While telehealth options have been around for a while (think 24-hour nursing hotlines), the field has been a distant cousin to in-person care. A 2017 survey by Avizia, a telehealth company, found that only 18 percent of surveyed patients used telehealth options.
But that was then. Telemedicine has exploded recently with the physical distancing restrictions of COVID-19. In fact, telehealth, a service formerly only covered by Medicare for rural areas, now benefits from a wholesale lifting of federal restrictions because of the pandemic while expanding the services covered. Providers who had previously shown little interest in investing in the infrastructure and technology needed for telehealth have scrambled to get on board, and remote health visit options have expanded. Patients can talk to a doctor for everything from a cough to psychiatric symptoms.
There are many good reasons for promoting telehealth options. Both patients and providers are protected from potential transmission of disease. It allows patients to be seen in the comfort of their own homes, saving them from lengthy and/or uncomfortable travel. Telehealth is also very efficient, making the most of the time of the provider and patient. Virtual healthcare is also accessible. While you may have to wait a day or two (or longer) to be seen in a physician’s office, a telehealth appointment is usually a matter of a half hour or less. With the concerns around COVID-19, small wonder that many patients (and doctors) who had not previously considered using telehealth are now much more receptive to it.
But telemedicine also carries risks. Chances are you won’t be seeing your own physician, so your telehealth provider will have an extremely limited medical history for you. Physical examination and observation are also confined to what can be seen on video (or if the “visit” is via a phone call, not at all). Consequently, the risk for misdiagnosis is even higher than it is for in-person visits (this JAMA Dermatology telehealth study outlines some of the factors contributing to telemedicine misdiagnosis).
Then there’s fraud. In 2019, 35 people were charged by the Justice Department in a telemedicine scheme that allegedly billed Medicare for $2.1 billion in fraudulent charges. With the relaxed regulations under COVID-19, including waiving co-pays, the conditions are right for much more abuse. So, with the relative anonymity of a single telehealth visit there is the question of whether you will be treated as a patient or as a billable.
So, all that said, what can you do to make the most of your telemedicine options?
If your provider offers a telehealth option, ask who you will be seeing. While some health systems use their own providers, others outsource the service to a telehealth vendor. If that is not an option you are comfortable with, let your provider know and seek another care solution.
Make sure you have the right equipment. At a minimum, you will need a computer or a mobile device that has an integrated camera and microphone along with a good internet connection.
Be prepared with questions and notes. Having detailed notes on hand helps ensure the provider will make an accurate assessment. Include what you are experiencing, when symptoms started, progression, etc. If the physician makes a diagnosis or prescribes medication, make sure they know what other medications you are taking and that you are clear and comfortable with their assessment and treatment. If not, ask questions until you are. Be sure to take notes and document the visit for your own records.
Follow up with your own physician. If your telehealth provider has prescribed medication or you are dealing with something more long term, schedule a follow-up appointment with your own physician.
Pay attention to billing. Your fees should be clearly stated and reasonable. Watch for unusual billing activity in your name and alert your health insurance company if you detect any charges you can’t identify.
Remember, telehealth is just one healthcare option. When it comes to navigating your care, you are your best advocate. If you believe you are dealing with something more serious or you have symptoms that require a hands-on physical examination or bloodwork, you should seriously consider seeking in-person care. Many practices set aside same-day appointments or have accompanying urgent-care options. If you do have the misfortune of a negative telehealth experience that results in a misdiagnosis or other harm, we urge you to consult with a knowledgeable attorney to understand your options.