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Scott Webb (Host): Virtual visits have been around for a while, but really came to light during the pandemic. It's a convenient way to see a provider for common illnesses from the convenience of your own home. Some patients may never have tried it and might be worried about how it works. So we want to explain how simple it is to see a provider and answer some of your frequently asked questions.

That's around virtual urgent care visits. And joining me today is Dr. Robert Marino. He's an urgent care physician and medical director of Franciscans express care centers in Northern Indiana.

this is the Franciscan Health Doc Pod. I'm Scott Webb. So Doctor, thanks so much for your time today. We're going to talk about the Franciscan's Virtual Urgent Care Visits primarily today, that's what we want to focus on, but before we get rolling here, just want to remind folks if they're having a real medical emergency, they should call 911, go to the nearest emergency department. What we're talking about today, this type of urgent care is really for non life-threatening illnesses and injuries. So that sort of disclaimer, out of the way, I want to ask you what types of illnesses and injuries can you treat on these virtual urgent care visits?

Robert P. Marino, DO (Guest): Reiterating what you said, we treat more basic issues with the virtual visits, minor coughs colds, minor flare ups of chronic conditions, like a sinusitis or bronchitis, things like that. We might even also treat some minor ear pain in a child or an adult that has chronic ear conditions. The limitations of course, is that we can't see the patient physically, do an examination, but we can definitely look into things and speak with the patient and talk to them, but basically mostly minor coughs and colds and minor issues.

Host: Yeah, minor issues. That sounds like a good way to sort of frame this you know, my recollection is of trying to remember back before COVID what life was like before COVID, it seems like the medical system was sort of inching its way towards virtual visits and telemedicine and so on, but really COVID kind of, you know, put the full court press on to really move forward with this.

And it seems like the medical system and patients that everybody has really sort of enjoyed this experience, responded well, but I'm sure there are some illnesses and injuries that are just not a good fit for a virtual urgent care visit. So maybe you can go through, as you were mentioning the things that are a good fit. What are some of the things, some of the reasons why folks should really be seen in person, see their primary and so on.

Dr. Marino: So So keeping in mind, the previous answer, being basic issues, then what would be not fit for a virtual visit would be something that is more advanced. So, not a minor bronchitis, but a bronchitis with, you know, some shortness of breath involved or some difficulty breathing. Someone who has chronic sinusitis, but it's a different presentation. They have worsening headaches or something that's not normal for their normal presentation. Ear pain that has hearing issues, or blood from the ear. Something that we would definitely need to see in-person. Uncontrolled fevers, injuries that we can't look at aside from the screen and I know this may sound common sensical, but there is something that we have seen a little bit of a trend that I think we do need to acknowledge. We do get a fair amount of people who want to do a virtual visit while they're driving a vehicle. And we, strongly recommend against that. In fact, we will usually ask you if you're driving to please pull over or reschedule and call back.

Host: Yeah, that's such a great tip and you know, we're all busy and we're all trying to multitask, doctors included, of course, we can get more done at least we think, when we multitask, but that's such a great tip. Pull over schedule this time. It won't take that long. We really don't want to do these appointments while you're driving.

So, that's a great tip and I'm glad that you check with folks to make sure, you know, it sounds like you might be driving. Could you just go ahead and pull over? Yeah, thank you, right?

Dr. Marino: Don't do that. We'll be treating a lot more than just a virtual visit. Unfortunately, if that happens.

Host: Yeah, absolutely. You know, I'm wondering, when we think about privacy and security, is it okay to have others, you know, with us during a virtual appointment, do they need to be in the room with us? How does that work when we kind of feel like we need to have someone with us or just want to have someone with us?

Dr. Marino: Well, actually in some instances it's actually required. So say we have a parent calling in for a child. We have to physically see the child in the visit. So, if someone's calling in for their young child and they said, oh, you have a minor cold or whatever, we usually would like to see that child in the screen.

And that way we can at least assess, you know, how they're doing, we can assess their behavior. Are they looking lethargic or is there an issue that we might need to have the parent you know, take that child in to see us personally. A caregiver asking for a visit for an elderly. We would obviously want to see that elderly person in the screen.

And we do ask that all involved must be visible to the provider just as if you came in to see us in person. So in other words, if we had both parents that were present, we would prefer to have them present on the screen as opposed to have one parent, and then another parent that we're hearing in the background doing something but commenting.

Host: Yeah, in the other room yelling, hey, have remind him about this.

Dr. Marino: Exactly. Yeah. So, you know, just like coming to see us, we wouldn't have a parents sticking their head in the room and say, oh, by the way, don't forget to talk to him about this. So when you have a visit, just pretend it is a visit in any area in the house where it's just like coming in.

And kind of that being said, it is somewhat funny sometimes with some of the background stuff that goes on during the virtual visit. So, it's always good to maybe think where you are in the house and what's going on around you while you're doing that virtual visit.

Host: Yeah, that's such a great suggestion. And of course, you know, for some things, of course the gold standard is still to be seen in person, but these virtual visits do work. I've done one myself and I sat in my kitchen and made sure I had good lighting. You know, the doctor could see me, I could see her and it worked pretty well.

And I think that's just a good suggestion you have just folks get in the mindset of just imagine you were coming into the office only now you don't have to drive in. You don't have to park. You don't have to take time off of work or anything, but let's try as much as possible to replicate that experience. So both people or all people together, not yelling from the other room, maybe not have the dog barking, you know, so that everybody can.

Dr. Marino: be funny, but right. It, it take away from the visit.

Host: Absolutely. And of course things happen. And, you know, as you say, sometimes it can be funny and we can share a laugh, but we all sort of have a job to do here. And when we think about that, if during the course of a visit, it becomes clear that a patient needs lab work or imaging, or you want to prescribe meds, how does that process go?

Dr. Marino: Building on what we just said, that is it kind of why we do, we would like to see, a very quiet area where we see somebody through virtual, we want to make sure we're doing the best evaluation you can, because we don't have the luxury of physically being in the presence of that person. So when we do make that decision that we do find that they do need either lab work or imaging, even if they need prescription medicine at that point, after the visit is done or even sometimes during the visit, we do have full access to the patient's chart. So we can place orders for lab work, we can place orders for imaging, and of course we can place orders for prescription medication.

However, if we're in a situation, especially through an Express Care Center where we're thinking that all labs or imaging are truly necessary, we'll probably be asking you at that point to come in person especially in the case of imaging where we're thinking if an injury is bad enough that we would actually like to get x-rays, we would probably want to see that person in-person, so that we can do a better physical exam.

Host: Yeah. And I think we've all had this experience doctor, where we met with our doctor and we felt fine and then afterwards, we didn't feel fine. Like we got sick later that day. People just get sick. What are you going to do? But in the case of a virtual visit like this, if a patient begins to feel worse afterwards, how do they follow up? What do they do? How can they get back on the line with the same provider like yourself?

Dr. Marino: When it comes to the Express Care Centers, again, the one thing that we do have to stress is we are an episodic care center. So just kind of like an emergency room, we take care of your acute issue. And then always we refer back to the primary care or the specialist. If for some reason, as in any visit, you don't feel better after the initial visit or you do feel better than you get worse again, then we always do recommend that you be seen. And in this case, we would probably recommend that again, you would be seen in person. So there's a variety of different things that a patient can do. The first and foremost always should be to at least try to call their PCP or specialist. I understand that a lot of the PCPs and stuff right now, they're are several months out because they're so busy, which is fine.

But, if they cannot reach their PCP, their primary care physician or their specialist, they can always recall our Express Care Centers. But if you've already been seen, as in most cases, if you've already been seen and you're not getting better or worse, getting worse, then at that point, we would probably recommend you come on in, we can do a better physical evaluation.

And in case of some of the more chronic issues, if you are being treated for something that we know you've had before, and you're not getting better with the standard treatment that you've had before, it is definitely time to see you because there may be some more advanced treatment that we need, which can't be done really through virtual. There's a lot of conveniences for the virtual, being able to do your visit from home, not having to drag children or elderly in to be seen, even something as simple as weather. And it's great but it does have its limitations and it has its advantages.

So as long as people understand what those limitations are, and we actually go through that, before every visit, there's a list of things that we have to speak to before we start the visit. And one of them is just that, that you know, please understand that, you know, the convenience of course, is that you don't have to leave your house, but the limitation is that we can only see you from a screen.

Host: Yeah, I see what you mean. And when we think about, you know, acute versus chronic and for those chronic things, definitely should connect with your PCP, probably need to come in. There's only so much that could be done, but really amazing how far medicine has come. We think about electronic medical records, virtual visits, we've come so far in a relatively short amount of time, which is great.

And I know that the insurance companies have gotten on board, whether it was because of COVID or during COVID or however this worked exactly. More and more of them are covering these types of visits, but I wanted to have you speak to it specifically about Franciscan's Express Care, virtual visits. How is insurance handling that? Are they covering, you know, the cost of these visits?

If they're not covering them, is the cost relatively affordable for folks? Take us through that.

Dr. Marino: So I think as you mentioned earlier, there was virtual visits that existed well before COVID I just don't think people were so aware of it. And then of course COVID was the catalyst, that well, people didn't leave their houses. They were literally told don't go to the emergency rooms. There were doctor's offices that closed. So, there was no other way to stay in touch with the patients. So, the insurance companies, addressed that. They do view virtual visits as essentially a regular visit. So all the qualifiers that you would have if you came in person, usually do apply. So we're talking about copays and deductibles, those all apply.

And we can also, you know, accommodate people without insurances, just like we would again, if you came in, in person and if I'm not mistaken, I think the out of pocket cost for the visit is somewhere around $49. But keep in mind that is just the visit, whether you have insurance or not, that's just a visit.

If we do need things like lab work, imaging, prescriptions, or if you ended up having to come in to physically be seen, that's all a separate cost item that the insurance company would take into consideration.

Host: Yeah, that's a great point. It would be great if we lived in a world where $49 covered yeah that visit, the labs, the imaging, prescription. I want to go to that place, but...

Dr. Marino: Sign me up for that one.

Host: Yeah, but as you say, insurance covering things when they're not $49 again, if you have to go in for something chronic or you need lab work, imaging, prescriptions, that's a separate matter different charges and so on. So Doctor, this has been really informative today. I really appreciate this. Thank you so much for your time and you stay well.

Dr. Marino: Oh, thank you very much. And it was a pleasure being a part of this.

Scott Webb (Host):

Visit Francisca and express care.org to find a location near you and to schedule a virtual visit. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan health doc pod.

I'm Scott Webb stay well, and we'll talk again next.