An academic's perspective on DTC telehealth services: Buyer beware

Photo: Lois Ritter

Telehealth revolutionized the way people receive healthcare since the beginning of the COVID-19 pandemic.

There have been many benefits to greatly expanded telehealth. But with the sudden and sizable explosion of any business comes the possibility of some players following the money and taking advantage of unknowing consumers.

What should people look out for when choosing a telehealth provider? How can they protect themselves?

We interviewed Lois Ritter, a teaching associate professor for the masters of public health program at the University of Nevada, Reno. Professor Ritter has worked in education, healthcare and research for more than 25 years.

Her work in education includes teaching in academic settings as well as in healthcare settings. Her research includes working in areas such as human trafficking, substance abuse and telehealth. Many of her studies have been statewide or national multi-year and multi-site projects.

Q. What are the benefits of consumer-facing telehealth services (as opposed to telehealth from your own provider organization, if you have one), and who typically seeks care from these services?

A. Consumer-facing telehealth services, also known as direct-to-consumer telehealth, have services available to the consumer 24/7. Consumers can initiate an appointment and consult with a healthcare provider on their own device, on their own schedule.

Telehealth visits with one's own provider typically require an appointment and may not be available on evenings or weekends. So if a child is screaming from an earache in the middle of the night, a visit can take place without having to incur an emergency room visit cost, leaving the home or waiting for an appointment.

Therefore, the consumer-facing telehealth services can be more convenient than using telehealth services through one's own provider.

Also, people who use consumer-facing telehealth may not have a medical home and hence, a primary care provider. Consumer-facing telehealth services may be less expensive than using telehealth through their provider if they have a high deductible. It is certainly less expensive than an emergency room visit.

People using the service also can be drug-seeking individuals. For consumers seeking medication there is no prior doctor-patient relationship so the telehealth provider will not be aware of the person's medical history and use of medications unless it is disclosed by the consumer or documented in a Prescription Drug Monitoring Program registry.

While this is a benefit to a consumer seeking medications, it is problematic for many reasons. The consumer may be using multiple providers from different consumer-facing telehealth services and/or multiple pharmacies and, hence, using too much of the medication. Drug-to-drug interactions can be missed.

Additionally, if the consumer has an allergy or medical reaction to certain medications, a reaction can occur, which can be fatal.

Sometimes a consumer may not disclose a piece of medical information because they do not realize it is important. For example, people with low blood pressure can have dizziness or other issues related to some medications.

Q. What should people be looking for – and looking out for – when choosing a telehealth service?

A. If a person elects to use consumer-facing telehealth services, they should do research on the company and the providers. The majority of these sites focus on promoting prescription items for a limited set of conditions or diseases such as anxiety, contraception and dermatologic conditions. Find a service that provides care for the consumer's medical issue and age (for example, pediatric care for a child).

Consumers typically need to complete an online questionnaire before the virtual appointment and to get a prescription. The requirements vary by service. Consumers should look for sites that request a medical history.

Consumers should check to see if their insurance company covers the service and, if so, how much is covered. Of course, the consumer will want to know the cost of the service when looking at options.

It is recommended that if a consumer intends to use these telehealth services, do the research prior to becoming ill. During a medical event, the person may not have the time or be well enough to look at the information in advance.

Q. How can people protect themselves when they're on the market for such a service and once they decide on one?

A. Consumers should discuss the problem and any relevant past medical information with the provider. For example, my finger that I broke two years ago is starting to ache. Inform the provider about medications they are currently taking.

It is best to have them in front of the person seeking the appointment so that questions can be answered if needed, such as the number of milligrams taken. Share with the provider medications that cause allergic or adverse reactions. Remember, this doctor does not have the patient's previous medical information.

It is recommended that consumers use video so that the user can see the provider and vice versa. Depending on the medical issue, the consumer may need to show the provider the issue, such as the injured finger.

Ask questions. If the consumer is feeling like a medication is being pushed on them, inquire about the reason for the medication and why it is being recommended. Ask about side effects and alternative treatments.

If a consumer is uncomfortable with the advice given, seek out a second opinion. If the consumer does get a medication they have not taken before, talk to the pharmacist when getting it filled. Ask about allergies, medication interactions, nutritional impacts and proper dosage.

Q. What do you think the future looks like for consumer-facing telehealth services?

A. I anticipate this type of care will continue to grow in the future. More insurance companies are reimbursing for these services, and the profits are high.

Another reason for the anticipated growth is there are many medication-seeking consumers, so if they do not receive the desired medication from their provider or misuse medication, then this is a path they take.

The number of people in health insurance with high deductibles is increasing, and they may prefer consumer-facing telehealth due to the lower cost.

There are factors that could inhibit its growth as well. One is malpractice lawsuits. No large lawsuits have occurred to date.

There is a gap in the literature on patient satisfaction and quality of care with consumer-facing telehealth as compared to provider-based telehealth and in-person care. If satisfaction and quality levels are low, then growth may slow.

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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