- The Washington Times - Wednesday, March 25, 2020

Should I visit a doctor’s office? Some people might be asking this question as the public navigates social distancing orders to stem the spread of the coronavirus. But many patients can see a physician without leaving the comfort of their homes.

Health officials, insurance companies and hospitals are advocating for people to avoid the doctor’s office and try telemedicine for minor problems.

“Telemedicine can be an important way to help cope with a pandemic in that it is a force multiplier — allowing infectious disease doctors, for example, to see patients remotely where there may be no infectious disease doctor,” said Dr. Amesh Adalja, senior scholar for Johns Hopkins Center for Health Security.

“Telemedicine can also allow patients with non-COVID related issues to be able to access medical care without having to travel to a facility.”

What kind of services are provided?

Robin Glass, president of the telemedicine company Doctor On Demand, said its physicians can treat 90% of the most common conditions seen in urgent care facilities via video chats, including cold and flu, sinus infections, skin conditions, UTIs, allergies and mental health concerns such as anxiety and depression.

Doctors also can provide preventive care and help manage chronic conditions. Licensed mental health providers can offer virtual help ranging from talk therapy to medication management.

Dr. S. John Korangy, founder and CEO of the telemedicine company CareClix, said technology has evolved dramatically, allowing physicians to conduct remote ear, nose and throat exams; examine skin lesions; and listen to hearts and lungs.

“Essentially we can perform a full exam with the obvious exception of not being able to physically touch the patient,” Dr. Korangy said, adding that his company has programs that operate in acute settings and manage patients from home or work.

How is it being used during the coronavirus pandemic?

Telehealth doctors can check patients for symptoms of possible coronavirus infection, then direct them to testing facilities or to visit an in-person urgent care or emergency department.

“By providing direct access to physicians and medical care, telehealth enables patients to stay at home, be evaluated remotely and only if necessary go to a healthcare facility,” Dr. Korangy said. “This reduces the burden on hospitals and health care facilities who can focus on highly acute patients while the less acute individuals can be managed remotely from their homes.”

Some telemedicine companies have added services such as a coronavirus resource center, webinars about COVID-19 and a virus risk assessment.

Ms. Glass said Doctor on Demand physicians are seeing patients for a wide range of symptoms, including those with concerns about coronavirus and those with other acute or chronic concerns who are opting out of in-person care at this time.

Only about a third of visits are related to COVID-19, she said, adding that her company is seeing an uptick in behavioral health visits.

Who offers it?

Insurers and hospital systems often offer telemedicine services.

U.S. officials announced earlier this month they would expand telemedicine access through Medicare, which covers people aged 65 and older and those with disabilities. Many Medicare Advantage plans offer access to virtual health care.

The federal government has asked states to expand coverage of services under Medicaid, which covers low-income people.

What are the benefits of telemedicine?

“Telemedicine is easier for people to access, because they can do it from home or another place of their choice, and are thus more likely to use it than if they had to travel to an appointment,” said Dr. Tom Frieden, president of Resolve to Save Lives and former CDC director.

He added telemedicine services are more often available outside of typical business hours when most doctor’s offices and clinics are closed. Virtual health care is also generally less costly to both patients and health care systems than in-person medical visits.

Virtual health care enables patients to access care anytime and from anywhere, Dr. Korangy said, and allows health care institutions to manage medical groups across multiple facilities over a large geographic area. Telemedicine can also prevent unnecessary medical visits such as to the ER.

What are the limitations of telemedicine?

Although telemedicine can successfully address many concerns, it has some physical and regulatory limitations. In these cases, telehealth companies may collaborate with brick-and-mortar facilities.

“There will be times when a hands-on physical exam or lab tests will be needed, in which case that can be scheduled as it normally would,” Dr. Frieden said. “In some cases, a telemedicine visit may not be conducted by a person’s usual care provider, which reduces continuity of care. However, increased use of electronic health records makes that problem less likely.”

And of course, telemedicine cannot replace a visit to urgent care or an emergency department.

How much does it cost?

Prices vary, depending on the health plan and the services provided.

Millions of Americans can access telehealth services at reduced co-pays through their health plans or employers. The cost of a Doctor on Demand visit is $75 and is available directly to consumers.

MDLive also charges $75 for an urgent care visit through video chat. Another company, 98point6, diagnoses and treats through secured text messages and charges a $20 annual fee, then $1 for each visit.

Most states have regulations requiring commercial companies to reimburse for telemedicine services, Dr. Korangy said. Medicare and Medicaid programs also have expanded many of their services to reimburse for virtual health care.

During the coronavirus crisis, many providers and insurers are waiving costs associated with telehealth for a limited time. They also have pledged to cover coronavirus testing for those who meet federal health guidelines and whose doctors request it.

• This article is based in part on wire service reports.

• Shen Wu Tan can be reached at stan@washingtontimes.com.

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