Telehealth Practices

| August 5, 2008

Telemedicine sometimes gets a bad rap as not being complete enough or mature enough to appropriately triage medical emergencies when necessary.  A lot of attention has been paid to physicians like Dr. Jay Parkinson, armed with mobile devices and covering his patients on foot in New York City.  More traditional office based physicians have made comments like these:

Who is Jay? Is he legitimate? Is he a good doctor? Would you want this dude rolling up to your house without having any relationship with him? As a recent graduate does Jay have the skills to take care of your needs without the benefit of physician colleagues and mentors? Would I as a referring physician want to take Jay’s patients? This dramatic departure from the traditional patient-physician relationship can have some dramatic consequences. Creating your practice outside the constructs of current medicine seemingly would disconnect the patients further from an already disconnected system. In addition, I have personally found that communicating primarily online is a recursive and progressively consuming process. The more you email, IM, and communicate electronically, the more people will communicate back to you through these channels. There is an incessant ramp up and exponential demand (“electronic tax”) as more and more messages demand your attention. Jay makes a large assumption that the the $500 x 1,000 patients is going to make it worth his time to be available as he outlines (BTW, this salary [minus his cost which probably are minimal] would place him in the top1% of all general practitioners in the country). You have all felt it when you went away on vacation to find that your unrelenting inbox has filled up with another 300-500 messages that require a response. It is a beast. Personally, I can mitigate this by prioritizing senders but this could be a dangerous form of triage for Jay. Will Jay be able to keep up on the electronic treadmill?

Nonetheless, there are hundreds of thousands of mentions of Jay Parkinson, MD on Google with very positive encounters, pleased patients and increasing notoriety with speaking engagments and TV appearances talking about this new kind of practice, so-called concierge practices that can be very mobile, highly tailored and timely.  This story I came across talks about another similar model:

Although the world is increasingly becoming more 24/7, making an appointment with a doctor is so last century. Want a checkup the same day? Good luck. Want to swing by in the middle of a weekend? Don’t hold your breath. And, if you live in the suburbs and must see a specialist near an urban hospital, get ready to take on enough traffic to make you sick.

However, there may be a cure for these inconveniences.

Aventura-based AmeriGroup Holdings recently launched, which offers webcam appointments with physicians on a flexible schedule that includes nights and weekends. There are obvious limitations to what a doctor can offer without a physical examination, but simple diagnoses that require just a look over, a chat and a prescription can work online.

The company’s Web site lists dozens of conditions its doctors can treat, including cold, flu, headache, allergies and heart problems. It also treats children who are at least 2 years old. Doctors can’t prescribe controlled substances through MDWebLive.

Dr. Stephen Q. Parker, president of AmeriGroup’s medical association, said any patient with a serious condition or in need of a more thorough exam will be referred to the nearest medical facility.

"We can’t be all things to all people," said AmeriGroup CEO Robert Smoley, an attorney. "We’re not trying to replace primary care physicians."

Visits are recorded for playback by either doctor or patient, and the medical records are stored with MDWebLive. The company set up an electronic prescription service to send orders to the patients’ designated pharmacy.

"It is convenient for the physician," Parker said. "It’s a way to supplement your income in times of cutbacks in every area."

All of that convenience isn’t free. Physicians must pick up part of the company’s medical malpractice insurance premium, but the company provides its software at no cost.

Patients must pay a $99 annual membership fee, which includes a webcam, and $40 per consultation. Smoley said he hasn’t signed up with any health plans for coverage, but patients can submit their receipts to their health plan and ask for a partial reimbursement.

When it comes to health plans recognizing Internet and telephone consultations – called telemedicine – it’s hit and miss.

Humana’s South Florida medical officer, Dr. Jill Sumfest, said the company is looking into this technology, but does not have a formal coverage policy yet. It has paid for e-mail communications between patients and physicians when using approved medical billing codes.

Telemedicine has been in place since 1996 at the University of Miami’s Miller School of Medicine, which offers it to military bases and Veterans Administration and Florida Children’s Medical Services clinics. Dr. Anne E. Burdick, associate dean for telehealth and a professor of dermatology at UM, said psychology and dermatology are two of the specialties easily practiced via videoconference.

Category: TeleHealth

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