Telehealth: What it is and What it Means for YouJul 23, 2020 12:21PM ● By Kate Sage, D.O.
Welcome to the world of working from home, webinars, virtual happy hours… and online doctor visits. Here is your tutorial to navigating these virtual visits. First of all, not all doctor’s offices, hospitals or healthcare systems do things the same way, so expect some differences if you go from one virtual visit to another. However, in general, the same few things will be covered.
Before your visit, you will likely receive a phone call to confirm. You may actually get several phone calls to remind you of your appointment time, tell you how to sign on virtually to the visit, and to verify your insurance and billing. You may get a phone call from a medical assistant to go through some health history. Alternately, you may also receive an email with a link to update your health history. Many patients have noticed the (helpful?) increase in communication when planning a virtual visit.
To start a virtual visit, both the patient and the physician need a visual and audio device. For most people, that’s a phone or a computer with the video and audio options turned on. It’s recommended to test the video and audio before the visit to make sure that you can see and hear your doctor, and that your doctor can see and hear you. Make sure that you have a consistent Internet connection so that the video and audio are clear and not delayed. For some exams, it’s also helpful to move the video around to help show the doctor a part of your body that may be hurting or injured.
Again, virtual visits vary by office, but most places will direct the patient toward a “patient portal” or a specific website where the patient will wait in a virtual waiting room for the visit to begin. While in the waiting room the patient may be asked to fill out online paperwork to make sure that the health history on file is up to date and accurate. If a medical assistant called you before the visit, you shouldn’t have to do much of this. Usually this includes medical conditions (e.g. diabetes or high blood pressure); surgical history (e.g. tonsillectomy, knee replacement); an allergy list; a medication list; a social history (e.g. how many cigarettes the patients smokes or how much alcohol the patient drinks); and family history (e.g. if a first degree relative like a mom or dad died of a hereditary disease). You may be asked to fill out a brief history of the medical problem, and answer some relevant questions related to that problem. Also in some cases, you may be asked to enter physical exam findings such as a height and weight, a temperature, or your pulse rate if you know how to find it. Sometimes, a medical assistant will enter the virtual waiting room, ask the patient about all of the above, and then fill it in for the patient. There is also a place where the patient consents to the virtual visit, but this may be a check box, an online signature, or a verbal consent.
After all of this is filled out, the doctor arrives! Virtually! First, the doctor usually makes sure that the patient and doctor can see and hear each other. Your doctor may ask you to verify who you are and your birthday. Don’t be offended! Your doctor recognizes you and is just confirming that you’re the correct patient for legal purposes. Your doctor may ask you a few strange questions; for example, in some health systems, the physician has to verify that the patient is not driving during the virtual visit. The doctor then may review any changes that were made in the first part of the visit regarding the medical history or surgical history. Then, the visit starts. At this point it tends to be like a regular doctor visit. The patient tells the doctor about the medical problem and the doctor asks relevant questions. Sometimes the doctor may ask the patient to point to certain areas on the body that may be painful, or the doctor may ask the patient to move the camera so the doctor can see the relevant area.
The physical exam portion of the visit is tricky on a virtual visit. Your doctor may ask you to perform relevant physical exam findings, so if you have a cough, for example, your doctor may ask you to cough and deep breathe on camera so the doctor can see and hear. If you have knee pain, the doctor may ask you to walk, move your leg, or squat to help make a diagnosis. Your doctor may also ask you to do part of the physical exam yourself so that the doctor can see it. For example, the doctor may have you put your hand in front of the camera and then squeeze and let go of your fingertip so that the doctor can assess your circulation. Depending on the medical problem, there are many different types of exams that your doctor may ask you to do. If you’re uncomfortable with any of it, just tell your doctor.
Once you’ve gotten through that part of the virtual visit, your doctor can make recommendations. The doctor can put in virtual orders for labs or X-Rays, and can send prescriptions to the pharmacy. Your doctor may recommend that you make an appointment to come into the office, or may refer you to a different office. The medical assistant may come back on in order to help coordinate that part, but typically you end the virtual visit and the office calls you later to set up the follow up appointment.
What about HIPAA?
HIPAA, the acronym for the Health Information Portability and Accountability Act, is the law that protects patient privacy. At the beginning of COVID-19 there was some relaxation of the guidelines in order to let doctors speak with patients virtually through minimally encoded systems. At this point, most health systems, hospitals and offices are using robust online systems that make it very difficult to trace personal medical information.
What about cost?
Billing for online visits varies. A virtual visit with audio and video may be billed as a telehealth, and you may be expected to pay a co-pay. If your doctor has a thorough discussion with you and is able to do part of a physical exam on video, then you may be billed at the same level as an office visit. If you do a virtual visit, expect that you will be billed in some capacity, that you may have a co-pay, and that you may have to pay some of your deductible for your care. The specifics will depend on your insurance and the complexity of the virtual visit. It may be worth checking in with your insurance company before the visit if you’re concerned.