How Does Telemedicine Work?

Telemedicine is treating patients and delivering care from a distance using technology. Doctors are able to connect with patients through online platforms to discuss their health concerns, perform virtual exams, make diagnoses, and prescribe treatment.

“It’s not that much more sophisticated than using FaceTime,” explains Dr. Alejandro Badia, MD, FACS, hand and upper limb surgeon and founder of Badia Hand to Shoulder Center in Doral, Florida. “All you need is the ability to see each other.”

Dr. Badia has been using telemedicine for about seven years, mostly for his international patients, which comprises about one-third of his practice. But with the pandemic, everyday he says his center does at least two to four consultations with people who are nervous about leaving home.

“When you have a crisis like the pandemic, all of a sudden everybody jumps on the telemedicine bandwagon,” says Dr. Badia, who is also co-founder of OrthoNOW, a network of orthopedic urgent care centers. Noting the high adoption rate by physicians during the lockdowns, Badia expects that telemedicine is now here to stay.

“WIth the successful increase of telemedicine consults since the pandemic there are still barriers that must be addressed at a policy and legislative level” adds Susy Salvo-Wendt, Summit Healthcare telehealth specialist. “Those barriers include reimbursement parity with in-patient visits, licensing and credentialing of tele-providers and the standardization of best practices.”

One way telemedicine works is when a patient initiates an online appointment with their physician or another provider which is called Direct to Consumer (DTC) telemedicine. For example, patients usually reach Dr. Badia through his website, where they can schedule a consultation. “I usually start with telemedicine before a patient jumps on a plane to see me, says Dr. Badia. Over video conference, he is able to do a full ortho assessment. “We can get a good idea about what’s going on and decide on next steps,” he says.

During the appointment itself, doctors and patients need to have a strong connection, and doctors must be able to get the right view. It’s usually more comfortable for the patient and a better view for the physician if the patient is on a laptop or desktop versus a phone or tablet, says Dr. Badia. “While most patients have mobile Wi-Fi or broadband in some rural areas this is still a barrier for telemedicine”, states Susy Salvo-Wendt. Telemedicine Specialist.

The doctor will usually begin with a conversation with the patient about their concerns and their health history. From there, the doctor can also perform a “physical” exam. For Dr. Badia, that may include asking the patient to move a certain way to check their range of motion. “They can show me their limitations,” he says.

To supplement the visits, doctors may also request the results of prior diagnostic exams. “They can all be sent through telemedicine,” says Dr. Badia. Patients can download their MRI or X-Rays through various portals, for instance. “Then I can examine them, I can talk to them, and when they come to Miami, we’ve already got a plan in place,” he says.

Telemedicine visits work mostly the same way for all types of doctor visits, from general practitioner concerns to specialties like neurology, dermatology, psychiatry, and more.

Telemedicine has many advantages as well as a couple of drawbacks.

Telemedicine benefits

• It defies distance. Patients can now access specialists who may be hundreds of miles away who they might not ordinarily be able to visit.
• It saves time. Badia has a large number of patients from the Florida Keys, which are about four hours away by car. “If I can examine their shoulder remotely and answer their questions, I save that person 8 hours of travel,” he says. Of course, even nearby physician appointments can require a few hours of your time.
• It can save money for patients. In some cases, patients might have to miss work or arrange childcare in order to get to a doctor’s appointment. Plus, there could be travel or parking costs involved. Telemedicine cuts all of that out. “It’s a huge downstream benefit that we’re not even talking about that much,” says Dr. Badia.
• It has the potential to improve patient outcomes. If a patient is able to consult their doctor from home, they may be more likely to stay on track with preventative care visits or follow up appointments. They might also be able to use telemedicine to avoid an emergency room or urgent care trip for minor infections or illnesses that can be treated at home with medication ordered by a telemedicine doctor.

Telemedicine limitations

• Sometimes, in-person visits are necessary. Some examinations do require physical touch, such as when doctors need to perform an exam to feel for irregularities. And patients might be required to see doctors in person who might want to closely monitor vital signs like blood pressure or heart/lung performance.
• Telemedicine visits must follow HIPAA rules. If a physician wants to offer telemedicine, they can’t simply invite the patient to Zoom with them. “You have to offer a platform that is HIPAA compliant,” says Dr. Badia. While this is not a limitation per se, getting set up on a proper platform could be a barrier for some physicians to get on board with telemedicine.
• Some technical knowledge, and/or caregiver support may be required. Especially with older patients, not having a basic level of tech savviness, the proper equipment or a stable Wi-Fi connection could be an impediment to telemedicine care. In many cases, a caregiver or family member can step in to assist. In addition, if the doctor needs to observe how the patient walks around the house, for example, it could require having someone there with them to hold the device.

Anyone can be a good candidate for telemedicine, especially for first-time consultations or follow-up visits that don’t require in-person physical treatment or examination.

“There are specialties that require less physical exams than others, for example mental health,” says Dr. Badia. Telemedicine is ideal for those patients.

Another good candidate for telemedicine is a patient who needs to discuss test results. “An internist who ordered a blood panel can discuss the results of that test remotely with the patient so they don’t have to come in,” says Dr. Badia.

Does Insurance Cover Telemedicine?

One positive thing about the pandemic is that the insurance industry has been more accepting of telemedicine, says Dr. Badia. “There’s no reason that the patients should be physically in front of me for the insurance to approve that visit,” he says, but in the past, that was sometimes a challenge.

“After the lockdown, within four to six weeks, many of the insurance companies were covering telemedicine, and some on par, basically reimbursing the physician offices the same as if they saw the patient in person,” says Dr. Badia.

On the patient side, health insurance coverage varies by provider and by plan, so it’s always a good idea to check with your provider as to how they cover telemedicine visits. “The patients don’t always know, and our staff doesn’t always know,” says Dr. Badia. “Sometimes they have to call for prices. It completely varies.”

OnlineDoctor.com interviewed this expert for article guidance:

Dr. Alejandro Badia, MD, FACS, hand and upper limb surgeon and founder of Badia Hand to Shoulder Center in Doral, Florida

• Health & Human Services: What is Telehealth?
• Mayo Clinic: Telehealth: Technology Meets Health Care
• AMA: Telemedicine During the COVID-19 Public Health Emergency Frequently Asked Questions