When the pandemic set aside office visits to his office, Dr. Dael Waxman “wasn’t exactly happy to be home.” But he quickly moved on to video and phone dating.
Now, he finds, there are good reasons to keep these options open, even though office visits have resumed and many parts of the country have drastically eased coronavirus restrictions.
One thing is that some patients “have to overcome a lot of obstacles to get to me,” Waxman said, in family doctor with Atrium Health in Charlotte, North Carolina. “I have a lot of single moms. They have to quit their jobs, get their kids out of school and catch two buses. Why would they want to do that if they don’t need to?”
Telehealth served as a lifeline for many during the pandemic, going from a minority proportion of office visits to a majority, at least for a time. However, it cannot replace practical care for some conditions, and for those who do not enjoy fast broadband Internet service or smart devices, it can be difficult or impossible to use.
As things move toward a new normal, lawmakers and insurers, including Medicare, are debating how to proceed, the most important question is whether providers continue to be reimbursed at the same rate of payment as for coverage. face-to-face once the public health emergency COVID-19 is over.
While this debate is deepening — one side points to the costs associated with setting up these services, the other argues that payment rates should decrease because telecare services are cheaper to provide — it is left to patients decide whether these visits meet their needs.
KHN asked these questions to the doctors, who gave advice on the types of concerns that are best treated in person and when video visits are most helpful. Not in vain, they recommended that patients ask their provider what type of visit is best suited for their particular circumstance.
Four additional things we learned:
1. Some things only need to be done in person.
Chest pain, shortness of breath, abdominal pain, new or increased inflammation of the legs; all these things point to the need for a face-to-face visit. And, of course, blood tests, vaccinations, and images must be done in person.
“If yours blood pressure is really tall or has some symptoms of worry, such as chest pain, you need to go to the office, “said Dr. Ada Stewart, president of the American Academy of Family Physicians, who published an online guide to to telemedicine visits.
If patients are worried enough about the situation they consider going to an emergency care clinic or even an emergency room, “they should be seen,” Waxman said. And that would happen in person.
If a condition, even something seemingly simple, has not been resolved in a reasonable amount of time, go to the office. Waxman recalled a patient with eye problems who went to urgent care and received antibiotics, but the eye was still irritated after treatment.
“Since it hadn’t resolved, I was worried about shingles,” he said. It turned out it wasn’t herpes zoster, but a different problem, Waxman learned after referring the patient to an ophthalmologist.
Face-to-face visits can also be more productive because a doctor gets visual clues about what might be wrong with seeing a patient walk, sit, or talk.
While video visits are wonderful, said Dr. David Anderson, a cardiologist affiliated with Stanford Health Care in Oakland, California, sometimes things appear in person that may not surpass the video.
“I can’t say how many times I sit with a patient and I think we’re done. Then the problem that really is the problem arises and we spend the next 45 minutes there,” he said.
Finally, a good reason to get into it is simply if this is what you prefer.
“The other day I had a patient who said he could have made a phone visit, but he was from old school and I just preferred to be in the office,” Waxman said.
2. Sometimes a TV is better.
You don’t always have to walk to a doctor’s office or clinic.
Stewart, of the GP group, said consultations for chronic conditions, such as diabetes or hypertension, which are “basically under control,” can be easily managed remotely.
Cardiologist Anderson agreed, especially for periodic evaluations or to check how a patient handles a new drug.
“If I have a [stable] An 82-year-old patient and his daughter have to lose their jobs and have to come 30 kilometers to take their mother because we have 15 minutes to talk, it’s something that the efficiency of a video visit is good. ” , he said. But if that same patient complains that “when they take a walk in the morning, they’re out of breath and they weren’t before, I’d like to see that person face to face.”
And sometimes it is preferable to do video monitoring for stable patients with chronic diseases. “By phone or video, I found that there was a lot more time without being distracted for education,” he said.
It is helpful if patients can monitor their blood sugar or blood pressure at home and then report their statistics during television.
But some patients can’t afford blood pressure control at home, so that can be a limitation, Waxman warned. And even those who have a monitor should initially take it to the office to make sure it’s correct, he said.
Some dermatological conditions, such as rashes and others, can be managed through video, as long as the patient is comfortable using the smartphone or tablet on the computer and can get a good picture of the problem area. . While between 70% and 80% of skin problems can begin with a video visit, he estimated, the rest require a personal evaluation, perhaps even a biopsy.
3. Everything works better when both parties get ready.
Both patients and providers can get the most out of a video visit if they first take a few simple steps, experts said.
Find a quiet place without distractions. Turn off the TV. Keep a family member in mind if you want a second set of ears, but choose a private setting if you don’t.
“You won’t believe the circumstances in which people approach me,” Anderson said.
Some are in their cars, “maybe because it’s the best place to get internet service” or they are in their pajamas, just after breakfast.
“There’s a whole lack of preparation and seriousness,” he said.
Have a list of the medications you are taking and write down the problem or symptoms you want to talk about, as well as the specific questions you have, to make the most of the time available, Stewart advised.
Suppliers must also take action.
Anderson said they should read patients’ medical records in advance and concentrate because there are fewer clues about the patient’s concerns about the video than in person.
Anderson said doctors “should be doubly vigilant”, pay attention to all their suspicions and be very thorough because “it would be much easier to lose something important.”
4. What can happen next?
Some advocates say insurers should make sure that their reimbursement policies do not favor one type of visit over another and that no patient feels pressured by a television.
During the emergence of COVID-19, Congress and the agency overseeing Medicare temporarily made it easier for beneficiaries to use telehealth, for example, by removing geographic restrictions and allowing audio-only visits in some circumstances. Medicare also began reimbursing providers for both telephony and face-to-face care.
Many private insurers followed Medicare’s example; some also voluntarily waived the cost-sharing requirements for telecare patients.
Many expect Medicare Advantage plans to continue to cover TVs once the emergency officially ends and traditional Medicare can follow suit. The Medicare Payment Advisory Commission, a non-partisan agency that advises Congress, has recommended that they continue to temporarily cover some services while the agency collects data on a wide range of effects, including concerns that telehealth increases spending and the benefits it provides. can offer.
This data is important, said Fred Riccardi, president of the Medicare Rights Center. The expansion has helped many Medicare beneficiaries, he added, but “has left some communities behind,” including older adults, those with disabilities, and those in areas with erratic Internet service. And future policies should ensure that patients who prefer face-to-face visits can continue them, he said.
Anderson, the cardiologist, agreed that televisions “have a wonderful place” in the range of options, but warned against cost-saving measures by insurers that could require patients have a video visit before receiving coverage for an office visit.
“I would see it as an unfortunate delay in attention,” he said.
(c) 2021 Kaiser Health News. Distributed by Tribune Content Agency, LLC
Citation: Doctors Explain How to Make the Most of Your Retrieved Telehealth Visits (2021, June 3) Retrieved June 3, 2021 at https://medicalxpress.com/news/2021-06-doctors-telehealth.html
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