Need to See Your Doctor? Try Telemedicine. 

By Mary Anne Dunkin | March 24, 2020

Are you having a flare, due for a routine doctor’s appointment or experiencing troubling respiratory symptoms? “Pick up the phone, not the keys,” advises Rena Brewer, CEO of the Global Partnership for Telehealth, a nonprofit agency focused on increasing access to healthcare through technology. Many of the issues that once required a visit to the doctor can now be handled more safely through telemedicine.

Since the COVID-19 pandemic began, health care providers have been seeing far more patients remotely, by videoconference or even phone, and federal confidentiality laws have been relaxed, making these consultations easier.     

What Is Telemedicine?

Telemedicine involves seeing a doctor remotely via a two-way video and/or audio connection. Historically, the doctor would be in his office in front of his computer and the patient would be in an exam room with a computer, webcam and a presenter – usually with a medical assistant trained to do a physical exam and gather basic patient information. This model is still used in some cases. It allows atients in rural clinics and hospitals to access specialists at major medical centers; nursing home residents to be examined without leaving their beds; and children in some disadvantaged areas to get checkups by a pediatrician from their school nurse’s office.

In the past, rheumatologists were slow to adopt telemedicine because of barriers, including insurance coverage, HIPAA compliance (for confidentiality) and licensing issues (providers had to be licensed in the state where the patient was receiving treatment), says Daniel Albert, MD, a rheumatologist at Dartmouth-Hitchcock Medical Center, who has been incorporating telemedicine into his practice for years.

In addition, doctors and patients preferred in-person visits, in part so the doctor could physically examine joints. So telemedicine wasn't widely adopted in rheumatology.

“Then here comes COVID-19, a special set of circumstances where in-person encounters are discouraged,” says Dr. Albert. “Both patients and physicians [were] reluctant to have in-person encounters.”

To reduce the need for such encounters and improve efficiency, the U.S. Centers for Medicare & Medicaid Services lowered some of these barriers, making it possible for new and esstablished patients to see their doctors for COVID-19 concerns, routine rheumatology visits and even appointments with mental health professionals.

Under the Telehealth Services During Certain Emergency Periods Act of 2020, the secretary of Health and Human Services (HHS) was authorized to temporarily remove restrictions on the patient’s location in certain situations for telehealth services to Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. This means the patient does not need to be in a clinic or in a rural area for Medicare, Medicaid or CHIP to cover telemedicine visits. The bill also allows Medicare, Medicaid or CHIP beneficiaries to receive telehealth services via their smartphones and removes geographic licensing restrictions, allowing doctors to treat patients even in states where they are not licensed. Since then, the practice has continued to be widespread, even after the pandemic officially ended. 

Make a Telemedicine Appointment

To receive telemedicine, you need a phone, a computer with a microphone and webcam, a tablet or a smart phone.

In some cases, the doctor’s office will email you a web link where you can register, an app for you download or instruct you to access the visit through the facility's secure, online patient portal. The app will connect you to the portal where you can see and speak with your doctor at your appointment time. Under the relaxed regulations, your doctor may consult with you by phone or use a common application like Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom or Skype, (but not public platforms like Facebook Live or TikTok).

What Telemedicine Can and Can’t Do

One limitation of telemedicine, of course, is that a hands-on exam by your rheumatologist is not possible. However, it can be useful for addressing urgent care needs, says Brewer, which many public and private insurers now cover.

You aren’t likely to have the stethoscopes, otoscopes and devices that can transmit images to your doctor that would be in a clinical setting, so your visit will be limited to what you tell your doctor and what she observes.  

“They can see how you are breathing, they can hear if there’s a cough. They can talk to you and assess symptoms in general and tell if you are sick,” she says. “If you have a digital thermometer you can hold it up and show the provider.”

Before your consultation, be sure to have a list of your medications and medical history, including your conditions. If you have a home thermometer or other testing devices for glucose, blood pressure etc., have those on hand as well; the doctor may want your results or, if you are using video, watch how you use the equipment to make sure you’re getting a correct measurement.

Apps for Urgent Care

If you have an acute illness unrelated to your arthritis, your first choice should be to contact your primary doctor who knows you and your medical history, says Brewer. But if your primary care doctor is unable to see you or does not offer telemedicine, you might consider an urgent care app, such as Doctor on Demand or MDLive, which give you virtual access to a primary care doctor 24/7.

Once you download and open the app on your phone, it will provide a list of available doctors along with their pictures and profiles. You select the doctor you want to see, and if the doctor is available, you can click to see him or her immediately or schedule a convenient time for a call back. The app does the rest.

If the doctor determines you need a prescription, she can send it to a pharmacy of your choice. The doctor can also advise if you need to be seen in person or to go to an ER.

Paying for Telemedicine

The cost of a telemedicine visit will vary based on your insurance type, but traditionally in most cases, it will be the same as an in-person visit. If you are not sure what your insurance covers, check your policy and call your health care provider to confirm before scheduling your visit.