“I wasn’t really excited to be at home,” said Dr. Dael Waxman, when the visit to the clinic was stopped due to a pandemic. But he soon switched gear to video and phone bookings.
Now he has good reason to keep these options open, even though office visits have resumed and coronavirus restrictions have been significantly relaxed in many parts of the country. I found that.
For one, some patients “have to overcome many obstacles before they come to me,” said Waxman, a family doctor at Atrium Health in Charlotte, North Carolina. “I have a lot of single mothers. They have to quit their jobs, send their kids to school, and then get on two buses. Why do they do it when they don’t have to? Do you want to? “
Telehealth served as a lifeline for many during the pandemic, increasing from a small number to a large number of office visits, at least for some time. However, it is not a substitute for hands-on care in some situations, and it may be difficult or unusable for people who are not blessed with high-speed broadband Internet services and smart devices.
As the situation moves into a new routine, lawmakers and insurers, including Medicare, are discussing how to proceed. The biggest problem is face-to-face compensation after the COVID-19 public health emergency is over. Whether to refund to the provider at the same payment rate ..
While the debate intensifies, one points to the costs associated with setting up such services, while the other argues that telemedicine services are cheaper to offer and payment rates should be lower — that. It is up to the patient to decide whether such a visit meets their needs.
KHN asked such a question to the doctor. The doctor advised on the types of concerns that are most appropriate to meet in person and when video visits are most useful. Not surprisingly, they encouraged patients to ask the provider what type of visit was most suitable for their particular situation.
Additional things we learned:
1. Some need to be done directly.
Chest pain, new shortness of breath, abdominal pain, new swelling in the legs, or increased swelling-all of which indicate a direct visit. And, of course, blood tests, vaccinations and imaging tests need to be done directly.
“If you have very high blood pressure or have anxious symptoms such as chest pain, you need to go to the office,” said Dr. Ada Stewart, president of the American Society of Home Medicine. To visit
If the patient is very worried about the situation and is considering going to an emergency clinic or emergency room, he “needs to be seen,” Waxman said. And that happens personally.
If it looks simple but doesn’t resolve in a reasonable amount of time, go to the office. Waxman remembered a patient who had an eye problem and received emergency treatment and was given antibiotics, but the eye was still inflamed after the treatment.
“I was worried about herpes zoster in my eyes because it wasn’t resolved,” he said. After referring the patient to an ophthalmologist, it turned out to be another problem, not shingles.
By observing the patient’s way of walking, sitting, and speaking, doctors can visually understand what is wrong, which makes face-to-face visits more productive.
The video visit is great, said Dr. David Anderson, a cardiologist at Stanford Health Care in Oakland, California.
“I can’t say how many times I’ve been sitting with the patient, but I think that’s it. Then it becomes clear that it’s really a problem and I’ll spend the next 45 minutes on it.” He said.
Finally, the legitimate reason to join is simply whether you like it.
“I could have come to the hospital by phone the other day, but some patients said they liked to stay in the office in the old fashioned way,” Waxman said.
2. Sometimes it is better to visit TV.
You don’t necessarily have to go to the clinic or clinic.
Check-in for “basically controlled” chronic illnesses such as diabetes and high blood pressure can be easily processed remotely, said Stewart, a group of family doctors.
Cardiologist Anderson agreed, especially for regular assessments and to see how patients are treating new medications.
“If I have [stable] The 82-year-old patient and his daughter need to take a break from work and bring their mother 30 miles away to sit and chat for 15 minutes. This is the efficiency of video visits, “he said. But if the same patient complains, “I’m short of breath when I take a walk in the morning, but it wasn’t before,” I would want to meet him in person.
Video follow-up of stable patients with chronic illness may also be desirable. “I found on the phone and video that I had much more time to get an education without distraction,” he said.
It would be useful for patients to be able to monitor their blood glucose or blood pressure at home and report statistics during a TV visit.
However, Waxman warned that some patients couldn’t afford a home blood pressure monitor, which could be a limitation. He said he needed to bring it to and make sure it was accurate.
3. With both sides prepared, everything works fine.
According to experts, both patients and healthcare providers can get the most out of their video visits with a few simple steps in the first place.
Look for a quiet place that won’t distract you. Turn off the TV. If you need a second ear, have your family present, but if you don’t, choose a private setting.
“I can’t believe the situation where people zoom in on me,” Anderson said.
Some people have just finished breakfast in their car, “maybe it’s the best place to use internet services” or in their pajamas.
“There is a total lack of preparation and seriousness,” he said.
He advised Stewart to have a list of the medications he was taking, write down the problems, symptoms, and specific questions he wanted to discuss, and make the most of his time available.
Providers also need to take action.
Anderson said the patient’s medical records need to be read and focused in advance. Patients’ concerns about video have fewer clues than face-to-face meetings.
Doctors “have to be doubly vigilant,” Anderson said.
4. What could happen next?
Some supporters say insurers do not prioritize one type of visit over another, and that patients do not feel compelled to visit on television. Insist.
During the COVID-19 emergency, Congress and the agency overseeing Medicare temporarily made telemedicine accessible to beneficiaries — for example, removing geographic restrictions and allowing voice-only visits in some circumstances. Medicare has also begun to evenly repay providers for telemedicine and face-to-face care.
Many private insurers have followed Medicare’s leadership. Others have voluntarily abandoned the cost-bearing requirements of telemedicine patients.
Many expect Medicare Advantage plans to continue to cover television visits after the formal end of the emergency, and traditional Medicare could follow suit. The Medicare Payments Advisory Board, a nonpartisan body that advises Congress, recommends temporarily continuing to cover some services, but the agency is concerned about telemedicine increasing spending and that. We are collecting data on a wide range of impacts, including the benefits that may provide.
That data is important, said Fred Riccardi, president of the Medicare Rights Center. The expansion has helped many Medicare recipients, but “has left some communities behind,” including the elderly, people with disabilities, and people in areas with poor internet services, he added. He also said that future policies need to allow patients who wish to meet in person to continue.
Cardiologist Anderson agreed that television visits are a “great place” for a range of options, but he may require patients to make video visits before they are seen. Warned about cost savings by the company.
“I would consider it an unfortunate delay in care,” he said.
The rise of telemedicine during a pandemic has reduced the number of patients absent from treatment sessions.
Kaiser Health News is a national news editorial agency that creates detailed journalism on health issues. Along with policy analysis and polling, KHN is one of the three major operating programs of the Kaiser Family Foundation (KFF). KFF is a donated non-profit organization that provides the public with information on health issues.
How to get the most out of your telemedicine visit
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