In a matter of months, COVID-19 changed our doctor visit routines. Both healthcare providers and patients who would have never considered a virtual telehealth platform flocked to them throughout 2020 to avoid the risk of deadly coronavirus exposure. According to data available through the CDC, over 1.6 million telemedicine visits took place between January and March 2020, roughly 50% more than the same period in 2019. Neurology visits via telehealth at Johns Hopkins went from a negligible percentage before COVID-19 to about 95% being conducted virtually in April 2020.
Whether you call it telehealth, telemedicine or e-health, the delivery of healthcare through electronic devices such as a computer, tablet or phone encompasses many types of medical services. Telehealth is the broadest term, referring to everything from doctor visits, to health education, training or remote monitoring of vital health information in real time. Telemedicine typically describes the digital equivalent of an in-person doctor’s office visit.
While not at the peak levels during the height of the pandemic, a survey conducted by the National Center for Health Statistics found that telehealth still accounted for over 23% of medical appointments as of late June. Telehealth has been especially well received by young adults, with 44% of Gen Z and millennials saying they may switch providers in order to get telehealth access.
Making good healthcare choices can be difficult, and with telehealth added to the mix it’s important to consider when it can be beneficial and when it’s better to pass on the screen time.
What’s in it for healthcare consumers?
Convenience. Traveling to see a doctor involves time, effort and expense. Across the spectrum of incomes, physical capabilities and occupational status, who wouldn’t prefer skipping a waiting room filled with sick people, and not having to put up with drive times that are often longer than the actual visit with the doctor?
Accessibility. Getting to a doctor’s office isn’t always just a matter of convenience. Dr. Dael Waxman, a family physician in North Carolina, told Kaiser Health News that some patients have to overcome a lot of obstacles to get to him. “I have lots of single mothers. They have to leave work, get their kids out of school and then take two buses,” he said. “Why would they want to do that if they don’t have to?” The flip side of this is that not everyone has reliable internet service or access to smart devices.
People with mobility issues can face a series of herculean tasks in getting to doctor appointments. The time and effort to fit a walker or wheelchair in and out of a car or public transportation, and then navigating long hallways and dodging chairs and filing cabinets along the way, can be cumbersome. Opting to arrange and pay for transportation assistance such as a wheelchair van can ease these physical challenges, though the expense may create another type of strain. Even temporary impairments such as a broken arm or head injury can make a physical trip to the doctor a strategic challenge. Telehealth bypasses all of these encumbrances.
Access to more providers. Telehealth gives patients access to healthcare providers outside of their local area. Doctors and specialists within a health plan aren’t always geographically close by, but a telehealth visit makes it easier to access them. “Telehealth can also be really helpful for second opinion consults,” says Dr. Andrea B. McKee, in an article about telehealth in OncologyLive. McKee, who is chief of radiation oncology at Lahey Hospital’s cancer center in Burlington, Massachusetts, also points out that involving a patient’s out-of- town family in treatment or follow-up discussions can be readily accommodated via a telehealth appointment.
Access to more providers can also result in shorter wait times for appointments as a larger pool of providers can smooth out scheduling bottlenecks. This is especially relevant in the area of mental health, given the shortage of providers in many areas and increased demand due to COVID-19.
Chronic disease management. Successful management of chronic diseases such as diabetes or hypertension often involves regular monitoring and check-ins to keep the patient on track. A telehealth visit can help a patient focus on his or her care by removing discouraging obstacles to get to the doctor’s office. Dr. David Anderson, a cardiologist affiliated with Stanford Health Care in Oakland, California, gave an example to Kaiser Health News: “if I have a [stable] 82-year-old patient and her daughter needs to miss work and come from 30 miles away to bring Mom in for us to sit there for 15 minutes to chat, that’s something where the efficiency of a video visit is good.” He wouldn’t however, advocate a telehealth visit if that same patient complains that they are suddenly short of breath. “That person I would want to see face to face.” Anderson adds another plus: “On the phone or by video, I found there to be a lot more non-distracted time for education.”
Telehealth or in-person? When to consider one over the other
It can be difficult to figure out if a telehealth visit will be an adequate substitute for in-person care — or if it is cost-effective. Kaiser Health News reported that one man was directed to use a telemedicine portal to treat a rash and was billed $235 for a 5-minute appointment. The rash couldn’t be definitively diagnosed with online observation, so an in-person appointment was required — along with another charge, this time for $460.
Certain conditions such as chest pains, shortness of breath, abdominal pain, increased swelling in the legs and serious injuries require hands-on attention. Vaccinations, blood work and diagnostic tests such as colonoscopies or MRIs must be done in person as well. There’s also room for preference. If you think you’ll get more out of an in-person visit, you shouldn’t be pressured to go the telehealth route.
The American Academy of Family Physicians supports telehealth and identifies ailments such as colds, flu, sprains and sinus infections as good candidates for a virtual visit. Follow-up appointments, getting test results, managing medications and receiving health information about your specific conditions can also be efficiently handled through telehealth.
Big and small telehealth business models
Many patients first experienced telehealth during the pandemic through a virtual visit with healthcare professionals they’d normally see in-person. Increasingly, there are other options. Teladoc, one of the first companies to get into the e-health business, has been joined by corporate behemoths Walmart and Amazon to offer online access to doctors and other health services. Some telehealth companies offer specialized services, such as Livongo for chronic disease management, and Talkspace and Ginger for mental health. Most of these services allow anyone, with or without insurance, to directly connect and pay for their services. Health plans are also providing these services to their members, often at zero cost to them, for example, Michigan State University offers Livongo to members seeking this type of specialized care.
Not a new phenomenon, but an expanding one
Using a virtual platform to visit a healthcare professional isn’t new. For years, Medicare paid for virtual visits under certain conditions for those living in rural areas. But last December, Medicare moved nine telehealth services to its permanent list of approved services. Commercial insurers for the most part are following suit, covering telehealth services, though specifics such as whether copays or coinsurance will apply to telehealth may vary by plan.
Time will tell
While patients and physicians report that they like telehealth and expect it to continue, concerns remain. Dr. Paul Hyman, a primary care physician in Maine, wrote in a JAMA article that he values the physical examination even more after providing virtual care during the pandemic. “The physical examination remains a place where I offer something of distinct value that is appreciated,” he writes. The value of in-person visits cannot be underestimated, he adds. “Many of us have cases where an unanticipated finding on examination feels as though it saved a patient’s life. A discovery of an irregular mole, a soft tissue mass, or a new murmur — I do not forget these cases, and I do not think the patients do either.”
Dr. Peter Pronovost, a national expert in medical innovation at University Hospitals Cleveland Medical Center told Kaiser Health News that more data and analysis is needed to determine if telehealth can be a useful tool to improve health outcomes. “Right now there’s a lot of focus on shiny objects — ideas that sound cool — rather than solving problems. We know preciously little about its impact on quality.”
