Op-Med is a collection of original articles contributed by Doximity members.
The expansion of internet access and technology has put telemedicine on the cutting edge of healthcare delivery. Seventy-seven percent of Americans have a smartphone. Three-quarters of Americans have access to high-speed internet at home.
How can you better help your patients by incorporating telemedicine? In my experience, four major issues prevent patients from getting the right care at the right time: (1) geographic or mobility barriers, (2) not knowing who you need to see, where to find them, and when that visit needs to occur, (3) not being able to access a doctor, (4) not having adequate financial resources.
1. Geographic and Mobility Barriers
Geography or transportation issues also limit in-person patient access to doctors, especially subspecialists. Your patient may need to drive long distances or spend hours on public transportation for a 20-minute visit. While an in-person visit is usually necessary when you first meet a new patient, follow up visits can be handled via telemedicine and use of local health care resources, like outpatient labs or imaging centers.
Where to go for what, to be seen by whom, and when?
Telemedicine can address all of these issues. Urgent consultations via telemedicine could be built into the schedule of the doctor covering urgent visits for your practice any given day. This allows for your practice to see more of your own patients given the increased convenience for your patients, allowing for them to fit the visit more seamlessly into their day (they wouldn’t have to find a babysitter, drive to your office or wait for a ride). The on-call physician can also visualize the patient calling for advice, giving you more information to work on when your patient calls for advice. For example, you can see how hard an asthmatic is working to breathe. You can see how bad of a laceration your patient has or how swollen their ankle is. Your patients can also be saved exposure to sick folks in the waiting room, an extra trip to you if the problem needs an ER visit or simply a direct trip to outpatient radiology.
No local doctor available
Telemedicine provides an opportunity for people to access doctors when there are limited or no local options. Several successful programs already exist to improve access to specialists. The ANGEL program in Arkansas connects women with high-risk pregnancies living in rural areas with maternal-fetal medicine specialists at the University of Arkansas in Little Rock to help monitor and manage their pregnancies. Without telemedicine, these women would either have had to travel great distances for frequent visits with the doctor or have no access to the correct subspecialist at all. Telemedicine has been shown to decrease wait times for your patients to see a subspecialist.
Inability to pay for healthcare
Insurance coverage for telemedicine services varies depending on your state. In some states, telemedicine visits are reimbursed at the same level as an in-person visit. In many states, this is being pursued legislatively.
In 2017, the Centers for Medicare and Medicaid Services included new billing codes addressing coverage for telehealth services. The Department of Veteran Affairs also took a major step forward in providing telehealth services to 22 million American veterans by securing a $260 million contract with 1Vision LLC to deliver home-based telemedicine. Congress also passed a law removing state licensure barriers for VA physicians, allowing all veterans to access the limited number of subspecialist physicians. This suggests that legislation on the state level will ultimately provide health insurance coverage for telemedicine services. Until then, you can negotiate your rates for telemedicine services directly with your patients. Ultimately, choosing to receive medical care via telemedicine results in lower costs in dollars, time, and improved health due to improved access to a doctor.
Medical visits cost your patients money and time. In 2015, the average amount of time a person spent seeking medical care was 121 minutes, including 37 minutes of travel, 84 minutes in the clinic (of which 20 minutes was spent with the doctor). Because telemedicine visit occurs online, the time cost is essentially the duration of the visit.
Telemedicine is here to stay because it’s good for patients. I encourage doctors to seek out telehealth opportunities.
Dr. Irene Tien is a board-certified Emergency Medicine and Pediatric Emergency Medicine physician with 20 years of clinical experience in academic and community emergency medicine and urgent care. She has performed clinical research and has been a speaker at research and medical conferences. She is most recently a telemedicine entrepreneur who offers personalized telemedicine services as a partner in the RoweDocs multi-speciality physician network. Her current professional interests include promoting patient empowerment by improving health literacy via her blog at www.my-doctor-friend.com, improving patient access to physicians using telehealth, and patient advocacy.