What to Know About Telehealth for Hepatitis

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Telehealth, especially in the context of the COVID-19 pandemic, has been increasingly adopted as a facet of mainstream health care—not only by primary care physicians but a great many medical specialists as well.

Telehealth is especially well suited for healthcare providers managing the care and treatment of people with acute and chronic hepatitis.

Doctor on a telehealth consultation with an older male patient
Yoshiyoshi Hirokawa / Getty Images

There are many different types of doctors who are qualified to treat hepatitis based on whether the cause is infectious or noninfectious. These include gastroenterologists, who specialize in diseases of the digestive system, and hepatologists, who specialize in diseases of the liver.

Infectious disease specialists are also trained to diagnose and treat viral hepatitis infections, while primary care physicians have the medical expertise to manage the long-term care of people with chronic hepatitis (in coordination with a hepatologist or gastroenterologist).

Telehealth offers these healthcare providers the means to oversee the care of people with hepatitis. This includes managing treatment compliance and side effects, reviewing lab and imaging test results, and providing dietary and lifestyle counseling.

When to Use Telehealth

Hepatitis is a the name of a condition marked by inflammation of the liver. Although the inflammation is most commonly caused by the viruses hepatitis A, hepatitis B, and hepatitis C, it can also result from noninfectious causes, such as alcoholic hepatitis, nonalcoholic fatty liver disease, toxic hepatitis, autoimmune hepatitis, and liver cancer.

Because the causes and treatments of hepatitis are varied, there are limits to what telehealth can do for patients. While there are visible tell-tale signs of hepatitis illness, including jaundice (yellowing of the skin and eyes), pinpointing the exact cause of symptoms invariably requires a hands-on exam.

Even if a telehealth provider is able to spot the signs of hepatitis in someone whose condition is subclinical (without notable symptoms), the healthcare provider would almost always need to refer that individual to a specialist for an in-person evaluation.

When to See a Healthcare Provider in Person

It is important to see a healthcare provider in person if you develop acute symptoms of hepatitis, including

  • Fever
  • Fatigue
  • Pain in the upper-right abdomen, just beneath the ribs
  • Nausea or vomiting
  • Dark cola-colored urine
  • Light clay-colored stools
  • Joint pain
  • Jaundice

Overall, telehealth is best suited for people who have already been diagnosed with hepatitis rather than those seeking a diagnosis. With hepatitis patients, telehealth is most effective for the management of chronic liver diseases as well as the drugs used to treat them.

Diagnostics

Telehealth can be used for diagnostic purposes in people with hepatitis, including:

Treatment and Management

Telehealth also can be used for the treatment and long-term management of hepatitis, including:

  • Monitoring the care of people with hepatitis A, which mainly involves rest, supportive care, and the avoidance of alcohol and certain medications
  • Managing the treatment of people with chronic hepatitis B, which may include the use of antiviral drugs and interferon injections
  • Monitoring a person's treatment response to hepatitis C therapies, including routine viral load testing to confirm a sustained virologic response (the medical definition of a "cure")
  • Managing the treatment of people with autoimmune hepatitis, which typically involves the use of prednisone or Imuran (azathioprine)
  • Overseeing the management of people with nonalcoholic fatty liver disease (NAFLD), including weight loss and dietary changes
  • Overseeing the care of people with alcoholic hepatitis, which often includes an alcohol treatment program, dietary support, and anti-inflammatory drugs like corticosteroids to reduce liver inflammation
  • Monitoring the treatment of toxic hepatitis, which involves the avoidance of the toxic substance as well as chelating agents for people with heavy metal poisoning
  • Preparing for liver transplant surgery in people with decompensated cirrhosis or liver cancer (as well as postoperative follow-ups)

Telehealth can help monitor comorbid conditions like human immunodeficiency virus (HIV), which affects around 30% of people with hepatitis C and may require an adjustment in treatment.

Benefits and Challenges

Telehealth services have their benefits and risks and may not be appropriate for everyone. While levels of acceptance among consumers are generally high, there may be limitations that make telehealth less than ideal for some.

Benefits

There are a lot of pros associated with the use of telehealth in people with hepatitis, not least of which is the fact that 67% and 51% of people with chronic hepatitis B and C, respectively, do not know they have been infected.

There are many who argue that telehealth can better tend to underserved and difficult-to-reach communities that are most likely to have undiagnosed and untreated hepatitis infections.

Among some of the key benefits of telehealth in people with hepatitis are:

  • Convenience: Telehealth is ideal for people with mobility issues and those with chronic hepatitis who need oversight but less hands-on care. Telehealth is especially useful for people with acute hepatitis, who typically have severe fatigue and are advised to stay in bed.
  • Time: Telehealth eliminates the time spent driving to and from appointments as well as office wait times. Furthermore, a 2020 study in Gastroenterology reported that gastroenterologists spent a similar amount of time in telehealth visits as in-person visits and even more time with new patients.
  • Cost: Generally speaking, the cost of a telehealth visit is lower for uninsured and underinsured people.
  • Choice: Telehealth allows you to consult with providers who might otherwise be too far away for you to consider. This can be especially helpful if you want a second opinion on surgery or a treatment decision.
  • Referrals: Studies have shown that gastroenterology referrals take an average of 72 days before an in-person appointment can be scheduled. By contrast, 75% of referrals for telehealth appointments with a gastroenterologist occur within two weeks.
  • Treatment coordination: Hepatitis treatment often requires multiple providers, including a primary care physician, specialists, surgeons, nurses, and dietitians. Telehealth allows multiple providers to participate in consultations and coordinate care so that procedures do not overlap.
  • Access to information: Telehealth services have evolved so that medical tests and reports can be shared live, satisfying the "meaningful use of electronic health records" requirement of the Centers for Medicare and Medicaid Services (CMS).
  • Group participation: This is especially important for people who are frail or infirm, allowing family members, legal guardians, and health advocates to ask questions and assist with treatment decisions.
  • Asynchronous visits: These are consultations in which nonurgent concerns are sent to a provider via a secured messaging system, which are then answered within a day or so. Asynchronous visits are ideal for asking questions about medication doses, diet, or non-severe side effects.

Telehealth and Patient Confidentiality

Telehealth providers must adhere to the same patient confidentiality practices outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), including the secure transmission, storage, and sharing of electronic health records (EHR).

Challenges

Despite high levels of acceptance among consumers, telehealth services may not be suited for everyone, either because of structural concerns or medical limitations. Some of the challenges include:

  • Lack of broadband access: Studies have shown that around 24 million people in the United States—roughly 7% of the population—have no broadband access. People on Tribal lands and those in rural communities are most affected.
  • Technical limitations: Outdated hardware, incompatible software, slow Internet speeds, poor image resolution, small screen size, and host unreliability can make it difficult to access or utilize telehealth services effectively.
  • Cost: Even if the cost of telehealth is covered by insurance, acquiring a mobile device or broadband service may be out of reach for some consumers.
  • Hearing impairment: Although there are TTY/TDD telehealth services for people with hearing loss or deafness, not every telehealth provider offers this. Vision impairment may also limit telehealth interactions.
  • Diagnostic limitations: A hands-on physical exam is essential to not only diagnosing but characterizing liver conditions. Oftentimes, the subtle signs of hepatitis relapse—like scleral icterus (yellowing of the eyes)—can be missed on a laptop or tablet image. Similarly, the onset of decompensated cirrhosis (in which the liver is no longer functional) may be missed without a physical exam.
  • Liability and malpractice: Not all liability insurers cover malpractice for telehealth providers. This is especially true for high-risk practitioners, like transplant surgeons, who may be swayed from participating in telehealth.

Because telehealth is still in its infancy, there are few studies comparing treatment outcomes in people who use telehealth services versus those who access in-person care exclusively.

How to Prepare for a Telehealth Visit for Hepatitis

If you have been diagnosed with hepatitis, it helps to prepare for a telehealth visit in the same way you would any medical appointment. You will also need to prepare from a technical standpoint so that you don't experience any disruptions or glitches.

Before Booking

There are several things you need to do or consider before booking your telehealth appointment.

  • Choose a provider: Your current healthcare provider may offer telehealth. If not, your insurance provider may offer a telehealth directory based on medical specialty. Or, you can ask your primary healthcare provider for a referral and call the specialist to see if telehealth is available. You may also find specialists using the American College of Gastroenterology's online directory.
  • Check prices: Telehealth practices charge different rates. If you don't have insurance or telehealth benefits, you may want to compare prices to find the most affordable option. You can also ask if the telehealth providers offer a no-interest payment plan or a sliding-scale discount based on financial need.
  • Check your coverage: Even if your telehealth provider accepts your insurance, check whether they are in-network providers (which are generally cheaper) or out-of-network providers (which are generally more costly). Also, check co-pay or coinsurance costs to better calculate your out-of-pocket expenses.

Scheduling the Appointment

When booking the appointment, there are several things you will need to check to ensure a glitch-free visit:

  • Ask about accepted payment: Telehealth services generally ask that out-of-pocket costs be paid immediately before the scheduled appointment. When booking the appointment, ask what type of payment is accepted. If your form of payment is not accepted, ask if there is a way to prepay by check, PayPal, or other methods.
  • Determine what type of visit it is: Will the appointment be done by phone, or will it be a video conference call accessed by a link on a mobile device? Are you seeing the doctor, a nurse practitioner, or another healthcare provider?
  • Ask what to expect: This can help you determine what type of device to use. For example, if lab reports or imaging scans are being reviewed, you may need to use a laptop, a desktop computer, or a tablet rather than a smartphone.
  • Double-check what is needed from you: This may include vital signs, updated blood tests, consent forms, intake forms, or certain medical records. If you have electronic files you wish to share, ask where to send them and in what format.

Preparing for the Appointment

To ensure that the telehealth visit goes smoothly, be sure to do the following at least a day in advance of your appointment:

  • Check your Internet connection: Organize a dry run with a friend via Skype or Zoom to ensure your camera and speakers are on and that the volume is adjusted. If your broadband connection is spotty, see if a friend will let you use theirs. (However, avoid using Wi-Fi in public places where there will likely be noise, a lack of privacy, and an unsecured network.)
  • Prepare your space: You will need to find someplace in your house that is quiet, well-lit, and private. Avoid sitting in front of a sunny window, where you will likely blackout on the screen. Be sure that everyone in the house knows when your appointment is so that they can keep quiet and out of your way.
  • Dress for the appointment. If there is a rash that you want to show to your healthcare provider, wear something that can easily be removed or rolled up. The same applies if you're having a postoperative follow-up.
  • Prepare a list of questions. Write down any questions or concerns you have so that you don't forget. And, be sure to have the contact details of any doctor or healthcare professional you want your medical records shared with.

Will Insurance Cover Telehealth for Hepatitis?

In 2020, the Centers for Medicare and Medicaid Services (CMS) notified healthcare provider that they could charge for telehealth services at the same rate as in-person visits. This increased the number of practitioners who offered telehealth services to all patients, including those with private insurance.

Telehealth benefits vary by insurance plan, as follows:

Audiovisual vs. Audio-Only Telehealth

Medicare and Medicaid only cover certain audio-only visits, including visits for diabetes management, speech therapy, psychotherapy, smoking cessation, and alcohol or opioid treatment. If your telehealth visit is audio-only, call the CMS hotline at (800) 633-4227 to determine whether it will be covered.

What Happens During the Visit

On the day of your appointment, be prepared to stop everything you're doing at least 15 minutes beforehand. This gives you time to settle the kids, prepare your space, turn on your computer, and turn off the TV and other distractions. If someone is sitting in on the appointment with you, make sure that they are ready as well.

Oftentimes, you will be called 15 minutes in advance of the visit to confirm that you are ready (or advise you if the provider is running late). The office may also want to take payment with a credit card or debit card at this time.

When it is time for your consultation, the appointment will follow the same basic steps:

  1. A link will be sent to you by text message or by email. The link will connect you to the secure portal where you can sign in and wait in the virtual "waiting room."
  2. The designated provider will greet you and discuss your medical concerns. If you are a new patient, this may involve reviewing your medical history, symptoms, and lab reports. If you are a current patient, the provider may want to discuss your treatment plan and/or lab results.
  3. If a visual exam is needed, the provider will walk you through what to do and what they need to see. In some cases, the provider will want to take a remote snapshot to include in your file.
  4. If lab reports or imaging scans are being reviewed, do not hesitate to ask what the findings mean. Be sure that the reports are copied to your primary care provider and any other relevant specialist.
  5. Ask any questions you have prepared or that have come up during the appointment. Take notes so that you don't forget what has been said.
  6. The provider will end the appointment by summarizing what has been discussed, including any procedures or treatments you have agreed to.
  7. If medications are being prescribed, either the provider or someone in the care team will confirm to which pharmacy the prescription should be sent. Have the pharmacy's phone number and address handy.
  8. If tests are needed, a nurse or physician's assistant will provide you with instructions on where to go and how to prepare. Detailed instructions may also be sent by email.
  9. If a follow-up appointment is needed, either the provider or a scheduler will book the time and date. Confirmation of the appointment will be sent by text or email.

A Word From Verywell

Telehealth, once regarded as a stopgap measure during the COVID-19 pandemic, is increasingly being considered standard of care for many health conditions. It is not only convenient to consumers but can increase the reach and productivity of a gastroenterology or hepatology practice.

Even so, telehealth should not be considered a replacement for all in-office procedures or tests. Although a telehealth review of blood tests may confirm that you hepatitis A, B, or C, a hands-on exam may help spot the subtle signs of liver decomposition, viral relapse, or other complications that can alter the treatment plan. In-person visits also are necessary for blood work and imaging appointments.

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