One night, when her face turned puffy and painful from what she thought was a sinus infection, Washington resident 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 DeVisser, a stay-at-home mother, had an antibiotics prescription called in to her pharmacy.
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 DeVisser, fluent in Skype and FaceTime and eager for cheaper, more convenient medical care, are trying them.
“I’m terrible about going to the doctor, just because of the time it takes,” 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 misdiagnosis via video is great.
LISTENING CAREFULLY
Legislatures and medical boards in some states are listening carefully to such criticism 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 medication to be prescribed via video. Health systems, facing stiff competition from urgent-care centres, retail clinics and start-up companies that offer video consultations through apps for smartphones and tablets, are increasingly offering the service also.
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 smartphones or tablets for the visits, which are trending towards more basic care.
In Philadelphia, Jefferson University Hospitals now let 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 open soon a $US54 million ($72.52 million) virtual care centre 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 $US40 or $US50 for consultations – less than for visits to emergency rooms, urgent care centres 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, which are available only at certain times.
VIRTUAL URGENT CARE VISIT
Hope Sickmeier, 51, a fourth-grade teacher in Ashland, Missouri, 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,” 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 Governor Jay Inslee, a Democrat, signed legislation requiring insurers to cover a range of telemedicine services if they covered 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.
OPENS THE DOORS
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 did not require it.
Even as virtual visits multiply, researchers say it is not clear whether they really save money or provide better outcomes.
Virtual urgent care visits are undoubtedly less expensive than trips to the emergency room, said Dr Ateev Mehrotra, a professor of health policy at Harvard Medical School, who has studied telemedicine.
“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,” Mehrotra said, pointing to research that suggests most people do not end up seeking care when they feel sick. “So it could increase healthcare spending overall.”
New York Times