Telehealth versus Telemedicine – How it works

Po-tay-toe or Po-tah-toe, is there a difference?

How about if you are talking about telemedicine or Telehealth? Let’s start by clearing up any ambiguity on the terms.

Telemedicine – used to refer to traditional clinical diagnosis and monitoring through technology.

Telehealth – is more commonly used today.  It describes a broader range of diagnosis options, including management and education. Examples may include counseling, home health, and chronic disease monitoring and management.

Types of Telehealth Services

1. Video conferencing – a live video conversation between a provider, caregiver, or patient. These types of sessions are used when the option of an in-person visit may not be available.

• For example, a patient has a concern with a mole on her arm and would like to share with the provider the symptoms and changes she is concerned about. She lives in a remote area requiring an hour’s drive time. Video conferencing allows for the patient to be seen. Because there is video, she can show the provider the mole and details of her concern visually. 

2. Asynchronous Video (store and forward) – delivery electronically of your documented Personal Health Information (PHI).

• For example, your provider needs to consult with a specialist regarding your diagnosis, and your PHI needs to be shared with the specialist so a collaborative and informed discussion can occur.

3. Remote Patient Monitoring (RPM) – the collection of PHI from a patient. The information is sent electronically to a healthcare provider for review and monitoring.

1. For example, a patient is in a senior living facility. Maintaining vitals is essential to monitor and provide direction to senior living staff or rounding providers for quality care coordination.
2. Reference: John Hopkins Telemedicine Demo

4. Mobile Health (mHealth) – use of mobile phones or other smart devices (smartphones or tablets) leveraging the associated software applications. These devices/apps can monitor blood sugar, water intake, moving goals, and heart rate, to name a few. The goal is to bring awareness to health behaviors as well as integrate with a patient’s health record.

Advantages:

• A decrease in patient wait time for an appointment.
• Minimize unnecessary visits to ER or urgent care.
• Continuity of care by seeking care from your provider office.

How it works:

Practices may vary in their telehealth policies and how they are implemented in their organization.  Below is an example of how it may work.

Step 1: Confirm Options

You make a call to your provider office, and you select the option for an appointment.  A provider, medical assistant, RN, or LPN may triage the call to determine if the issue may be resolved through a video conference call or if a face to face appointment is needed.

Step 2: The Appointment

If this option for video conference is confirmed, the representative will explain the process and validate the correct technology (computer, smartphone, or IPad) is available.  A scheduled time will be set for the video conference visit.  The provider will call you at the scheduled time to address your concerns.

Step 3: Payment

Coverage is impacted by federal and state laws as well as insurance company’s policies. Telehealth is being viewed more progressively to reduce costs and keep patients healthier.  The latest information shows that over 30 states are required to pay for telehealth services via a parity law.  To view states with parity law and private insurance coverage:   Reference: American Telemedicine Association

Average costs are typically comparable to a face to face visit for commercial (HMO, PPO, POS) subscribers or less depending on the provider.  You can always ask for a cost estimate from your provider before the visit. Depending on your plan, a copay may be all.

Medicare at one time had limited reimbursement for services. They only allowed for Telehealth for patients who lived in a rural area. Given Telehealth’s increased adoption, the list of services has increased.  Reference CMS finalizes policies to bring innovative telehealth benefit to Medicare Advantage.

Medicaid is state-based, and subscribers should check their state Medicaid website or call the customer service line to confirm covered telehealth services.

When should I use Telehealth?

• Inquiries about medication or pharmacy refills
• Follow up on post-treatment care and check-in
• Questions about common medical issues, stomach issues, headaches, muscle aches, sore throat, and coughing or back pain.
• Medical care is not available during regular business hours, holidays, or weekends.
• Rural areas making drive time long and tedious if inclement weather.
• The patient is limited in movement or unable to leave home.

Telehealth options will continue to expand with the advances in technology, including smartphones, watches, and other monitoring devices.  Physician groups are investing in telehealth solutions to offer patients and working with insurance companies to support reimbursement and coverage.