6 Things To Know About Telehealth

Source: Vox/Recode, Rebecca Heilweil
Photo: James Bareham for Vox

Due to Covid-19, video chats with doctors are becoming mainstream. Here’s how it all works.

Health care in the United States has never been easy, but with the coronavirus pandemic, a visit to the doctor’s office is just plain risky. That’s why this crisis has become a moment for telehealth, which connects patients to doctors through the internet. Although telehealth has been around for a few years, recent updates to regulations and a surge in demand has made it the easiest way to get many different types of medical care. And, because you don’t have to leave your house to see a doctor, telehealth is also the safest option right now.

Though it’s been a popular platform for therapy for some time, telehealth is an option for many kinds of health care. Urgent care centers are encouraging patients to use their telemedicine options instead of coming in. Some hospitals are making use of virtual platforms to screen and triage patients who might have Covid-19, while others are using the technology just to free up space and personnel. Telehealth visits across the board were up 50 percent in March, by one measure, and are on track to hit 1 billion by the end of the year.

“Our challenge has always been that we haven’t had wide-scale adoption because there just hasn’t been wide-scale awareness,” Hill Ferguson, the CEO of the telemedicine provider Doctors on Demand, told Recode. “In the last month, we’ve had everyone from the president of the United States down to local governors to CEOs of health care companies all saying use telemedicine as a first line of defense.”

Still, the idea of talking to a doctor through a computer or a smartphone is undoubtedly intimidating for many. There are new services to learn about, privacy concerns to deal with, and insurance issues to figure out. But with rapid changes, telehealth has never been simpler.

1) Telehealth is easier than going to the doctor’s office

Telemedicine is typically as straightforward as a patient chatting with a doctor over a video call. Because these consultations require a layer of privacy and security, there are regulations in place for patients’ protection, but those are changing in the face of the Covid-19 crisis.

The Department of Health and Human Services has announced that video platforms, like FaceTime and Skype, are temporarily acceptable for health care providers to use. Zoom has also been given temporary approval, although the platform is currently struggling with some security issues. You also might use a service that’s specifically designed for telehealth consultations, like VSee, Doxy, thera-Link, and Amazon Chime. Officials say that public-facing platforms like Facebook Live and TikTok should be avoided.

If you have a regular doctor, it’s possible they already have a telehealth system in place, so check in before looking for another provider. But if you don’t have a primary care physician or need urgent care, you should check out telemedicine platforms, like Doctors on Demand, Teladoc, and Amwell. (If you have insurance, check the insurer’s website, as insurance may only cover or offer discounts for certain platforms.)

With any of these telehealth platforms, you should look for HIPAA and HITECH compliance, as well as end-to-end encryption. HIPAA refers to the Health Insurance Portability and Accountability Act, and this regulation broadly requires restrictions on who can access your personal health information, including when it’s processed digitally, among other privacy assurances. (You can find a list of platforms that claim to be HIPAA-compliant here.) HITECH refers to the Health Information Technology for Economic and Clinical Health Act, which builds on HIPAA’s privacy protections while governing and encouraging the use of electronic medical records.

2) Virtual care helps everyone combat the coronavirus

Many hospitals are encouraging patients to use virtual urgent care for a consultation before heading to a clinic. This is especially important for patients who think they have Covid-19 but aren’t sick enough to require hospitalization. Virtual consultations allow doctors to triage patients without the risk of spreading the virus, and patients can get quick treatment for their symptoms. (Currently, there’s no proven treatment for the virus itself.)

“Doctors’ offices are going to be a very high-risk site for Covid transmission because people that come there will be sick, and doctors themselves are going to be important vectors of Covid transmission,” explains Michael Barnett, a professor at the Harvard T.H. Chan School of Public Health. “We know that health care professionals are getting infected at very high rates, and people can shed the virus when they’re asymptomatic.”

Even if you feel healthy enough to visit your doctor in person for a checkup, you should reconsider. Many routine health care needs can be addressed using telemedicine tools, and staying home is still the best way to do your part in the fight against the pandemic.

3) Insurance companies are making it easier to pay for telehealth

If you have private health insurance, you should check to see whether your insurer has made adjustments to their policies for reimbursement for telehealth. For instance, Aetna and Blue Cross Blue Shield are waiving copays for telemedicine for many members until June. But, as always, be prepared to read the fine print. Insurance companies have historically been slow to offer telehealth options.

“Insurers, in general, are not trying to add lots of new things that their patients can do to keep health care costs down,” Barnett explains. “Providers do just fine in the status quo of deeper service medicine and having people come in person.”

In the face of the coronavirus outbreak, however, government health care programs are opening up more to telehealth solutions. For instance, the Center for Medicare and Medicaid Services (CMS) is now reimbursing Medicare patients for telehealth services across the country. The government had previously limited telehealth to particular circumstances, like patients in rural areas, and those patients would typically still need to travel to a medical facility to consult with a doctor at another location. CMS is also encouraging states operating Medicaid programs to expand telehealth services.

All that said, even those without any health care coverage should be able to access telehealth services. Some community health clinics have already transitioned to telehealth services, and the Department of Health and Human Services has sent $100 million to more than a thousand health centers in part to promote telehealth. The telehealth platform Roman is also offering free Covid-19 risk assessments.

For affordable mental health care services, you might consider the nonprofit Open Path Psychotherapy Collective, which offers counseling for between $30 and $60 a session. There are also low-cost text-a-therapist services like TalkSpace and BetterHelp, though they’re not a replacement for speaking to a therapist in real time. You can learn more about finding a therapist in this Vox guide.

4) Telehealth is more versatile than you think

Telemedicine is particularly suited to certain types of medical care, including general consultations with doctors, mental health care, follow-up appointments, and even some specialties, like dermatology. It’s also fairly routine for doctors to write prescriptions after a telemedicine visit, and the government is lifting some restrictions for prescribing controlled substances via telemedicine curing the Covid-19 crisis. On the other hand, certain tasks like vaccinations and taking samples need to be done physically.

“There are definitely gray areas where telemedicine is not great, but there’s still a big chunk of medicine that could quite easily be taken out of the office and very conveniently delivered in some other medium,” Barnett says. “For physicians, a good 50 to 80 percent of what we do — depending on what you practice — really doesn’t need to happen in person.”

If you have the right equipment, a surprising number of health measurements can also be done remotely. As the Center for Connected Health Policy, a nonprofit that promotes telehealth, points out, there is a wide array of medical devices out there than can help you do anything from check your blood pressure to measure your blood oxygen levels. Some wearables, like the Apple Watch, can even produce electrocardiograms. In a telehealth scenario, these tools can provide your doctor with valuable information about your health.

5) Telemedicine is tough without proper internet access

Telemedicine often requires broadband that’s strong enough to host a stable video call, in addition to a device with the proper hardware. But according to a 2019 Pew study, 44 percent of Americans who make less than $30,000 a year don’t have access to home broadband, and 29 percent don’t have access to a smartphone.

Rural areas, as well as some city communities, are particularly vulnerable to this digital divide. While they’ve traditionally helped low-income people and rural Americans access the internet, libraries and community centers have been shut down to comply with social distancing requirements.

There may be some signs of hope, however. The FCC has also loosened rules governing the Lifeline Program — which entitles some low-income Americans to discounted telephone and internet services — and has said no one will be kicked out of the benefit until the summer. If you already have a smartphone, your provider may have expanded the amount of data available on your mobile plan in response to the Covid-19 crisis. And you may not need a phone that’s video-capable. CMS has now announced that providers can “evaluate beneficiaries who have audio phones only,” according to a statement from the agency, in addition to expanding 80 other telehealth services.

6) In-person health care might never be the same again

Whether the coronavirus pandemic will make telehealth mainstream remains to be seen. It’s also worth keeping in mind that the Covid-19 response has caused other types of health care to be put on hold, including treatment for cancer and gender-affirming procedures. We’ll eventually need to find a way to safely return to delivering many forms of in-person care.

Still, many people are using telehealth technology for the first time, and creating their initial impressions of telemedicine.

“For the first time ever, we’ve had massive levels of consumer awareness,” Ferguson, the Doctors on Demand chief executive, told Recode, adding that there may be even more significant changes in store for brick-and-mortar clinics and private practices. “They’re trying things for the first time and they’re realizing, ‘Wow, I can actually do a lot more to treat my patients over video than I ever thought.’”

Many of the adjustments for telehealth, including the suspension of copays and certain regulations, are temporary. But it may be hard for insurers and the government to pull back once patients become more used to using digital health services. After all, even when this pandemic is long gone, who wouldn’t want the convenience of reaching a doctor from anywhere? We might all be healthier for it.

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https://www.vox.com/recode/2020/4/8/21212432/telemedicine-how-to-video-chat-doctors