Recall, for a moment, your last trip to the doctor’s office or hospital. How long did it take you to get there? How long did you have to wait before being seen? How long did you delay that visit, which may have been important but not that important, because you had trouble finding two or three hours in your busy schedule? You are not alone – that is the reality most of us experience when interacting with the healthcare system.
Telemedicine, where patients are able to telephone or video conference with their doctor or nurse practitioner, eliminates the logistics of traveling across town, waiting in a room of potentially sick people, and waiting again in a small room, all just to have a conversation that often results in a prescription or specialist referral that extends the chain of logistical headaches. What if that process could be simplified to a matter of a few clicks and no waiting?
Telemedicine takes many different forms. Some doctor’s offices and hospitals have been quick to embrace the technology for common illnesses like the flu and strep throat, psychiatric mental health appointments, and even diagnosing a stroke. The potential advantage is clear: patients can get seen more quickly, and more cheaply, which could save money for insurers and increase the number of patients doctors are able to see.
These benefits have experts predicting a huge market for telemedicine in the future: a Dublin-based research firm calculated the global market at $17.8 billion in 2014 and another predicts that the market will expand to $34 billion by 2020. With such a big opportunity up for grabs, established healthcare organizations and new startups are jockeying for position.
Doctor On Demand is the poster child for the emerging wave of telemedicine startups. The San Francisco-based company has more than $50 million in funding, dozens of physicians including general medicine and psychiatry, and has signed 200 employer clients. Adam Jackson, CEO of Doctor on Demand, says that the technology benefits both patients and doctors.
“Our patients rave about the service because they get to video conference with a board-certified MD from their home or office without having to take off work and sit in a waiting room,” he said in an email. “Doctors also love it. It’s the first viable ‘work from home’ option for primary care physicians. Our flexible shift model and payment structure allows doctors to work flexible schedules while earning the same or more than they would in an offline setting.”
Jackson continued, “Self-insured employers are also offering it for free to their employees, which helps drive adoption and save money.” Interest from businesses is likely to grow: last month, the National Business Group on Health (NBGH) reported that 74% of employers plan to offer telemedicine coverage to employees in 2016, a sharp increase from 48% in 2015.
The business case for employers, and health insurers, is convincing. Doctor on Demand charges $40 per visit with an adult or pediatric physician, about $100 for an hour with a psychiatrist, and $70 for almost an hour with a lactation consultant. That simple pricing compares favorably with the costs, in time and money, of an in-person visit: Doctor on Demand’s $40 care is a fraction of the average cost of a primary care, urgent care or emergency department visit – $100, $150 and $700 respectively. Doctor on Demand claims that it can replace 46% of primary care visits, 35% of urgent care visits, and 12% of ER visits for an average employer.
Telemedicine appeals to employers and policy makers for another reason besides incremental cost savings and convenience for urban and suburban patients: for rural patients, telemedicine changes everything about healthcare access. Health systems are building new satellite facilities, equipped with video conferencing technology and staffed by nurse practitioners who can provide basic tests, in out-of-the-way rural communities. Now patients do not have to travel for hours to the nearest office or hospital for routine care.
This talk of cost savings and access brings up another question: who should pay for these visits? At the moment, reimbursement for telemedicine visits is uneven across the nation. Some private insurers cover telemedicine, but others do not. Medicare, the giant insurance program for older Americans, covers the visits for patients who live in “Health Professional Shortage Areas” but patients must attend the virtual appointments from medical facilities, not from their homes.
There are risks with telemedicine, though. Before, the only real option for patients was to visit the doctor or hospital “just in case” the symptoms were serious. Soon, patients might turn to on-demand video conferencing first. For patients with a heart attack or a serious infection disguised as something minor, those minutes or hours of lost time can be dangerous. There is also the risk that diagnoses will be inaccurate or incomplete if doctors cannot conduct the routine tests that would be performed during an in-person visit. In a world of telemedicine, there will be a higher burden on the patient to recognize what is and is not serious.
Some startups entering the telemedicine space are focused on particular specialties, unlike the broader Doctor on Demand. 1DocWay, based in New York, partners with psychiatric hospitals, health systems and emergency departments to facilitate mental health consults and therapy. The co-founder of 1DocWay, Samir Malik, wrote in an email: “Our focus on psychiatry had enabled us to move quickly towards integration, as many primary care physicians and medical clinics have identified mental health as their top clinical need.”
While there is certainly a need and a growing demand for telemedicine capabilities, there are issues and challenges to address. Jeremy Kahn, a Professor of Critical Care Medicine at the University of Pittsburgh School of Medicine, wrote in the New England Journal of Medicine earlier this year that past studies of telemedicine have not looked at patient-centered outcomes and that “the legal and regulatory infrastructure for telemedicine has yet to catch up with the technology, which changes on a near-daily basis.”
Kahn recommends more research that tests patient-centered outcomes and determines which contexts are best suited for telemedicine. He also states that we must “integrate telemedicine into the existing care system in ways that do not detract from the interpersonal and interprofessional relationships that we all recognize as essential to effective, patient-centered care.”
Ultimately, Kahn hopes, we will have a healthcare system that is “not just different and more modern but also better.”
NOTE: The views expressed here are those of the authors and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com
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