A year ago, if you were feeling sick, you might go to urgent care or your primary care physician. Since the beginning of the pandemic, however, it’s much more common to pick up your smartphone and chat about your symptoms with a doctor or nurse via telehealth.
Telehealth has exploded in popularity in 2020; so much so that the American Medical Association (AMA) has called for expansion of telehealth services beyond the pandemic through bipartisan legislation in the form of The Telehealth Modernization Act of 2020.
The bill would make telehealth accessible to patients across the nation, whether in a city center or rural area, as well as allow all types of practitioners to offer telehealth services. Prior to the beginning of the COVID-19 pandemic, these services were limited.
Since the beginning of the pandemic, telehealth has become wildly popular. Between February and April, the number of insurance claims utilizing telehealth skyrocketed from just over 500,000 claims in February to over 12.3 million in April, according to a study by the COVID-19 Healthcare Coalition.1
This sharp spike in telehealth use and unilateral support by the AMA begs the question: after it is safe to go to the urgent care or doctor, is there a reason to do so? Physicians have mixed opinions.
Latoya Thomas, director of policy and government affairs at Doctor On Demand, a telehealth provider, says that the benefits of telehealth far outweigh the drawbacks. Doctor on Demand has provided telehealth services for six years but saw a sharp spike in the spring.
While Doctor on Demand initially primarily served the urgent care space, it quickly expanded to cover primary care, behavioral health, and comprehensive chronic condition care.
One of the benefits of telehealth, says Thomas, is access.
“We don’t turn anyone away. You can go through your insurance provider or you can pay out of pocket, as you would at any clinic,” Thomas tells Verywell. “We’ve also made the process pretty seamless. You can use your laptop, your computer, or a mobile device like a smartphone or tablet to access.”
The typical time to access a primary care doctor through a traditional health avenue can range from four to six weeks, an untenable amount of time even without a pandemic. Instead, Doctor On Demand cites a six-minute average wait time to speak with a physician.
Knowing how much your visit will cost is a big plus, she says. Once patients log into the service, their rate is displayed for that service, leaving no surprise bills to come.
While Doctor on Demand lists prices in their interface, each telehealth provider operates differently. For many users of telehealth services, a quick chat with a doctor by video call can save thousands of dollars in unnecessary emergency room visits. Many insurers are urging users to take advantage of telehealth services by focusing on fixed fees that rival a trip to urgent care or their primary care doctor.
For older adults, technology can prove to be a barrier, however. Thomas says that their providers offer several options for how to communicate with patients, whether by phone, video call, or secure messaging. For some, technology resistance may be too big of a barrier.
Considering many telehealth services offer appointments around the clock, telehealth also offers more options for parents at home with kids, in areas where physical distance is a barrier, or when the risk of infection to the patient is more dangerous than the acute symptoms being diagnosed.
While ease of access can be a plus, the somewhat sporadic nature of telehealth can be a drawback, according to Kayur Patel, MD, and chief medical officer of Proactive MD. Proactive MD works with employers to provide onsite or near-site care for companies.
Patel says that for most patients, establishing a doctor-patient relationship is the foundation of quality care. Without it, the patient population runs the risk of receiving incorrect diagnoses and prescriptions.
“Telehealth is a cheap solution,” Patel tells Verywell. “You have an acute problem, and we find out what to do to fix it using instant communication. But the reality is that whoever shows up when you place your call, is your physician. And they don’t really know you.”
Without a full breadth of understanding a patient’s potentially complicated health history, there is the potential for unwittingly prescribing either the wrong medication or too much medication, Patel says.
“Say you call with a kidney stone issue that you’ve had before,” he says. “I’m going to give you a small prescription for narcotics and see how it goes. And then you could go to the ER because it doesn’t get better. Or I can say, ‘Go to the ER right now. You have two options.’ If you say you don’t have money for the ER, then here’s the script, let’s see if it works.”
For many people, chronic disease management constitutes a large portion of their medical cost burden. But even in acute conditions addressed over telehealth, there are limits to what physicians can diagnose virtually. If labs need to be taken or tests administered, the virtual portion of the appointment may be minimal, as testing sites are accessed and costs mount.
Telehealth is likely here to stay, whether in its current form or in a hybrid form. Patient-doctor relationships remain important though and if a telehealth model is to be effective, it’s important to establish a continuum of care. Easy access to non-emergency services like behavioral health services may be especially well executed in the virtual space.
One area that has shown significant successes with telehealth is behavioral and mental health. Access to therapists and psychiatrists from the comfort of home has spurred many people to access care that might not have done so before the pandemic.
Thomas says that in a study conducted in 2019, telehealth visits were shown to be extremely effective. In a group of 2,300 participants over the course of four telehealth psychiatry visits, their PHQ-9, a depression metric, scores improved by 50%.
Josh Jonas, LCSW-R, and clinical director and co-owner of The Village Institute, a therapy practice in New York City, took his practice entirely online when the pandemic hit. Given the opportunity to visit with patients remotely without a mask or in-person with masks and complicated scheduling to allow for proper sanitation, he opted for the virtual option.
Jonas says that allowing patients to be in their own physical space can be a boon to psychotherapists, especially with male patients.
“There’s something a bit safer for men about being on a screen. It feels more like a business call to them,” he says. “When they come into the office, there’s a vulnerability that can feel very uncomfortable to them.”
While there are patients that can’t wait to get back in the office for sessions, Jonas says that the time savings for both clinicians and patients is undeniable.
“I have people that used to have to take three hours out of their day to come to a session. Now they just click a button. And selfishly, I’m the same,” he says. “When I finish working, I close the computer and go outside and my wife and son are right there.”