have to do is put your phone on silent and you’re good. But with telehealth visits, you want to make sure you’re going to have real quiet time, without kids or other people coming in.”
Stern uses Zoom, one of the most popular video-call platforms. He prefers patients to use computers rather than smartphones whenever possible so he can see them better. “With therapy, you really want to capture someone’s body language,” he says. He often utilizes a whiteboard feature on Zoom to draw out concepts for patients, mimicking ones he’d explain visually in person on paper. He also uses Zoom’s chat function to send patients relevant links.
Telehealth visits can also enhance mental healthcare because they give providers a peek into patients’ living environments, Stern says.
“I can really learn a lot about patients from where they live and how they live,” he says. “Telehealth visits are a great opportunity for your provider to learn a lot more about you. Use the opportunity to show more of your life to your therapist.”
Stern says that among his colleagues, interest in telehealth appointments has definitely picked up in recent weeks. “Everyone’s talking about it,” he says. “More and more people are moving to telehealth visits.”
Doctors and health systems are also encouraging patients with mild coronavirus symptoms to stay at home and get screened by phone or video chat, rather than in person.
Vazquez Bryan says that especially for healthcare providers who aren’t currently on the frontlines of caring for COVID-19 patients, “we want to try to keep our doctors safe, but also be available.”
In the last week alone, Brennan has helped three major health systems in the US get fully set up with telehealth for COVID-19 screenings. And separately, at the Cleveland Clinic, infection control specialists are screening possible COVID-19 patients virtually.
Healthcare providers can’t diagnose COVID-19 during video visits, but they can offer self-care and quarantine tips, let patients know when they need to go to a hospital, and if they do, help to coordinate their arrival in the ER. The Centers for Disease Control currently recommends contacting your doctor if you have symptoms including shortness of breath, a high fever or coughing.
While policies are still evolving, most insurance companies are now waiving costs for COVID-19 testing but not treatment.
“The federal government has encouraged no cost to patients for all telehealth,” says Brennan. “It’s not solidified on what commercial payers will do, and it will vary state to state. But from everyone I’ve spoken to, no patients will be charged.”
That means you likely won’t have a co-pay for video or phone screenings to determine if testing is appropriate, and if you end up needing an actual COVID-19 test, that should also be free.