Have you ever felt ill enough that you wanted to see your doctor, but there was no way to do so? Technology now allows a way to see someone right in the comfort of your own home or wherever it is that you need them. Virtual visits – appointments with providers conducted through your computer, tablet, or smartphone – are growing in popularity as a means of expanding access to health care.
Of course, not all medical issues can be addressed this way, but for patients who are not mobile or who live in remote communities, it may provide access to the care they need. It can also help people who lead busy lives and want a quick after hours consultation for something like a sore throat or rash.The American Academy of Family Physicians (AAFP) says that, with some precautions to protect patient privacy and ensure adequate documentation and follow-up, virtual visits can be a valuable part of the health care system.
A Growing Trend
A shortage of doctors, long wait times for appointments, and the pace of life have all contributed to the popularity of virtual visits, sometimes referred to as telemedicine. Patients appreciate the convenience of being able to visit with a doctor without leaving home. And some doctors’ groups appreciate being able to help patients who may otherwise have difficulty getting in to see them.
“Generally, the AAFP is very supportive of telemedicine because it’s a patient-centric and potentially cost effective way to provide care,” says Matthew Burke, MD, a practicing family physician in Washington, DC, “but the types of care and how it’s used are still being researched because it’s a very new area, and the devil is in the details.”
As videoconferencing technology advances and doctors become more comfortable with the practice, the number of virtual visits continues to grow. One research firm estimates that there will be 130 million provider-patient virtual visits in 2018, up from only 5.7 million in 2014.
How it Works
A computer, tablet or smartphone is used for most virtual visits. Many providers use an app that you can download to facilitate communication. These apps claim to help providers comply with federal health privacy regulations and protect your privacy.
For some conditions, doctors can do many of the same things in a virtual visit that they would do in person, including diagnosing, treating, and monitoring conditions; prescribing medication; and ordering tests. But these visits are not for emergencies – you should go to an emergency room for that. Common medical problems that doctors regularly address through virtual visits include things like sinus infections, pink eye, rashes, and cold and flu symptoms.
Some advanced technologies even allow patients to measure and send their vital signs – including blood pressure and heart rate – to their doctors electronically. This is helpful for patients with chronic conditions – like diabetes or heart disease – who need regular monitoring by their doctor.
Of course, virtual doctors can’t do everything. “Sometimes – especially for injury or acute illness – telemedicine can have limitations because you can’t run a strep test or perform an X-ray over the phone,” says Burke. “You’ll have to go in and see someone for that.”
When to Consider a Virtual Visit
Don’t waste time on a virtual visit for true emergencies, like a head injury or chest pain. Go straight to the emergency room for any of those. If you suspect strep throat, or another condition that requires a lab test, you may be better off going to an urgent care center. But consider a virtual consultation when you suspect your condition might be easy to diagnose. These are usually temporary, minor conditions that don’t require a lab test. Your doctor might also offer virtual visits for routine follow up for certain conditions.
Some common medical complaints a doctor might address in a virtual visit include:
- Allergies
- Conjunctivitis (pink eye)
- Cough, cold, and flu
- Diarrhea
- Earache
- Fever
- Migraine
- Rash
- Sinusitis
- Sore throat
- Stomachache
- Urinary tract infection
- Vomiting
Controlling Costs
One of the benefits of virtual visits is the potential to lower costs for patients. Your out-of-pocket costs will depend on your insurance plan and the virtual service you use. One survey of telemedicine users in 2014 found that about half of patients would have accessed care at more expensive emergency rooms or urgent care centers if a virtual visit was not available.
Most insurance companies cover virtual visits, and some plans don’t charge anything if you access their doctors. Medicare covers some virtual visits, but reimbursement rates are often low, and Medicaid coverage differs from state to state. The Center for Connected Health Policy offers an interactive map describing state laws and Medicaid reimbursement policies.
What to Look for in a Virtual Visit
“Telemedicine can have real value when you and the physician have an established relationship,” says Burke. The virtual visit can build upon your relationship and allow you to check in about a symptom or about your medications or treatment plan.
Ada Stewart, MD, a family physician in Columbia, SC agrees. “I think that it’s best to have someone within your network,” she says. “Even if it’s not your doctor, they usually they can get access to records easily, and can access medication information, for example.”
“One of the concerns a lot of providers have is how to guarantee that anything that’s done virtually gets into the patient’s chart so you do not further fragment care,” says Stewart. That is one of the reasons the AAFP recommends that virtual visits be done between doctors and patients who have an existing relationship.
For the most effective visit, groups like the Federation of State Medical Boards (FSMB) and the AAFP have developed guidelines for doctors. Among their recommendations, these groups suggest that virtual visits: :
- Ensure continuity of care
- Protect the patient’s privacy
- Are fully documented by the physician and included in the patient’s health record.
Improving Access for Rural Patients
Virtual visits can help people who live in remote areas, those with limited mobility, and those with time constraints that make office hours a challenge to connect with medical providers.
In remote areas lacking access to specialist care, virtual visits can make a big difference. “We use telemedicine for our specialty care because our patients can’t get to the big hospitals in the city for referrals,” says Stewart, who cares for underserved patients in rural South Carolina. “Our patients come in and if they need specialty care we can use telemedicine to access specialists in psychiatry and neurology, because those are departments that are hard for our patients to access in town.”
Challenges in Telemedicine
Because virtual visits are relatively new, there are still some kinks to work out. In a survey of doctors in 2014, the AAFP found that only 15 percent used telemedicine in their practice in the past year. The doctors believed telemedicine could improve access to care, but reported that a lack of training, low levels of reimbursement, the cost of equipment, and concerns over liability were reasons they hadn’t fully embraced the practice.
“Right now, providers aren’t taught how to do this and how to do it well,” says Stewart. Increased training for physicians and improved reimbursement policies are expected to expand access in the future.
Selected References
Heidi Godman, “Need an Appointment Right Away? Consider a Virtual Doctor Visit,” Harvard Health Letters, Sept. 16, 2016
Committee on Pediatric Workforce, “The Use of Telemedicine to Address Access and Physician Workforce Shortages,” American Academy of Pediatrics, July 2015
Miranda A. Moore, et al., “Only 15% of FPs Report Using Telehealth; Training and Lack of Reimbursement Are Top Barriers,” Robert Graham Center, Jan. 15, 2016.
