“Online doctor visits can be easy, but Congress thinks they increase costs”

WashingtonPost Online Doctor Visits

This Washington Post article by Phil Galewitz (produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation) propagates some very basic misunderstandings about remote Doctor consultations that I think are worth highlighting.

mHealth Insights

A woman sends blood pressure and pulse information to a doctor, who is visible on a monitor looking at aCT scan of the patient. (iStock)

Unless the video call tech doubles as a time machine (and could take you back 20 years to a time when CT scans were reviewed by Doctors after being printed onto Xray film) why would anyone pick such a ridiculous stock image?

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home. For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor. So she turned on her computer and logged on to http://www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem Blue Cross Blue Shield of Ohio. She spoke to a physician, who used the camera on Miles’s computer to peer into her mouth and who then sent a prescription to her pharmacy. “This was so easy,” Miles said

Imagine how much better it would be for Patients to be using their mobile phone eg. easier to use, report your concerns from the comfort of your bed on a wintry morning, no need to wait on your PC to grind to a start, opportunity to use the powerful cameras on your mobile phone instead of the low quality web camera on your PC, etc.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it. Anthem and a health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient

I think it’s key to appreciate there’s nothing virtual about a Doctor consulting a Patient remotely via video.

I also don’t think it’s fair to suggest that because only 2 Medicare advantage insurers offer these visits that’s a reflection of the lack of value that they can provide as there’s plenty of other things that these insurance plans don’t cover, cover with expensive riders or intentionally would rather have their customers uncertain about.

Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers

I think this is nothing more than a lack of acceptance that the world has changed and a defence of the outdated approach that’s being taken to maintain the status quo. The 2000 year old office visit model is dead thanks to the successes of modern medicine and we now need to serve Patients with chronic conditions in between office visits.

In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services — barely a blip compared with the program’s total spending of $466 billion, according to a study in the journal Telemedicine

Can you imagine any other service industry spending just 0.001% of their budgets serving customers remotely? Is it any wonder the US healthcare system wastes so much money on extended hospital stays and avoidable readmissions when you realise insurers are investing so little in supporting Patients the moment they leave the building?

“The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel,” Ateev Mehrotra, a Rand Corp. analyst, told a House Energy and Commerce subcommittee last year. “Telehealth may be ‘too convenient.’ 

Ateev hasn’t yet realised that the new definition of quality in healthcare is convenience. Arguing against making care convenient while the US spends $3.8 Trillion a year on healthcare is nonsensical, you might as well start building Hospitals on top of very steep hills and build steep staircases in front of the doors of Primary Care Clinics.

But the telemedicine industry says letting more beneficiaries get care online would reduce doctor visits and emergency care. Industry officials, as well as the American Medical Association, the American Hospital Association and other health experts, say it’s time for Congress to expand use of telemedicine in Medicare

It’s not just the “telemedicine industry” (a term I see being used in the USA to refer to vendors trying to flog expensive outdated bespoke equipment to Doctors when they could for the large part make do with the mobile devices they already have in their pockets) eg. check out the evidence published by John Bachman MD, Professor of Primary Care at the Mayo Clinic, that shows how remote interaction using nothing more than the tools of our time can reduce the need for GP visits by 40%.

Popular outside Medicare. “There is no question that telemedicine is going to be an increasingly important portal for doctors and other providers to stay connected with patients,” former Surgeon General Richard Carmona said in an interview

Let’s not forget that wealthy members of society have had this type of access to healthcare professionals for years because they’re the customers of Concierge Doctors who know that if they don’t give their Patients the access that they want they will simply take their business to someone who will.

Some health experts say it’s disappointing that most seniors can’t take advantage of the benefit that many of their children have. “Medicare beneficiaries are paying a huge price” for not having this benefit, said Jay Wolfson, a professor of public health, medicine and pharmacy at the University of South Florida in Tampa. For example, he said, telemedicine could help seniors with follow-up appointments that might be missed because of transportation problems

This is a really good point and a great reminder of why we need to do everything we can to get seniors using mobile tech.

What thoughts did you have on reading the article?

About David Doherty

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1 Response to “Online doctor visits can be easy, but Congress thinks they increase costs”

  1. Some feedback received after sharing this post on Linkedin:

    Aschkan Abdul-Malek​: ​We see radiologists and patients requesting CT prints on x-ray film all the time in developing countries.

    David Doherty​: ​Oh dear. It must be a colossal waste of resources. In this case though it’s unforgiveable (the Radiologist has at a minimum got a computer, broadband and a webcam in front of her and the lighting that room is ridiculous). Can’t imagine the despair being felt by that poor Patient…

    Aschkan Abdul-Malek​​: ​Considering how expensive silver film is, one of our biggest selling points to hospitals is that they’ll actually save 3-4 USD per patient just in film by not printing the images and transferring them over our platform. However, it’s the patients that continue to ask for film as a way to be sure they’re getting what they paid for. Then again, I’ve heard funny anecdotes of unscrupulous providers putting patients in elevators, closing and opening the doors, and telling them they’ve been CT’d, so the validation of a print isn’t wholly unwarranted. show less

    David Doherty​​: ​Your customers must be complete and utter idiots, do they not have any radiology training? Hopefully one day soon a Patient will grab their phone and record the scummy behaviour of these warts and they’ll get exposed.

    Karl Von Batten​: ​Using a major full service hospital as an example, I have to say that video medicine do increase general healthcare cost. I say this because in terms of a hospital’s operational structure, video medicine does not eliminate or reduce the cost generating operational assets required to provide a host of healthcare services.

    Karl Von Batten​: ​In fact, video medicine adds another operational cost generating element to this already existing operational structure. Hence, the operating cost required to implement, use, and maintain a video medicine system adds to the already existing operating cost. Factor in the principle of moral hazard, and it can be theorized that attending physicians will see an increase in the number of patients they see. This it can be argued will increase operating cost.

    Karl Von Batten​: ​In my opinion, (I have not studied any data to back up this claim) the only way for video medicine to have a cost reducing effect on general operational cost is if the traditional operational assets were reduced or eliminated. Nevertheless, this might prove difficult to achieve based on the fact that full service hospitals must maintain a certain level of beds and operational assets to effectively deliver a host of healthcare services. Regardless, I do believe that video medicine is a value plus, and will prove to be cost effective for small clinics. This is because small clinics do not need to maintain the vast amount of operational asset required by larger full service hospitals.

    David Doherty​: Hi Karl Von Batten, I think you’d find Eric Topol‘s book “The Patient Can See You Now” to be an interesting read. The reality is we don’t need to channel all funds through Hospitals and as explained in the article video connections can reduce Hospital admissions, duration of stays and readmissions.

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