Coronavirus Escape Plan: What You Need to Know and How to Use Telemedicine

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Published By Everyday Health

Telemedicine — connecting with a healthcare provider for a virtual visit using a smart phone, tablet, or computer — is soaring in America, and it’s not just because of the COVID-19 global pandemic, although this crisis is focusing increased attention on this option for seeking medical care remotely.

“Telemedicine can make it easier, faster, and safer to get the healthcare you and your family need,” says Rachel Bishop, MD, internal medicine doctor and medical director of Houston Methodist Virtual Urgent Care in Texas. “Wait times are shorter than most in-person medical visits. You don’t have to take time off from work or find childcare. And virtual visits can reduce your exposure to viruses and other infections.”

Precisely because of the coronavirus pandemic sweeping across the United States, the federal government, some local governments, health insurance companies, health systems, and private telemedicine companies are all taking steps to make virtual medical visits and online health assessments available to more people.

Indeed, in a poll conducted by healthcare research, information, and publishing company Castle Connolly, approximately one-third of the doctors who answered said they were handling more consultations via apps and devices during the pandemic.

Some systems are offering free virtual COVID-19 assessments to anyone who contacts them, and while the disease cannot be diagnosed without a lab test, a remote healthcare provider can direct you to the next appropriate step, whether it’s staying home or seeking in-person care.

There’s no better time to learn about your telemedicine options than now.

COVID-19: Hope vs. Hype and the Silver Lining

How to Get Started Using Telemedicine

With more and more medical practices offering virtual care options, you may want to check first with your primary care doctor, if you have one, or a group medical practice with which you already have a relationship, to see if they’re using phone calls, video chats, or other online methods to conduct remote patient visits.

Pediatricians are also increasingly offering telecare, and many specialists, such as cardiologists, neurologists, obstetricians, and oncologists, are also offering care to their existing patients via telemedicine.

You may also want to check with your health insurance plan to see whether it has its own telemedicine interface, has partnered with a telemedicine company, or has preferred services. Using a telemedicine plan that accepts your insurance is one way to keep your costs down.

Another option, if you’re employed, is to ask your human resources department if the company has a preferred telemedicine provider — and whether there’s a cost savings to you in using it.

Medicaid covers some telehealth services, although the specifics vary from state to state. You should contact your healthcare provider if you have Medicaid to ask what services are available to you.

Medicare beneficiaries also now have broader access to virtual visits, following a federal rules changes in March 2020.

Some physical urgent care centers are offering telehealth, and at the very least, most will speak to you on the phone about whether or not to come to the center. If you have any upper respiratory symptoms or other symptoms suggesting possible COVID-19, they likely will have special instructions for your visit.

Telemedicine apps are another option. Many apps offer basic primary and urgent care, and some offer additional services, such as dermatology, nutrition counseling, or mental health help.

Learn More About Telemedicine Apps

What You’ll Need for a Successful Virtual Visit

Telemedicine experts recommend having these on hand for a successful virtual visit:

A Charged, Plugged-In Device With a Strong Signal You don’t want to run out of power or lose your connection during your appointment! Use Wi-Fi if your cellular data plan is limited.

Ear Buds With a Built-in Microphone It will be easier to hear the healthcare provider, and for them to hear you.

A Quiet Location With Good Lighting Turn off the TV, mute notifications on your phone, and tell others in your house you’ll be busy for the next 15 to 20 minutes before you start your visit. Make sure there’s enough light for the health professional to see your face — and any rashes or other physical problems you want to show them.

If you’re not at home during the virtual visit, find a quiet, private spot where you can shut the door. “I’ve had people try to do virtual urgent care visits while they’re driving a car. We tell them to hang up and we’ll reschedule later,” Dr. Bishop says.

A Flashlight You may need extra light to give the doctor a clear view of your sore throat, a mouth problem, or even a skin problem. “That’s a big one for our urgent care service at Mount Sinai,” says telemedicine expert Brendan Carr, MD, chair of emergency medicine for the Mount Sinai Health System in New York City. “People often call for sore throat, but it’s hard to see back of a throat without a flashlight.”

A List of Your Medication and Supplements, Health History, and Questions A telemedicine doctor who’s seeing you for the first time can better help you if they know about any chronic health conditions or other important health issues you have, as well as the prescription and over-the-counter drugs and supplements you currently take. It’s also smart to jot down your questions ahead of time, Bishop suggests.

If you’re seeing your usual doctor via telehealth instead of in-person, be sure to mention any new symptoms you may be having, any new over-the-counter products you may be using, and any prescriptions you need to have refilled.

How to Get Screened Safely for COVID-19 Symptoms

Telehealth companies, health systems, and health-insurance companies across the nation are offering free online help to people worried they may have coronavirus symptoms, which include fever, a cough, and shortness of breath.

To find a free assessment in your area, contact your doctor, your local health system or hospital, or your health insurance company. Or check with one of the private telemedicine companies offering free online assessments, such as RoDoctor on Demand, or in parts of California, Google’s Project Baseline.

You can also use the Centers for Disease Control and Prevention (CDC) online Coronavirus Self-Checker, which can’t connect you with a doctor but can help you decide whether to contact one yourself.

Hospitals across the United States are also adding telehealth coronavirus assessments in their emergency rooms, says Dr. Carr.

“At Mount Sinai and at other hospitals, you can sit in an enclosed space and interact with a healthcare provider on a tablet or computer. They will assess you and determine whether or not you should be tested,” Carr says. “This can reduce exposure to the virus for other people in the ER and for hospital staff, which is very important right now. Our service can also help schedule a test, to prevent testing sites from becoming inundated. For people whose symptoms do not indicate coronavirus, a visit is very reassuring, too.”

Urgent Care: Telemedicine’s Leading Edge

Under normal, nonpandemic circumstances, virtual urgent care may be the best way to deal with non-life-threatening health concerns that crop up in the middle of the night, while you’re on vacation, or when you can’t get to your primary care doctor’s office for some other reason. For symptoms that suggest a sinus infectionurinary tract infection, or pink eye — the same types of issues you’d take to a local urgent care center — a virtual urgent care visit with a doctor can lead to a diagnosis, at-home treatment suggestions, a prescription for medication if needed, and, if necessary, recommendations for tests and follow-ups with an in-person health professional.

Who Provides Virtual Urgent Care A growing number of hospitals, healthcare systems, health insurance companies, and private, direct-to-consumer telemedicine companies all offer urgent care services. Virtual urgent care companies include Amwell, Doctor On Demand, MDLIVEPlushCareTeladoc, and others.

Cost of Virtual Urgent Care A telemedicine urgent care visit could cost as little as $35 — the cost for anyone who uses Houston Methodist’s urgent care service, according to Bishop — to $75 or more. You may pay more if you use a company that doesn’t take your health insurance (or you don’t have health insurance), and you may pay less if you use a service covered by your health plan or by your employer. 

How Virtual Urgent Care Works You need audio and video for this type of telehealth visit, so use a smartphone, tablet, or laptop or desktop computer with a video camera. Download the app for the urgent care service you want to use, and follow the directions for scheduling an appointment and providing credit card information for payment. You can usually meet with a doctor online within minutes.

Virtual Visits and ‘E-Consults’ With Your Own Doctors

When it comes to telemedicine, different primary care practices do it differently. Some practices, such as Parsley Health, offer the option of in-person visits but are able to conduct all care via telehealth — although you will likely still need to visit a physical facility for such things as lab tests, imaging tests, vaccines, and certain procedures.

Other practices may offer only certain types of interactions online. For example, you doctor may be able to review your lab test results or check on your progress after some procedures via phone, video, email, or secure online messaging but still want to see you in the office for other types of care.

In some cases, you’ll need to provide certain data before a virtual visit, such as readings you upload from your glucose meter to your doctor’s patient portal, if you have diabetes, or from a blood pressure monitor if you have high blood pressure.

In rural areas, your family doctor may be able to help you access online health services, such as mental health appointments and visits with specialists. Indeed, video conferencing with specialists is an important way that rural patients and their doctors can get help managing complex chronic diseases.

If you’d like to try an online consultation with a doctor you currently see, ask the doctor, or their office assistant, if this service is available and right for you.

“A consult or scheduled, virtual visit with your own doctor means you’re working with someone who knows you and your health history,” Bishop says. “Some doctors in our system will also do on-demand urgent care visits for their own patients, so it’s worth asking.”

Generally, you pay the same price for a virtual visit with your doctor as an in-person visit. But pricing and availability vary between doctors, health systems, health insurers and states, so it’s worth checking with your doctor and with your health insurer to find out what’s available to you, Bishop adds.

Second Opinions, Mental Health, Physical Therapy, and More

Why drive hundreds, or even thousands, of miles when you can get the care and health information you need at home? There are plenty of options, including:

Second Opinion Services

Major medical centers including the Cleveland ClinicStanford, and Harvard-affiliated Partners Healthcare offer virtual second-opinion programs that give you access to top specialists who can review a medical diagnosis or treatment plan online.

Mental Health Counseling and Treatment

Psychiatrists, psychologists, and other mental health counselors offer telehealth appointments through many organizations — including private practices, private telemedicine companies, and the US Department of Veterans Affairs. Ask your family doctor or health insurer about your options.

Physical Therapy

Several private telehealth companies as well as physical therapy practices now offer virtual visits with a physical therapist. According to the American Physical Therapy Association (APTA), onscreen PT is happening mostly in rural areas but could expand. It’s not a good choice if you need hands-on care to guide your physical therapy, but it’s being used with older adults, people who are homebound, and in medical fields including cancer care, women’s health, cardiac rehabilitation, and more, according to the APTA.


Pros of Virtual Medical Visits

Are telemedicine virtual visits worthwhile? According to experts and recent research, the upsides include the following:

They save time. “A lot of people don’t have time to drive to an appointment and then sit in a waiting room for 10, 20 minutes or longer,” says Bishop. “We have patients who use Houston Methodist Virtual Urgent Care at work, going into a private office and shutting the door for their appointment, or using it from home.”

They save money. While the cost of a virtual visit varies widely depending on your health insurance coverage, choice of provider and type of service (read on for details), it’s likely to cost less than a visit to an in-person urgent care center or hospital emergency room for the same problem.

For example, you could spend as little as $4 (with some employer-sponsored plans) to $75 (without using insurance) for a virtual urgent care visit. That’s a wide range, but it’s less than the average $176 price tag for a visit to an in-person urgent care center or the $350 to $600 you could spend for treatment of an earache, bronchitis, or strep throat at a hospital emergency room, according to Dignity Health, one of the nation’s largest healthcare providers.

Then there’s the cost of transportation. You won’t have to shell out money for gas and parking or for a taxi, train, or bus. “For someone who’s driving an hour and a half and paying $25 for parking for a routine checkup after a successful knee replacement, a virtual visit can be a big savings,” Carr notes.

Bishop adds childcare costs to the savings, too. “You won’t have to pay a babysitter while you go to the doctor,” she notes. “Just find a quiet spot in your home, tap on the app, and get started.”

You avoid exposure to infectious germs. Virtual visits keep you out of settings where you could be exposed to the flu or other infectious viruses, bacteria, or other germs, Bishop notes. “That can be important if you have low immunity, if something is going around in your community, or at times like this when coronavirus is spreading,” she says. “It can help you stay healthy if you’re not sick, but just need to see the doctor for something minor or for your annual well visit or for a routine visit to manage a chronic health condition such as high blood pressure.”

You get access when health services aren’t available near you. For people who live in rural areas of the United States, telemedicine is helping to bridge big gaps in access to healthcare. According to a 2016 Harvard Medical School study published in the Journal of the American Medical Association, 80 percent of Medicare telehealth visits in 2013 were for counseling and other mental health services, for example.

Meanwhile, the CDC is supporting telehealth services in rural areas of the United States that improve stroke care through hospital consultations with far-away neurologists, virtual programs for diabetes management and prevention, quitting smoking, managing epilepsy, and telemedicine screenings for eye diseases.

Potential Downsides to Telemedicine

These possible drawbacks to virtual visits won’t apply to everyone, but they’re worth considering when weighing your options for seeking medical care:

You may still need an in-person appointment or a medical test. Sometimes, the doctor you see onscreen during an urgent care virtual visit may recommend a face-to-face appointment with your own primary care doctor or at a brick-and-mortar urgent care center. You may also need laboratory or other tests to confirm a diagnosis.

You may receive better care in person. In plenty of studies and surveys, consumers are extremely happy with telemedicine appointments. But in a study published in May 2019 in the journal Pediatrics, of nearly 530,000 medical visits for respiratory infections in kids ages 0 to 7, researchers from the University of Pittsburgh Medical Center’s Children’s Hospital of Pittsburgh found that children received antibiotics at 52 percent of telemedicine visits, but just 42 percent of urgent care and 31 percent of primary care doctor visits. And fewer telemedicine visits followed guidelines for when to prescribe these often-overused drugs.

“I’m a pediatrician and a parent,” lead researcher Kristin Ray, MD, of UPMC Children’s Hospital of Pittsburgh, told the Children’s Hospital Association. “I completely understand the appeal of being able to access care immediately when a child is sick. I appreciate that need and desire for care in the home at all hours. I think we just need to continue, as healthcare systems and individual providers, to make sure we are meeting the demand and need while maintaining the quality that our patients deserve.”

And in a study of 16 online telemedicine companies published in July 2016 in JAMA Dermatology, researchers from the University of California in San Francisco found that sometimes online doctors misdiagnosed skin cancer, herpes, and syphilis, in addition to prescribing medication without taking a patient’s medical history. 

You may not be able to choose your healthcare practitioner. Unlike scheduling an online appointment with your own doctor or arranging for one with a specific specialist, you may not get to choose your provider for a virtual urgent care visit, according to the 2016 JAMA Dermatology study.

Best and Worst Times to Use Telemedicine

You wouldn’t log into a virtual doctor’s visit if you were having heart attack symptoms, but telemedicine can be a good choice for less severe health problems, from an earache to a skin rash.

Best Uses For Virtual Urgent Care The following can often be handled well by virtual urgent care providers: seasonal allergies, colds, constipation, coughs, mild diarrhea, ear problems, pink eye, respiratory problems, sore throat, urinary tract infections, flu symptoms, headache, nausea, and short-term vomiting.

When an In-Person Doctor Visit Is Better If you have a serious health problem that is likely to require a physical exam, lab test, X-rays or other scans, or other procedures, you will need to make an in-person appointment.

When to Get Emergency Help Call 911 right away if you think you or someone else is having a medical emergency, the American College of Emergency Physicians recommends. This includes broken bones, choking, stopped breathing, heavy bleeding, severe pain, head injuries with dizziness or confusion or loss of consciousness, serious burns, deep wounds, high fever, allergic reactions that include swelling and breathing trouble, heart attack symptoms (chest pain or discomfort, pain in the arm or jaw), or stroke symptoms (weakness or drooping on one side of body, trouble speaking, sudden inability to see, speak, walk, or mo

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