Does seeing your doctor online work?

Telehealth has been around for years but never really took off – until the Covid-19 pandemic. As America’s health centers have had to close their doors, seeing a doctor online has become a real alternative to face-to-face visits from alumni.

As the country continues to grapple with the pandemic, millions of Americans have met with doctors of all specialties – from emergency care to neurology – in the comfort of their homes.

And fortunately a lot. Patients are also likely – if not slightly more likely – to rate their caregivers high after phone or virtual doctor visits compared to in-person care, suggests a national Press Ganey survey released last month.

The healthcare company, which surveyed 1.3 million people in 154 doctor’s offices between January and August 2020, found that patients felt positive about “all measures of provider concern, their ability to establishing connection and building trust ”.

Madison Russell, a 20-year-old disabled student from Atlanta, Ga., Says that throughout the pandemic, there has always been a doctor available whenever she has an urgent care issue.

Even if she had to hang out for a bit in a virtual waiting room, Ms Russell says that “it was always better” than cooling her heels in a doctor’s office because she could “be productive and do something else in her. meanwhile, like cleaning the kitchen “.

Telemedicine peaked at around 37% of all doctor visits in early May, declined to 22% in early July and has remained stable at 15% since mid-August. But it’s still well above the pre-pandemic rate of less than 1%, according to Press Ganey.

One of the main reasons for this increase was the removal of regulatory barriers. Before the pandemic hit, Medicare, the U.S. program for elderly Americans, limited how providers were paid for telemedicine appointments.

Most remote visits wouldn’t necessarily be reimbursed at the same rate as if they were done in person, says Dr Jessica Dudley, clinical director at Press Ganey and assistant professor at Harvard Medical School.

Another limitation was that providers also had to be licensed in the state in which their patients lived.

But after state warrants ended in-person health visits, emergency Covid-19 legislation relaxed these Medicare payment restrictions and allowed doctors to practice across states, resulting in a massive increase in telehealth.

“Covid-19 has forced us to finally recognize the value of telemedicine in ensuring patient and physician safety,” says Dr. Eric Singman, neuro-ophthalmologist and associate professor at the Johns Hopkins School of Medicine.

Patients began to appreciate the ability to communicate with providers without putting themselves at risk during the pandemic and doctors embraced the change as well, with many trying telehealth for the first time.

Dr Singman’s virtual tours have been so successful that an organization in Texas recently started working with John Hopkins to allow him to see their local patients remotely.

A patient’s medical history is 90% of the diagnosis, says Dr Singman, “and the history is something we do verbally.”

When remote visits have a video component, doctors can do 95% of what they would do in person, he adds.

For some areas, like behavioral health, telemedicine may even be “much better” than in-person visits, says Dr. Joe Kvedar, chairman of the board of the American Telehealth Association and professor of dermatology at Harvard Medical School.

This is because practitioners can see patients in their everyday environment, which greatly helps them understand them. Patients also tend to be more relaxed at home than in the doctor’s office, he says.

Virtual mental health has been particularly important this year. Blue Cross health insurance company Blue Shield receives 28,000 telehealth claims per day, up from 200 in February – and half of those claims are for virtual mental health tours.

Elaine Vigneault, 44, of Las Vegas, recently had a telehealth appointment for a painful rash and said she preferred the virtual method to past in-person visits.

“It gives you the freedom to stay home and not have to expose yourself to anything that might be in the waiting room,” she says.

As soon as she “put her face in front of the camera” and described the discomfort, the doctor was able to diagnose her with shingles, a viral infection, she says.

Ms. Vigneault felt that she had her doctor’s undivided attention, although they were not in the same room.

In addition to reducing the risk of viral transmission, telemedicine is undoubtedly convenient. Delays, like getting stuck in traffic, are no longer a problem.

Since it’s just a matter of connecting to a call or an online appointment, it helps the patients to be on time and, in turn, the doctors.

At Mass General Hospital in Boston, where dermatologist Dr. Kvedar works, the average wait time for urgent care appointments is five minutes from the first start of the video call.

Despite the advantages, virtual doctor visits have their drawbacks.

Press Ganey found that patients tend to be dissatisfied with issues with scheduling appointments and technical issues such as poor audio and video connections.

“If I had a complaint about telemedicine,” says Ms. Vigneault, “it would be that there is no consistency.”

Each provider has their own way of making appointments and often uses different technology, she says.

For one of her virtual dates, Ms. Vigneault was supposed to receive an SMS followed by an email with some instructions, but she received neither.

However, it was a “little hiccup” easily resolved by calling her provider, she said.

Telemedicine has gone from a “little back road that no one took” before Covid-19 to a “16-lane highway” on the ground, says psychiatrist Dr. Ken Duckworth, senior medical director of Blue Cross Blue Shield of Massachusetts.

Before the pandemic, there were already signs that telemedicine would be “a huge thing for America and the world,” says Dr. Nicholas Lorenzo, chief medical officer of telehealth company MeMD.

“I hate to say that there is something positive about the pandemic, but the past 10 months have really taken telemedicine seven to ten years ahead.”

The pandemic has proven the effectiveness of telemedicine, which is surely here to stay.

But for that to happen, it is crucial that “the payment model and regulatory challenges” continue to be addressed in a post-Covid world, says Dr Dudley of Harvard.

“Telemedicine can be much more effective than having to drive somewhere, but that won’t happen unless organizations provide the resources, and in a way that normally feeds the clinic.