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What Can You Actually Do During a Video Visit?

Kelsey Tyler

Coronavirus information changes quickly, so please note the publication date on this story. You can find current recommendations and national outbreak data on the CDC website. Or, if you want local coronavirus updates, check out the department of health website for your state or your city. Enjoy reading and stay safe. 


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.

In March, 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.”

Routine appointments and sick visits

To get the most out of a telehealth visit, it helps to prepare.

The first thing to do is set up your technology. 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. Then, just like you would for an in-person appointment, you should prepare a list of questions or concerns. If you’re going over blood work with your provider, print out the report from your patient portal (if you can) 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. 

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.” (Here’s what to know about primary care video visits.)

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. (Here’s more information on insurance coverage for telehealth visits.)

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.)

Mental healthcare

Stern 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. (Here’s a 

“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.

“All medications, labs, referrals can be done electronically. There are no differences.”

Telehealth visits can also enhance mental healthcare because they give providers a peek into patients’ living environments, Stern says. (Here’s what you can do to get the most out of virtual sessions.)

“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.”

Coronavirus consults

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.

Follow-up care

In general, patients can get the same follow-up care from a video visit that they’d typically get during an in-person visit.
 
“All medications, labs, referrals — they can be done electronically,” says Dr. David Stern, a psychiatrist in private practice in Houston. “There are no differences.”
 
Doctors did use to write labs on a physical prescription pad, but that’s hardly done anymore, he adds. Most providers have transitioned to electronic prescriptions. For controlled substances like Adderall or Clonazepam, however, some doctors continue to use physical prescriptions to help prevent abuse.
“Still, it’s definitely possible and quite common to prescribe controlled substances remotely,” Stern says.
That’s because of a recent change in rules by the Drug Enforcement Agency (DEA). A 2008 act had prohibited providers from prescribing controlled substances without an in-person evaluation. Congress gave the DEA an October 2019 deadline to amend that law to account for telemedicine, but that never happened. Then, due to COVID-19, the DEA announced in March that because of the pandemic providers can now prescribe controlled substances without an in-person evaluation.
Show Comments (3)
  1. David Moon

    I had my first televisit (is that a word? Is now) with Dr. Vasquez yesterday. It was perfect – other than having to see myself on the screen also; but maybe I can turn that off next time).

    The visit was flawless, far better than just a phone visit. Plus – can’t make me get on a scale! Simply asked ” what was your last weight”? “Oh, you’ll be so proud of me! I’ve lost 22 lbs since last month”!

    This is certainly the way to go. Guess the hardest was having to read Dr. Vasquez in the article refer to me as her ‘elderly’ patients. But as my husband would say “but ya are Blanche ya are”!

    Dr. Vasquez is fantastic. Since she started she embraced tele-medicine through immediately utilizing the clinic’s established email portal for enhanced communication – this has also been beneficial, allowing – and encouraging – on-line communication. Within an hour after ANY visit, she has posted the visit synopsis with all pertinent discussions, changes and medication changes. Didn’t notice the request to take a photo of wt. as recorded on bathroom scale and send it in.

    This is Olympia Washington, near ground zero 30 miles away. Tele-medicine is the new normal – and welcomed. Seamless. Dr. Vasquez called, sent link, I opened on smart phone while talking and we were video-conferencing within a minute. Thanks to Dr. K also, who initiated the portal a year ago. She must be psychic. Will have to ask her about future of my IRA. EEEKKK.

  2. Debbie CWICK

    how do you find out if your insurance covers video appointments?

  3. Sebastian

    I understand that DR’s cannot provide person visit appointments right now, but I REALLY REALLY wish they could take a name and email and blast out when physical appointments are available. Right now I have to check constantly. It adds to my stress level. If they promise to send an announcement to everyone, that IRL appointments are back I wouldn’t have to worry about this doctor or any of my other doctors that I need to see in person.

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