See your online doctor working?

Telehealth has been around for years, but it never really took off – until the Covid-19 pandemic. As US health centers had to close their doors, seeing a doctor online has become a real alternative to personal visits in the past.

While the country is still struggling with the pandemic, millions of Americans have been meeting with doctors of all specialties – from emergency care to neurology – in the comfort of their homes.

And many fortunately. Patients are just as likely – or even slightly more likely – to evaluate their caregivers after telephone or virtual visits to the doctor compared to face-to-face care, suggests a national Press Ganey survey released last month.

The healthcare company, which surveyed 1.3 million people in 154 medical practices between January and August 2020, found that patients felt positive about “all measures of concern to providers, the ability to establish a connection and build trust “.

Madison Russell, a 20-year-old disabled college student from Atlanta, Georgia, says that during the pandemic, there was always a doctor available whenever she had an urgent matter.

Even if she had to stay in a virtual waiting room for a while, Ms. Russell says that “it was still better” than cooling your heels in a doctor’s office, as she could “be productive and do something else in the meantime, like clean the kitchen” .

Telemedicine peaked in about 37% of all medical care in early May, decreased to 22% in early July and has remained stable at 15% since mid-August. But that is still well above the pre-pandemic rate of less than 1%, according to Press Ganey.

The main reason behind this increase was the removal of regulatory barriers. Before the pandemic hit, Medicare, the US program for elderly Americans, limited the way providers were paid for telemedicine consultations.

Most remote visits would not necessarily be reimbursed at the same rate as if they happened in person, says Dr. Jessica Dudley, clinical director at Press Ganey and an assistant professor at Harvard Medical School.

Another limit was that providers should also be licensed in the state in which their patients lived.

But after state orders closed face-to-face health visits, Covid-19’s emergency legislation eased these Medicare payment restrictions and allowed doctors to work across state borders, driving the huge increase in telehealth.

“Covid-19 forced us to finally recognize the value of telemedicine in keeping patients and doctors safe,” said Dr. Eric Singman, a neuro-ophthalmologist and associate professor at the Johns Hopkins School of Medicine.

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

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

The patient’s health 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 are able to do 95% of what they would do in person, he adds.

For some fields, such as behavioral health, telemedicine may even be “often better” than personal visits, says Dr. Joe Kvedar, chairman of the American Telehealth Association and professor of dermatology at Harvard Medical School.

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

Virtual mental health was especially important this year. Health insurer Blue Cross Blue Shield has received 28,000 telehealth requests per day, up from 200 in February – and half of those requests are for virtual mental health consultations.

Elaine Vigneault, 44, from Las Vegas, had a recent telehealth consultation for a painful skin rash and said she prefers the virtual method to previous visits.

“It gives you the freedom to stay home and not have to expose yourself to whatever is 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.

Mrs. Vigneault felt that she had her doctor’s full attention, even though 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 an issue.

Simply being a matter of logging in to an online call or consultation, it helps patients to arrive on time and, in turn, doctors.

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

Despite the benefits, there are disadvantages to virtual medical consultations.

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

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

Each provider has its own way of scheduling appointments and generally uses different technology, she says.

For one of her virtual appointments, Ms. Vigneault was supposed to receive a text message followed by an email with some instructions, but she received none.

However, this was a “small hiccup” easily resolved by calling your provider, she says.

Telemedicine has gone from being a “small country road that nobody took” before Covid-19 to a “16-lane highway” in the countryside, says psychiatrist Dr. Ken Duckworth, senior medical director at Blue Cross Blue Shield of Massachusetts.

Before the pandemic, there were already signs that telemedicine would be “a big deal for America and around the world,” said Dr. Nicholas Lorenzo, medical director at the telehealth company MeMD.

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

The pandemic proved the efficiency of telemedicine, which is certainly 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 efficient than having to drive somewhere, but it won’t happen unless organizations provide resources, and in ways that would normally afford the clinic.”