Recently US News & World Report published an article detailing the disappointing experiences of patients using one of the largest online-only telemedicine providers. Interestingly, none of the patients had complaints about the telemedicine technology; it was the quality of care or lack of it, that resulted in dissatisfaction. The piece points out that insurance companies love telemedicine because it costs them about $45 per visit, vs. $100 – $125 for an in-office visit. So that begs the question, is it possible to deliver services through telemedicine and still give patients excellent care? We know it is with the right approach.
The Limitations of On-Demand Remote Medical Care
The idea of logging into an app and seeing a doctor whenever you want or need to is pretty attractive. It is less expensive and time-consuming than an in-office visit, many insurance plans pay for it, and who wants to sit around in a waiting room anyway? But these conveniences are offset by some genuine limitations, not with the technology, but with the relationship. When you use this type of service, you’ll be having a consultation with a provider that you don’t know and who does not know you. They will have limited if any, access to your medical history. Practicing medicine is difficult, doing it without any context at all is potentially dangerous.
For example, if a patient in an on-demand visit complains of a headache and reports getting them, “Once in a while.” The provider might suggest over the counter pain relievers or sinus medication. However, if the patient were visiting a provider with whom she had a long-term relationship, he might notice that “once in a while” is accelerating and the intensity of the headaches is getting worse, so perhaps diagnostic tests are in order. History and context are essential to high-quality medical care, that’s why we often call primary care, “Family medicine.”
On-demand remote care is great until it isn’t.
Relationships + Technology = Quality + Efficiency
Despite these concerns, there is another model that addresses both the advantages of telemedicine and the advantages of a long-term doctor/patient relationships. Medical practices can offer video-visits as a supplement to their traditional practice. That way, patients get cared for by providers who know them and their history. Providers have access to the patient’s complete medical record, and they are in the position to practice more holistic medicine.
For example, Dr. Joseph knows that Marcia gets three urinary tract infections a year. He knows that the appropriate diagnostic tests have been done to rule out structural causes. He knows that Marcia has a history of correctly self-diagnosing her UTIs. He would be entirely comfortable prescribing the antibiotic that always works for her. An on-demand provider without this context would be less likely to prescribe the medication due to the frequency of her infections and refer Marcia back to her primary provider, a frustrating and money wasting experience.
The Best of Both Worlds
Practices with an integrated telemedicine program get the advantages of the technology as well as the benefit of strengthened patient relationships an stronger patient loyalty. Video-visits are more efficient than in-office encounters, making it possible to increase practice revenue without hiring additional providers or office staff. Because many providers will pay for a video-based encounter, but not a telephone only conversation, telemedicine also creates the opportunity to turn un-reimbursed activities, such as reviewing test results, into paid ones. An additional benefit is that video-visits can be done anytime, from anywhere, so providers can work remotely for part of the week or offer after hours or weekend visits.
Patients turn to on-demand providers for the convenience, but when given a chance to get those advantages from their primary doctors, most people jump at it. In fact, the availability of telemedicine is becoming an important factor in provider selection for many patients. They recognize that the relationship is essential but want the advantages of remote care.
Telemedicine technology will undoubtedly help overcome the challenges that the American healthcare system faces in the coming years. We have an aging population with an increasing number of chronic conditions and a provider shortage that is predicted to continue to worsen. More efficient delivery of care is a good thing, but the quality of care should always be in the forefront when exploring solutions. Telehealth care delivered by traditional practices checks all the right boxes.