What is and isn’t telehealth care?


Perhaps during the pandemic you had a chat with your doctor about an ongoing condition or a new symptom that showed up. Your questions were answered, and maybe you got a prescription without stepping foot in a physician’s office.

Those are the so-called telehealth doctor’s visits — new and not-so-new ways of getting health care.

“Telehealth started in rural areas and has evolved,” says Melissa O’Connor, a gerontologist and associate professor at Villanova who is an expert on the topic. “During the pandemic, it really exploded.”

But the word has been “misused,” she told me.

O’Connor says that a iPhone call with a doctor is not telehealth in her estimation although at times such phone calls are very helpful. Diagnosing with iPhones is becoming common in areas where people must drive long distances to get care.

In some parts of the country, for example, where federally qualified health clinics may offer the only affordable dentist, eye doctor, or any medical specialist, a phone call and a remote diagnosis may be better than driving one or two hours to see the physician in person.

Telehealth, she says, is “the assessment and diagnosis of health from a distance” using some sort of diagnostic equipment such as a scale, glucometer, a pulse oximeter or a blood pressure cuff. In some areas of the country, telehealth devices may be found at regional medical centers meaning patients still must drive to reach them.

Such devices, however, are sometimes placed in people’s homes and used to monitor their conditions from a far. Home care agencies use them to keep tabs on patients when agency personnel are unable to visit in person. The home care agency usually rents the equipment and teaches patients how to use it. While home health agencies have been using remote devices to monitor patients in rural areas sporadically, even this solution doesn’t always work.

“Some people are not accepting of it,” O’Connor told me.

And some have trouble learning to use the devices. Rural residents who may not have broadband to use the technology and people with low incomes in urban and rural areas also struggle in the new medical environment. People with no tablets and devices and no internet access are at a huge disadvantage, she said.

When the need for home health visits no longer exists, the equipment goes away, too, leaving patients in the same predicament — having to drive or obtain transportation to a physician’s office.

“It’s definitely not as easy for people living in rural areas to get telehealth,” O’Connor added.

In thinking about whether telemedicine is a good option for you, be guided by your symptoms. Some symptoms simply warrant a visit to a doctor’s office such as chest pain, abdominal pain, shortness of breath that is new or swelling in your legs.

The American Academy of Family Physicians has an online guide (familydoctor.org/telemedicine) to help you decide whether you should see a physician in person.

One doctor told Kaiser Health News that while video visits “are wonderful sometimes things come up in person that might not over video.” On the other hand, if your high blood pressure or diabetes is under control, it may not be necessary to show up at a doctor’s office.

What about skin conditions? Doctors can examine them if you are adept at using a smartphone or computer tablet. You have to be able to maneuver the camera around so that the doctor can get a good look at the lesion you want examined. I can attest that positioning the camera in a way that lets a doctor do a good examination is tricky. Last year at the height of the pandemic I needed my dermatologist to examine a red spot on my leg. It took a good 10 minutes of moving my phone into position so the doctor could determine that the spot was nothing to worry about.

It’s too soon to declare the old-fashioned office visit dead. So far, how doctors doing telehealth visits should be paid is not resolved. Telehealth visits have been paid for by Medicare and reimbursed at the same rate as those made in person. After the health emergency, should those physicians doing the visits be paid less because telehealth visits are cheaper to provide? Some providers say “no” because there are costs involved in setting up telehealth services.

Then there could be other unknown problems. One cardiologist told a Kaiser reporter that although televisits have a “wonderful” place in the physician’s arsenal, requirements by insurers to have a video visit before allowing coverage could result in “an unfortunate delay in care.”

Trudy Lieberman, a journalist for 40 years, is a fellow at the Center for Advancing Health. Has the Affordable Care Act impacted your family? Write to Trudy at [email protected]. Send comments to [email protected].

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