The Pros and Cons of Telemedicine

Plain and simple – telemedicine improves access to doctors. Since there are widespread shortages of doctors and other healthcare providers, in both rural and urban areas, telemedicine provides access to services and doctors that would otherwise be nearly impossible.

Similarly, patients with rare diseases can connect with hard-to-find specialists who are too far to see in person. For instance, many patients don’t have access to a geneticist to diagnose rare genetic disorders, and telemedicine can bridge that gap.

For more information, read my blog post Can Telemedicine Help You Get a Proper Diagnosis for a Rare Disease?

It’s so convenient!

Why would you want to travel to your doctor’s office and wait in the waiting room for 20-30 minutes when you could wait for your telemedicine appointment while at home or at work?

Interestingly, one study found the average in-office medical visit takes 121 minutes – 20 minutes seeing the doctor and 101 minutes traveling to/from the doctor and sitting in the waiting room. Clearly, virtual visits save you time and eliminate travel-related stresses and expenses. And all that driving and waiting usually means more time away from work, family, and other obligations.

And of course, telemedicine is a great tool if you cannot get to the doctor due to illness, transportation issues or other impediments.

It can minimize unneeded visits to the doctor or ER.

It can be a waste of time and money to go to a doctor or the ER if your health doesn’t require an in-person visit. With telemedicine, you can speak with a doctor from the comfort of your home or job. Together you can decide if you should follow up with a visit to the doctor or go to the ER.

Reduced healthcare costs.

Telemedicine can reduce or contain healthcare spending by increasing efficiency via better management of chronic diseases, reduced travel times, and fewer or shorter hospital stays. Since so many of us have high deductible insurance plans, as well as responsibility for a portion of each bill, lowering healthcare costs helps us all.

There is a potential of improved quality of healthcare.

Telemedicine has the potential to improve the quality of care by making it easier to for providers to stay engaged with patients. Additionally, when doctors remotely track a patient’s health via monitoring systems, they can identify problems as soon as they develop.

Studies show that the quality of telemedicine services delivered are as good those provided through in-person appointments. Interestingly, according to the American Telemedicine Association, “in some specialties, particularly in mental health…telemedicine delivers a superior product, with greater outcomes and patient satisfaction.”

However, on a personal note, I know of a patient whose potentially fatal condition “slipped through the cracks” due to telemedicine. This patient had several telemedicine appointments, but the lack of in-person care made it hard for the doctor to realize just how sick she was.

The cons of telemedicine.

You can’t get physical!

Firstly, it goes without saying that physical exams are impossible via phone of computer. And of course, there are circumstances when an in-person visit is essential for diagnosis and treatment. For instance, doctors on the phone or computer can’t feel for swollen glands or look at throats or noses to test for COVID-19, strep throat or other infections.

Additionally, doctors can’t screen for blood pressure or cholesterol levels over the phone. In fact, the decrease in the number of in-person doctor visits due to COVID-19 led to a significant decrease in cardiovascular screenings, both important for the prevention of heart attacks and strokes.

Researchers compared primary care visits in the 2nd quarter of 2020 with the 2nd quarters of 2018 and 2019. They found:

However, for patient follow-ups and minor conditions, a virtual visit may be enough. And if the patient is too ill to leave their house or can’t leave due to the risk of exposing others to a potentially dangerous germ, a virtual appointment can be a good starting point.

And if a patient cannot travel far distances for an in-person appointment, a virtual appointment is far better than no appointment at all.

Technical glitches and obstacles.

Certainly, it’s frustrating when the image of friends or family freeze on the screen, or when audio cuts out, when chatting on video calls. But it’s more than annoying when glitches occur during a telemedicine appointment. A really bad connection can force you to cut the appointment short or reschedule altogether.

Additionally, connecting to a telemedicine appointment can be frustrating and time consuming. Sometimes you can simply click on a link you receive via email or text, but other times you have to download a computer application and then click through multiple steps to log in.

Not everyone can use video for appointments.

Unfortunately, it can be difficult, if not impossible, for lower income people to take advantage of video calling for telemedicine appointments. In fact, a 2020 study of telemedicine appointments among lower income patients found that most of the telemedicine appointments were conducted over the phone.

Could this impact the quality of care? Probably. Experts express concerns about the quality of audio-only appointments, as compared to video appointments.

As mentioned, the doctor you speak with during a virtual appointment may be a stranger to you since some doctors use outside telemedicine companies to provide virtual care for their patients. Additionally, many employers now provide telemedicine services from 3rd party vendors as part of their benefit offerings.

In these circumstances, you’ll connect with doctors who are unfamiliar with you and your medical history, which can impact the care you receive. Additionally, a new doctor will not have had any chance to earn your trust, yet trusting the opinion of your doctors is an important part of healthcare. Simply put, will you fully trust the advice of a doctor you never met?

Distractions can lower the quality of the appointment.

Researchers examined treatment recommendations from over 500,000 cases of children with acute respiratory infections (ARI). Their analysis found that children with ARI who were treated through telemedicine were significantly more likely to receive antibiotics.

The percent of children with ARI who received antibiotics was as follows:

• 52% of those who used telemedicine services.
• 42% of patients who went to urgent care.
• 31% of those who saw their primary care providers.

Additionally, a higher proportion of the antibiotics prescriptions written through telemedicine appointments disregarded medical guidelines regarding when to prescribe antibiotics. This was primarily due to doctors prescribing bacteria-fighting antibiotics to treat viral illnesses (e.g. colds and flus) which cannot be cured with antibiotics.

Why is this important? Prescribing unneeded antibiotics increases the chances of side effects and contributes to the increase of antibiotic-resistant germs. And that is nothing to sneeze at! Experts speculate that antibiotic-resistant germs may kill more people than cancer in the coming decades.

Clearly, this may be one place where the cons of telemedicine outweigh the pros. For more information, read this blog post on the dangers of too many antibiotics.

Interestingly, there is no evidence that adult patients receive a higher number of unneeded antibiotics from telemedicine appointments, as compared to urgent care or primary care doctor visits.

Does this mean that all patients who use telemedicine might get unneeded medications? I don’t know, but it’s worth keeping this study in mind if/when you use telemedicine services.

Data security concerns.

Cybersecurity is a notable concern in telemedicine. Unfortunately, cybercriminals can hack into telemedicine systems to steal personal and private healthcare information. Not only is this worrisome, but it’s also a violation of HIPAA laws. Sadly, there are currently no existing solutions to stop these criminals, but many experts across the world are hard at work trying to thwart these attacks.

The financial pros and cons of telemedicine.

Just like any other medical appointment, telemedicine visits come with a fee.

If you use a telemedicine company provided through your employer, there may be little or no cost for you. Or, it might be billed like any other medical appointment, with the same copays and deductibles. To avoid unexpected bills, ask your employer about cost and possible copays before you make an appointment.

If you schedule a virtual appointment through your doctor, your insurance will likely cover it. But don’t assume these visits are covered – and don’t assume your co-pay will be the same as for in-person visits.

Additionally, some doctors charge a convenience fee, which can range from $35 – $125, on top of the normal visit fee. These fees are not covered by insurance, so ask about fees before your virtual appointment!

Most states have telemedicine laws requiring coverage, but state policies change frequently. To learn about coverage in your state, visit the Center for Connected Health Policy website. It’s also a good idea to call your insurance company and ask them about coverage, including co-pays, for telemedicine services.

Medicare and telemedicine.  

In 2018, the Centers for Medicare & Medicaid Services (CMS) updated their rules to cover some telehealth services for patients in rural areas. However, due to COVID-19, CMS is now covering telehealth services by doctors and other healthcare providers to treat patients with COVID-19 and for other “medically reasonable purposes”.

The new rules, effective March 6, 2020, cover virtual visits from offices, hospitals and places of residence. Note that coinsurance and deductibles apply. It’s unclear if these updated rules will be permanent – time will tell.