The Cleveland Clinic recently announced a service called MyCare Online which gives patients the ability to see medical professionals any time of the day. The visits can take place on any device including computer, tablet or smartphone. The cost of a 10 minute visit is $49.
The most common conditions that can be diagnosed and treated include bronchitis, asthma, cough and cold, earaches, allergies, sinus infections, rashes, urinary infections and yeast infections. “The way we deliver services is rapidly evolving and technology allows us to make access to healthcare more convenient,” said J. Gregory Rosencrance MD, chairman of internal medicine at Cleveland Clinic Florida, in the news release. If an emergency happens at night or on a weekend, “patients can be seen and treated instantly or advised to go to the hospital for further treatment.”
The Cleveland Clinic is partnering with American Well. American Well is a large national provider of telemedicine services with alliances with many large insurers and medical providers.
“Several high schools in the Pugent Sound, Washington area will introduce the capability for parents to reach a sports medicine doctor virtually using a cellphone or computer for their children injured while a playing a sport. Physicians will consult and diagnose minor injuries like sprains and bruises, but more serious injuries like concussions would still need to go to the emergency room.
The state of Washington made changes this year to telemedicine law to allow coaches, trainers, students, and parents to log on to private portals to obtain consultations. The benefits of telemedicine include cost and convenience. The cost for an emergency visit is approximately $1400 while a telemedicine consultation costs $50. “We can talk to the athlete. We can ask how it happened. We can actually take the cellphone’s camera and look at the injured part of their body and see if it’s swollen, see if it’s bruised. Then we can come up with a preliminary diagnosis,” said Ryan Dirks, a sports medicine physician assistant.”
Colorado’s Medical Board recently adopted guidelines to enact a new telehealth law expanding services to urban residents in addition to rural residents. Additionally, the new rules do not require an initial in person visit, a particular technology, or for patients to be in a certain facility.
Colorado previously has required insurance coverage of telehealth visits for several years in counties of fewer than 150,000 residents, but now residents in larger cities are able to take advantage of the services. Studies show that Colorado faces a shortage of primary care physicians so telehealth allows these physicians to see more patients more efficiently.
The bill does not require insurers to provide for the telehealth benefits until the beginning of 2017. House Bill 1029 was sponsored by Reps. Perry Buck, R-Windsor, and Joann Ginal, D-Fort Collins.
Texas and Georgia appear to be leading the way in implementing telemedicine to public schools. The Children’s Health System of Dallas is expanding a pilot project in 2 preschools to 57 schools in four counties. The program allows for a virtual consultation between the school nurse and a doctor or nurse practitioner at Children’s Health. The cost of a telemedicine cart is $22,000 and is being funded by a Medicaid waiver. “You want to talk about access? You want to talk about affordability? This is their access,” says State Rep. Jodie Laubenberg. “We can treat the child, have him ready to go, and we can leave him here. … You don’t have to take off work. He doesn’t have to leave school. It’s less disruptive.”
Georgia through the Georgia Partnership for Telehealth (GPT) is also looking to expand its school telemedicine program. The GPT has received a grant from the Georgia Office of Rural Health’s 2015 Rural School-Based Telehealth Center Initiative to expand its pilot program to eight schools. “For a variety of reasons, whether it be distance or financial factors, not all children have access to the medical care that they need to grow in a healthy and happy manner,” Sherrie Williams, the GPT’s executive director, said in a press release. “This grant program will help get more children the care that they need and ultimately helps foster better lives for students in rural Georgia communities. That is a huge victory and we are glad to be a part of it.”
According to a market research report by Modor Intelligence titled “Global Telemedicine Market – Growth, Trends and Forecasts (2015-2020)”, the market for telemedicine is expected to reach $34 billion.
Factors contributing the growth include an aging population, increasing incidence of chronic diseases, rapid rise in the software market, and a desire to monitor patients in their own homes to decrease healthcare costs. North America is the largest market, accounting for more than 40% of market size, however the scope of telemedicine is increasing in developing countries.
“Telemedicine has revolutionized medicine as it has not only made healthcare more accessible to the rural population but also taken the burden off the overburdened healthcare setup. The hospitals and clinics can cater to the critically ill, while everybody else can get a consult through a simple phone call or by videoconferencing. There are a number of telemedicine startups that are investing in the telemedicine market. The advancing technology has ensured that telemedicine is as good as going to the hospital and physically meeting the doctor. It also ensures that everyone has access to a specialist consult,” the report stated.
Telemedicine is not just a hot medical topic in the United States. The Times of India is reporting that the central jail in Nashik Road has installed a telemedicine system to allow doctors at the local hospital to provide advice on conditions affecting the inmates.
The jail has a 72 bed hospital facility. For serious illnesses, the inmates are transported to the civil hospital. Civil surgeon GM Holey of the civil hospital said, “Over the past one month or so quite a few medical cases of jail inmates have been taken up for discussion through the telemedicine system.”
The prison has had 2 cases of attempted escape by prisoners during trips to the civil hospital for evaluation. Officials hope that the use of telemedicine may help prevent such incidents in the future.
Egede LE, et al. Lancet Psychiatry. 2015; doi:10.1016/S2215-0366(15)00122-4.
Many patients with major depression do not have access to evidence based psychotherapy. This group in the Lancet Psychiatry hoped to demonstrate non-inferiority of therapy delivered via telemedicine as compared to in person therapy.
The study randomly assigned patients from the Ralph H. Johnson Veterans Affairs Medical Center and four surrounding clinics being treated for depression. to eight sessions of either therapy via telemedicine or delivered in the same room. The primary outcome measured was treatment response according to the Geriatric Depression Scale, Beck Depression Inventory, and Structured Clinical Interview.
The study found that the response on all three measures was the same and non-inferior in the telemedicine group compared to the in-person group. “Telemedicine-delivered psychotherapy for older adults with major depression is not inferior to same-room treatment,” the researchers wrote. “This finding shows that evidence-based psychotherapy can be delivered, without modification, via home-based telemedicine, and that this method can be used to overcome barriers to care associated with distance from and difficulty with attendance at in-person sessions in older adults.”
HealthSpot telemedicine kiosks and Rite-Aid have announced the opening of 25 booths in stores in Akron, Canton, Cleveland, Dayton and Springfield. Based on feedback from this initial rollout, a decision will be made on whether more stores will install booths.
HealthSpot’s booths use high-definition teleconferencing to connect patients with on-call physicians. The booths have an attendant who helps operate and sanitize the system. Incorporated within the booth are digitally connected instruments such as stethoscopes, blood pressure cuffs, and cameras. The on-call physicians are from Cleveland Clinic, Kettering Health Network, and University Hospitals of Cleveland.
HealthSpot is a “natural extension” of the company’s offerings and provides an “alternative solution to accessing quality health care in a familiar, professional and convenient setting,” said a statement from Robert Thompson, Rite Aid executive vice president of pharmacy.
A new internet survey was recently performed by TechnologyAdvice. The study included 504 respondents and asked several telemedicine questions. Of those surveyed, approximately 75% would not trust a diagnosis made by telemedicine or give it less weight than an in-person meeting. Additionally, 56% said they would not be comfortable meeting a doctor for the first time by telemedicine. Only 7.5% said they would be comfortable using a healthcare kiosk in a retail setting.
“This is perhaps the largest issue that telemedicine vendors and healthcare providers will need to overcome,” say the lead author, Cameron Graham. The study goes on to comment that “”In order for telemedicine to make a meaningful impact on American healthcare, patients will need to not only become familiar with the concept, but also recognize the benefits it can offer over traditional appointments.”
Study was not all negative. 65% of respondents said they would use telemedicine after first meeting the doctor in person. Less than 30% had a strong opposition to the technology. The survey concluded, “If patients can be convinced that telemedicine provides an experience comparable to an actual visit – at least for preventative questions – there appears to only be a small amount of intrinsic opposition to virtual systems. Overcoming these concerns will be crucial for the long-term success of the industry.”
TACOMA, Wash. — One night, when her face turned puffy and painful from what she thought was a sinus infection, Jessica DeVisser briefly considered going to an urgent care clinic, but then decided to try something “kind of sci-fi.”
She sat with her laptop on her living room couch, went online and requested a virtual consultation. She typed in her symptoms and credit card number, and within half an hour, a doctor appeared on her screen via Skype. He looked her over, asked some questions and agreed she had sinusitis. In minutes, Ms. DeVisser, a stay-at-home mother, had an antibiotics prescription called in to her pharmacy.
Using videoconferencing, a doctor in Des Moines, foreground, discusses a case with a nurse in a clinic in another city.Iowa Court Ruling Says Doctors Can Prescribe Abortion Drugs by VideoJUNE 19, 2015
In the Iowa system, a doctor consults by video with a patient at a clinic, then remotely opens a drawer with two abortion drugs.Videoconferencing Is Used to Administer Abortion DrugsJUNE 8, 2010
The same forces that have made instant messaging and video calls part of daily life for many Americans are now shaking up basic medical care. Health systems and insurers are rushing to offer video consultations for routine ailments, convinced they will save money and relieve pressure on overextended primary care systems in cities and rural areas alike. And more people like Ms. DeVisser, fluent in Skype and FaceTime and eager for cheaper, more convenient medical care, are trying them out.
Dr. Ben Green, a physician who helped develop the telemedicine program at Carena, a company that offers virtual visits. Credit Evan McGlinn for The New York Times
“I’m terrible about going to the doctor, just because of the time it takes,” Ms. DeVisser, 35, said. “This feels empowering: You just click a button and the doctor comes to you.”
But telemedicine is facing pushback from some more traditional corners of the medical world. Medicare, which often sets the precedent for other insurers, strictly limits reimbursement for telemedicine services out of concern that expanding coverage would increase, not reduce, costs. Some doctors assert that hands-on exams are more effective and warn that the potential for misdiagnoses via video is great.
Legislatures and medical boards in some states are listening carefully to such criticisms, and a few, led by Texas, are trying to slow the rapid growth of virtual medicine. But many more states are embracing the new world of virtual house calls, largely by updating rules to allow doctor-patient relationships to be established and medications to be prescribed via video. Health systems, facing stiff competition from urgent care centers, retail clinics and start-up companies that offer video consultations through apps for smartphones and tablets, are increasingly offering the service as well.
While telemedicine consultations have been around for decades, they have mostly connected specialists with patients in remote areas, who almost always had to visit a clinic or hospital for the videoconference. The difference now is that patients can be wherever they want and use their own smartphones or tablets for the visits, which are trending toward more basic care.
In Philadelphia, Jefferson University Hospitals now lets patients have video follow-up visits with internists, urologists, and ear, nose and throat specialists. Mount Sinai Health System in New York is starting to offer video visits for primary care patients. Mercy, a health system based in St. Louis, will soon open a $54 million virtual care center to house a number of telemedicine programs, including urgent and primary care video consultations for chronically ill and other high-risk patients who need frequent assessments and advice.
Advocates say virtual visits for basic care could reduce costs over the long term. It is cheaper to operate telemedicine services than brick-and-mortar offices, allowing companies to charge as little as $40 or $50 for consultations — less than for visits to emergency rooms, urgent care centers and doctors’ offices. They also say that by letting people talk to a doctor whenever they need to, from home or work, virtual visits make for more satisfied and potentially healthier patients than traditional appointments that are available only at certain times.
Hope Sickmeier, 51, a fourth-grade teacher in Ashland, Mo., used her Anthem insurance for a virtual urgent care visit one Saturday night, three days into a toothache that kept getting worse. A week earlier, she had gone to the emergency room with a migraine and owed a $200 co-payment.
This time she grabbed her iPad, downloaded the app for the visits and scanned a list of available doctors, choosing one with “a trustworthy face.”
When the doctor appeared on her screen, she told him her symptoms and, holding her iPad close to her face, showed him her painful tooth and the swelling in her jaw.
“I was in so much pain, I didn’t care that it was weird,” Ms. Sickmeier said. “He got right to the point, which was what I wanted. He prescribed antibiotics and called them into an all-night pharmacy about 20 minutes away.”
Washington State gave a victory to the industry in April when Gov. Jay Inslee, a Democrat, signed legislation requiring insurers to cover a range of telemedicine services if they already cover those services when provided in person. But the new law, which made Washington the 24th state to ensure reimbursement for some telemedicine services, does not cover virtual urgent care outside a medical facility.
Dr. Green’s desk at Carena. Advocates say virtual visits for basic care could reduce costs for patients and medical providers. Credit Evan McGlinn for The New York Times
Still, the law “opens the doors with a lot of our payers,” said Matt Levi, CHI Franciscan Health’s director of virtual health services. He added that some insurers, like Molina Healthcare of Washington, the state’s largest Medicaid plan, were starting to cover virtual urgent care, though the law does not require it.
“We are jumping in with both feet on this,” said Peter Adler, president of Molina Healthcare of Washington. “We think it’s the future, and it’s here now.”
Some large insurers are starting to pay, too. UnitedHealthcare, the nation’s largest insurer, announced in April that it would cover virtual visits for most of its 26 million commercial members by next year, citing the shortage of primary care doctors and the cost of less than $50 per virtual visit. Anthem will cover virtual urgent care visits for 16 million members in 11 states by the end of this year, and it expects the number to reach 20 million next year. Both insurers are relying on third-party telemedicine companies to provide the doctors and the technology platform for the service, just as most health systems do for now.
Even as virtual visits multiply, researchers say it is not clear whether they really save money or provide better outcomes.
“But I think it’s very plausible, and probably likely, that a lot of people who do a virtual visit would otherwise have stayed home,” Dr. Mehrotra said, pointing to research that suggests most people do not end up seeking care when they feel sick. “So it could increase health care spending over all.”
CHI Franciscan’s virtual urgent care program contracts with Carena, a private company in Seattle that employs 17 physicians and nurse practitioners to do virtual consultations in 11 states. Among CHI Franciscan’s patients, the most frequent users are women ages 25 to 55, and the most typical diagnoses are bladder infections, upper respiratory tract infections and pinkeye.
Users are prescribed medication about 40 percent of the time, said Beth Bacon, the company’s vice president for consumer affairs. Most visits take place on weekends or between 5 p.m. and 8 a.m., she said, when doctors’ offices are closed. Like other virtual urgent care programs, CHI Franciscan’s emphasizes that it is not for medical emergencies, advising customers on its website to “call 911 or proceed to the nearest emergency room” if they have chest pain, difficulty breathing or other potentially life-threatening symptoms.
Although Carena provides all the physicians for the program now, several CHI Franciscan doctors are training to become “virtualists.” Dr. Dan Diamond, a family practitioner at one of CHI Franciscan’s urgent care centers who recently trained to conduct virtual visits, said he enjoyed the less hurried pace.
“I don’t have people knocking on the door and saying, ‘Doc, we need you in another room,’ ” he said. “I’m able to focus on that one patient, without all the commotion that happens in an urgent care or an emergency room.”
Still, he added, “there are some times where we just can’t do it virtually and we need to lay hands on a patient.”
Ms. DeVisser turned out to be one of those cases. While happy with her virtual visit last summer, she ended up going to her primary care doctor a few weeks later because the antibiotics had not fully cleared up her sinus problems. He referred her to an ear, nose and throat specialist, who found through an examination that she had nasal polyps that needed to be removed.
“At least it mitigated the problem,” she said of her video consultation. “And it was much more comfortable than having to go sit with a bunch of other sick people in a waiting room.”