Transformative Medicine: Patient Visits Move Online

Video Visits With Patients Are Taking Off

Neil Chesanow


September 24, 2014

In This Article

Should You Offer Virtual Patient Visits?

It's becoming harder for patients to find a doctor, and harder to get an appointment even if they have one. When patients do get an appointment, spending a couple of hours in transit in rush-hour traffic, and being marooned in the waiting room because the doctor is behind schedule, gets old fast.

On top of that, with many employers switching to high-deductible health plans, seeing a doctor -- even for a minor condition, such as sinusitis, let alone a chronic condition, such as diabetes -- has become more expensive than ever.

These are among the reasons that virtual visits -- that is, physicians diagnosing and treating patients remotely on their computers, tablets, and even smartphones -- has reached what many experts maintain is a "tipping point."

Virtual visits that reduce the number of office visits are being embraced by insurers; health plans; employers; hospitals; accountable care organizations (ACOs); patient-centered medical homes (PCMHs); a growing number of independent physician practices; and most of all patients, for whom the convenience and cost of virtual visits with a physician are compelling.

Within the next year or two, it's likely that some of your patients will be diagnosed, treated, and prescribed medication by a doctor at a remote location for a nonurgent condition -- such as allergies, asthma, cold and flu, rashes, ear infections, sore throats, and urinary tract infections -- interacting with them on a tablet or even smartphone screen.

If the condition is urgent, the patient is directed to a local emergency department. If the condition requires an office visit, the patient is told to contact his or her doctor. If the patient doesn't have a physician, a local doctor is suggested.

Some physician practices are already setting themselves apart from local competitors by establishing an online presence, so that patients don't always need an office visit for minor complaints.

If you seek to attract more patients, or keep the ones you have from defecting to competing practices that have begun to offer the convenience of virtual access, adding remote consultations to your list of services may be worth considering.

Health Plans Are Leading the Way

Insurers large and small are partnering with telehealth technology providers to offer virtual doctor visits as an option to millions of members of their client health plans. For example, WellPoint and United Healthcare have partnered with American Well in Boston, Massachusetts. Cigna has partnered with Sunrise, Florida-based MDLIVE. Aetna has partnered with Teladoc in Dallas, Texas. All plan to expand virtual doctor visits to millions more members next year.[1]

"We're signing about two to three new health plans per quarter," says internist Roy Schoenberg, MD, MPH, American Well's CEO. "Even though the medical industry is conservative, telehealth is moving forward at a blazingly fast speed."

Smaller health plans are embracing virtual visits as well. In May, for example, Priority Health, a health plan based in Grand Rapids, Michigan, began offering 24/7 doctor access via telephone and video using MDLIVE's technology platform -- and its virtual network of physicians -- to its members throughout the state.[2]

"Every year, nearly 80% of our members have a health concern that can be treated using virtual visits -- ultimately saving them both time and money," Michael P. Freed, Priority Health's CEO, said in a statement.[2]

Even a patient with no health insurance can log onto the website of some telehealth providers and within a few minutes be talking with a board-certified doctor -- most commonly a primary care or emergency physician, whose credentials have been vetted, who is licensed to practice in the state in which the patient resides, and who has been trained to interact with patients online -- for about $49, the price point that appears to be the market standard.

Virtual doctor/patient interactions must meet Health Insurance Portability and Accountability Act (HIPAA) requirements for the security of protected health information. Afterward, the patient receives a personal health record of the visit that can be shared with family members or other providers.

Surveys Show Exploding Demand

Are virtual visits a flash in the pan? On the contrary, surveys of patients, physicians, and hospitals all point to soaring demand.

In August, Deloitte predicted that out of an average 600 million general practitioner appointments in the United States and Canada in 2014, up to 75 million could be electronic visits, including videoconferencing and remote consultations by telephone, texting, and secure email.[3] The latter may include the exchange of digital documents such as video clips, audio clips, still images, radiographs, MRIs, ECGs, EEGs, and lab results.

Such "eVisits" are not a substitute for every office visit, the reports adds, but even if only 30%-40% of office visits could be replaced by remote consultations, that would constitute a $50-$60 billion market.[3]

In August, research by Parks Associates specifically focused on the growth of videoconferencing for physician/patient visits. It predicted that virtual visits are about to triple -- from 5.7 million in 2014 to over 16 million in 2015 -- and will skyrocket to over 130 million in 2018.[4]

In California alone, the firm discovered, nearly 50% households with an broadband Internet connection already use an online health service from a doctor (the national average is 42%).[5]

In June, a FICO survey of over 2000 smartphone users in the United States and 11 other countries found that 80% want to use their mobile devices to interact with healthcare providers.[6]

In August, an HIMSS Analytics report revealed that of over 400 hospitals and physician practices surveyed, 46% already use some form of telemedicine technology, with videoconferencing the most widely used tool (by 57.8%) and the most widely considered for future use (by 67.1%).[7]

In May, a Harris Poll survey of 2000 adults conducted for MDLIVE found that 27% of the respondents who already had a physician would make sacrifices to have constant access on a mobile device. What sort of sacrifices? Thirteen percent would give up shopping for a month; 9% would forgo their next vacation; 5% would skip showers for a week; and 3% would forfeit a salary increase.[8]

Those most likely to make such sacrifices (42%) were, ironically, tech-savvy "young invincibles" (18-34 years of age) -- the very people who supposedly weren't going to sign up for Obamacare because, for them, healthcare wasn't a priority.[8] Now they're clamoring for 24/7 access to their doctors from their beds (33%), while at work (23%), while riding in a car (20%), while walking down the street (12%), while in the bathroom (12%), and while at a child's sporting event (8%), the Harris Poll survey found -- as long as it's a virtual visit.[8]


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