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Tim Panek has worked in primary care since 1999 and provided virtual care since 2011. He received his Master of Nursing from the University of Washington and has worked in many primary and urgent care settings in Washington State. He is an adjunct clinical faculty member at the University of Washington School of Nursing. He is also a high school soccer coach and enjoys golf, fly-fishing, skiing and hiking with his family.
The complex US health care system is under a tremendous amount of pressure. Many traditional health care business models are designed to allow high-volume, low-cost procedures to offset the costs of low- volume, high-cost procedures. An upward shift in the aging population is projected to result in a large increase in demand for health care, and new legislation such as the Affordable Care Act has added uncertainty to the future of health care business models and payment. Telehealth is projected to grow worldwide to 1.8 million users by 2017, according to the World Market of Telehealth.

According to a May 2017 article by Alignment Chief Medical Officer Ken Kim, the organization’s efforts paid off. “Because of the program, Alignment’s seniors are seeing reduced 30-day readmission rates … compared to the national Medicare average readmission rate of about 18%. In 2016, Alignment members enrolled in remote [monitoring] across all markets saw hospital readmission rates of 7.2%.”
Teladoc Health enjoys a killer advantage with its head start in telehealth. Around 40% of the largest companies in the world contract with Teladoc to provide virtual healthcare services to their employees. Over 35 of the biggest health plans in the U.S. have partnered with Teladoc. More than 290 hospitals and health systems have teamed up with the telehealth leader.

Where telemedicine refers specifically to the practice of medicine via remote means, telehealth is a blanket term that covers all components and activities of healthcare and the healthcare system that are conducted through telecommunications technology. Healthcare education, wearable devices that record and transmit vital signs, and provider-to-provider remote communication are examples of telehealth activities and applications that extend beyond remote clinical care.
If the state decides to cover telemedicine, but does not cover certain practitioners/providers of telemedicine or its telemedicine coverage is limited to certain parts of the state, then the state is responsible for assuring access and covering face-to-face visits/examinations by these "recognized" practitioners/providers in those parts of the state where telemedicine is not available.
Doctor On Demand’s mission is to improve the world’s health through compassionate care and innovation. We believe that health is personal, and means so much more than treating illness. We’re proud of the care we've provided over the years and the relationships we’ve developed with our patients, as evidenced by the 5-star reviews we continually receive. People use our service to gain access to some of the best physicians and licensed therapists in the country, all whenever and wherever is most convenient. It’s as simple as opening the Doctor On Demand app on a smartphone or computer.
A question popular among organizations that want to implement telemedicine solutions is regarding how their physicians will be reimbursed. With telehealth regulations varying for each state and with payers setting up different policies, it is difficult to find consistency. What does remain consistent is that telemedicine is advancing and its becoming difficult for the key players to keep up.
Project ECHO, a knowledge-sharing enterprise that works both across the U.S. and globally, offers a good example of how technology-enabled collaborative learning models work. Launched initially in New Mexico to help patients with hepatitis C gain access to specialty treatment, Project ECHO connects a team of specialists at a university medical center "hub" with teams of primary-care clinicians at community health centers—or "spokes"—across a state or region. This connection is recurring: Typically, it takes place every week or every other week, during telementoring clinics that operate like virtual grand rounds.
Telemedicine also can eliminate the possible transmission of infectious diseases or parasites between patients and medical staff. This is particularly an issue where MRSA is a concern. Additionally, some patients who feel uncomfortable in a doctors office may do better remotely. For example, white coat syndrome may be avoided. Patients who are home-bound and would otherwise require an ambulance to move them to a clinic are also a consideration.
In the last decade, rapid advances in medicine and technology has resulted in the use of new terms. Policymakers, healthcare systems, advocacy groups, and vendors may unknowingly use terms incorrectly when discussing medicine and technology. This is especially true when it comes to the terms, telemedicine and telehealth. Although the words are often used interchangeably, there is certainly a difference between the two.
Healthcare providers currently earn their medical licenses for a specific state. This lets them practice medicine legally in that state, and only that state. This presents a problem for telemedicine, as the entire goal is to break down geographical barriers between a patient and provider. According to medical licensing regulations, a specialist based in Colorado would not be legally allowed to treat a patient in New Mexico.
A sexually transmitted illness, which affects men and women of all ages, herpes is embarrassing to deal with. Whether in the form of a cold sore on your mouth, or a rash on your genitals, discomfort and unease is sure to follow. While there is no cure for Herpes at this time, there are several treatment options which have been made available across the United States.

Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are webcams, videoconferencing, phone lines, videophones and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchairs, braces or artificial limbs; and in speech-language pathology. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology (hearing assessments) is a growing application. Currently, telerehabilitation in the practice of occupational therapy and physical therapy is limited, perhaps because these two disciplines are more "hands on".


Medicaid: Every state Medicaid plan specifically covers at least some telehealth services, however states vary greatly in their coverage.  State-specific information is available on www.atawiki.org and the 50 State Telemedicine Gaps Analysis: Coverage and Reimbursement. ATA has challenged each state to fully cover telemedicine to increase coverage while simultaneously reducing service costs.
Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses, at a distance, for education, and for research. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.

Teladoc charges an annual subscription fee for its service plus a $40 co-pay per video or phone appointment with a doctor, though employers sometimes subsidize or cover the co-pay completely for their employees. Health insurance startup Oscar (co-founded by venture capitalist Joshua Kushner), for one, has promoted its ACA-compliant health plans with the perk of getting to talk to doctors 24 hours a day—through Teladoc—for free.


Medicare: Yes... in certain circumstances.  Many “telehealth” services, such as remote radiology, pathology and some cardiology, are covered simply as "physician services."  For traditional fee-for-service beneficiaries living in rural areas, Medicare covers physician services using videoconferencing and remote patient monitoring. The ~14 million beneficiaries in Medicare Advantage (managed care) plans, have complete flexibility in using telehealth, as long as their provider offers the service.  ATA is pushing the Centers for Medicare and Medicaid, and Congress to removing the arbitrary restrictions that limit telehealth coverage, so that all beneficiaries can get this great benefit.  The ATA Wiki has details explaining coverage details in Medicare. 
Patients should ask their doctor, hospital or healthcare provider about telemedicine services that are already available. In many cases, the provider may have an existing home health monitoring program or other telemedicine services.  There are also numerous private companies that sell basic telehealth services, including 24/7 access to a health professional, remote monitoring, medication adherence and online wellness apps.
Reimbursement for telemedicine services is often not as straightforward for traditional medical services. State telemedicine policy landscape is continuously shifting, affecting rules around reimbursement through state Medicaid programs and through private payers. Medicare does now reimburses for real-time telemedicine services, but places restrictions on the eligible healthcare providers, the location of the patient, the medical procedures that can be done, etc. The good news is, there is a shift towards more widespread reimbursement for telemedicine through all third-party payers, with less restrictions.  
While widespread research on the effects of telemedicine is still relatively young, many studies do show positive results. When the Veterans Health Administration implemented telemedicine for past heart attack patients, they sawhospital readmissions due to heart failure drop by 51%. Another study on the Geisinger Health Plan showed that telemedicine reduced 30-day hospital readmissions by as much as 44%. And while telemedicine skeptics often claim virtual visits tend to be lower quality than in-person visits, a recent study of 8,000 patients who used telemedicine recorded no difference in care outcomes between in-person and virtual care.
Children under 3 with a fever need to be seen immediately by a doctor in an office based setting. Children under 12 with ear pain can be treated if the pain is due to a virus (e.g. Colds), allergies, or an external infection. If there is a high likelihood it is a bacterial inner infection that needs antibiotics, they should be seen immediately by a doctor in an office based setting.
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