Is telemedicine a viable option in primary care?

Health care professionals are split almost evenly, 51% to 47%, on the priority of telemedicine within their organization, according to the most recent REACH Health poll that looked at telemedicine.

“Interestingly, this represents a slight decrease in priority ranking from the 2016 survey,” the authors wrote.

The authors received responses from 436 health care professionals, and attributed the results to uncertainty surrounding Medicare and Medicaid funding for telemedicine, as well as the future of the Affordable Care Act at the time of the poll, as well as the “continuing evolution and maturation of telemedicine, moving from ad-hoc project status to a mainstream service for many providers.”

There are other things clinicians need to consider when it comes the viability of telemedicine in primary care, two doctors told Healio Family Medicine.

Judd Hollander, MD , a professor of emergency medicine at Jefferson Health in Philadelphia and Roy Benaroch, MD, a practicing pediatrician and assistant adjunct professor of pediatrics at Emory University in Atlanta explain in this installment of Point/Counter.

POINT

When considering telemedicine in primary care, you have to start by asking how patients want to get their care. The answers to this typically depend on who the patient is, who the physician is, and generally speaking, how easy it is to access that physician and where they are.

Judd Hollander

There are surveys that are quite impressive, some of which show that as many as 80% of patients asked want to get care via virtual health. To some degree, primary care providers should deliver care in a way that is most effective, most convenient and least expensive and highest value to the patient. Here in Philadelphia, some of our patients end up paying $25 or $30 in parking, another couple of bucks in gas, and some have tolls to pay, too. At the end of the day, they’re spending a lot more of their money to see their doctor than they would have to if their primary care provider used telemedicine. Some of the visits, with patients who are really sick, may need to come into the office, but others can likely be seen via internet, video, and phone hookups. Many patients who need chronic care management can also be handled remotely.

Those same surveys that I alluded to earlier also show patients want to get their care in a convenient, less expensive manner, also show they are willing to switch to providers who offer telehealth from providers who don’t. Another survey looked at attributes that patients want in primary care, and the most common answer centered around cost and convenience, and far down the list was patients’ allegiance and desire to see their own doctor.

I tell my colleagues and peers that if you don’t want to do telemedicine, you are going to have a lot of free time on your hands, because the patients want it, and are willing to change providers to do it. Our health system was one of the first to adopt telemedicine and we have proven we can do it. – by Judd Hollander, MD

COUNTER

Telemedicine is viable in primary care, with some important caveats. I’ve had some experiences that have given me pause and make me think we’re rushing too quickly into this. The subject itself is somewhat poorly defined — people mean different things when they say telemedicine. One person may think telemedicine is simply a matter of making telephone calls. Most people, though, will think of it as a more interactive experience, using Skype or similar video technology. Some practitioners even take it a step further where he or she will send out a nurse to conduct a physical exam at a patient’s home or hospital bed. The commonality in these, and other telemedicine scenarios, is that the physician is usually not in the same location as a patient.

Roy Benaroch

Telemedicine is most widely used for very specific specialists like neurosurgeons and oncologists to provide service for people in geographically isolated areas, or for specialists consulting on complex cases, and that has been tremendously helpful. I’m supportive of these efforts, and I think we can all agree when used to help patients get medical care that genuinely need and might otherwise not get this health care, telemedicine is a good thing.

However, at the same time, there are for-profit companies that are starting to implement telemedicine services that raise big red flags. There is one company, Teladoc, that is strongly supported by Aetna, to the point where Aetna is telling its subscribers in lieu of going to see their physicians, the patient can have conditions like ear infections and strep throat diagnosed and treated through telemedicine. Both of these conditions require a physical exam. You can’t make these diagnoses without a proper, in-person examination.

Let me give you an example. I once had a patient who was 15 months old that was diagnosed with strep throat and prescribed antibiotics over the phone, without any examination or strep test. The provider based his diagnosis on the parents’ impression that their child had a sore throat. When you think about that, that is truly a terrible, egregious error and ridiculous decision that flies in the face of primary care physicians’ efforts to provide appropriate care and use antibiotics judiciously. Telemedicine is essentially trying to skim off the top in these types of situations. The insurance company is trying to provide cheap care by doing as little as they can, and that can be the problem with telemedicine.

In my practice, we are considering using telemedicine to provide followup care, things like behavioral health or psychiatric issues after an initial diagnosis is made, but this would be implemented on a limited basis, and with tight controls, and for the convenience of the patients.

So while telemedicine is a good option in certain circumstances, we need to proceed carefully when deciding whether or not it is right for our practices and/or the medical service being provided. – by Roy Benaroch, MD

Reference:

Reachhealth.com. “2017 U.S. Telemedicine Industry Benchmark Survey.” http://reachhealth.com/wp-content/uploads/2017-US-Telemedicine-Industry-Benchmark-Survey-REACH-Health.pdf. Accessed Feb. 13, 2018.

Disclosure: Hollander reports no relevant financial disclosures. Healio Family Medicine was unable to determine Benaroch’s financial disclosures prior to publication.