August 05, 2019
Telemedicine services are rising in popularity.
One recent analysis found that telemedicine services increased by nearly 1,400 percent between 2014 and 2018. And health care providers are using telemedicine in all kinds of ways – pre-screening appointments, post-surgical follow-ups and urgent care visits among them.
Penn Medicine has dabbled in telemedicine for more than 15 years, including establishing a virtual urgent care service that enables patients to receive care for low acuity issues without ever leaving home.
"You can get an evaluation and appropriate intervention," said Dr. Bill Hanson, Penn Medicine's chief medical information officer. "We've found that's been hugely satisfactory for the folks that use this service. They don't have to take time off from work. They don't have to drive to some place. They don't have to wait in a waiting room."
With telemedicine services becoming more common, Hanson answered some basic questions for patients considering them:
Many health systems, including Penn Medicine, offer virtual urgent care visits designed to provide on-demand health care services to patients without the hassle of juggling their schedules to drive to an in-person appointment.
All sorts of common ailments can be treated remotely, including sore throats, upper respiratory symptoms and urinary tract infections. If necessary, doctors can prescribe medications to be filled at the most convenient pharmacy.
Often times, the entire virtual visit takes less than 20 minutes.
But patients should not use telemedicine for an emergency situation, Hanson said. That includes traumatic injuries with – or without – bleeding, potential fractures or any symptoms indicating a potential cardiac or neurological issue.
"Those are all things that are going to require in-person assessment and, in many cases, imaging or an intervention," Hanson said.
Additionally, some outpatient clinics provide virtual follow-up examinations via telemedicine, including those following surgery. Hanson pointed to the checkups he received following hip surgery a few years ago as an example.
"Fundamentally, it was 'How are you doing, how's the exercise, how the incision look?'" Hanson said. "None of that really required me to be in the doctor's office. We're getting to understand better where telemedicine might be useful."
Most laptops, smartphones and tablets can accommodate a telemedicine visit – so long as the patient is in a place with sufficient internet connectivity, Hanson said. The devices also need to have adequate audio/video capabilities.
Penn Medicine conducts visits through its myPennMedicine app, the same portal that provides patients with access to their medical records and enables them to message their providers.
Prior to each appointment, a brief technology assessment is conducted to ensure the visit can be completed without a technological hitch.
Patients also should make sure they are in an appropriate setting during the telemedicine visit. That means finding a quiet place where a confidential conversation can play out without distractions.
A patient seeking a telemedicine appointment generally will receive one within two or three hours, Hanson said. A tech assessment will precede the visit.
Either a family care physician or a nurse practitioner will handle the visit. They ask about the patient's general health before inquiring about the issue necessitating the visit. In some cases, they may ask the patient to take their temperature, if possible, or use the camera to examine, say, the patient's throat.
"We usually cut to the chase," Hanson said. "If it's something we can deal with telemedically, we deal with it."
If the provider cannot handle the situation via telemedicine, they will encourage the patient to seek an in-person encounter at an emergency department or urgent care center.
If necessary, the provider will prescribe medications that the patient can pick up at their preferred pharmacy. But Hanson warned that Penn Medicine providers take a judicious approach to prescribing antibiotics.
"We're attentive to the unnecessary overprescription of antibiotics and not interested in giving antibiotics to someone who wants them but doesn't have the right symptom complex," Hanson said.
Health systems that offer telemedicine services can access a patient's medical records if a patient typically receives care via the health system. The medical providers can review the patient's medical history and enter the appointment with familiarity.
But Hanson warned that other telemedicine providers may not be able to do so. Telemedicine clinics that are unaffiliated with a health system – like those run by pharmacies – do not have access to patient records, preventing familiarity and a continuum of care.
Health systems also can connect patients to other providers within their networks if needed, another capability that unaffiliated telemedicine clinics lack.
"That's what people are looking for – Do I have something I can address using this vehicle," Hanson said. "If not, what's Plan B? It may be they're perfectly happy to have an appointment at a doctor's office in the next 24 to 48 hours."
Coverage varies by state and insurer.
Many states, including New Jersey and Delaware, have adopted parity laws that require insurers to cover telemedicine services on the same basis and at the same reimbursement rate as in-person medical services. Those states also have adopted parity laws for Medicaid services.
Pennsylvania has not enacted any such telemedicine laws, enabling insurers to classify telemedicine services differently than traditional medical services. In doing so, they often do not cover various telemedicine services or offer reimbursements at different rates than traditional services. Those interested in telemedicine services should check their health insurance coverage to avoid any surprises.
"The insurance companies have a growing interest in (telemedicine), recognizing that this is an area that their customers are demanding," Hanson said. "But they have a concern that this could be an area of over-utilization, both by their members and potentially by the medical community. They're very interested in understanding how to go about doing this in a way that is, at the very least, net neutral."
Patients should ask themselves a series of questions following a telemedicine visit, Hanson said.
Among them: Was the service delivered in a timely fashion? Was the provider professional and express familiarity and empathy? Did they seem to understand how to carry out health care services in a telemedical fashion?
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