The doctor will log on now: Telemedicine catching on with consumers
Posted April 12
When the flu strikes, you can drag your achy-breaky body out of bed and drive, shivering and miserable, to a doctor's office where you will sit in a waiting room, being sneezed on by other sick people.
Or you can log on to your computer, consult with a doctor over the Internet for about a third of the cost, and go back to bed.
Despite its practical benefits, fewer than 40 percent of tech-savvy Americans have heard of telemedicine, which enables patients to consult with a doctor over the phone or via a video connection within minutes of making a request.
But the majority of people who have used an "e-doctor" for everything from flu symptoms to toenail fungus to marriage counseling say it lowered their health-care costs, and medical professionals say the industry is poised to grow rapidly.
“We’re in that early phase where there is a fair amount of hype from some people, and a fair amount of pushback from others, plus logistical challenges. But it’s beginning to tip,” said Dr. Robert Wachter, a professor and interim chairman of the Department of Medicine at the University of California and author of “The Digital Doctor.”
“It strikes me as being inevitable. I can’t picture a scenario in which it doesn’t become the dominant way that people get care,” Wachter said. “A generation of future patients are going to say, ‘What do you mean I have to take a half-day off work and go see the doctor? That’s crazy.’”
When actors posing as patients consulted with virtual doctors about common conditions that included ankle pain, viral pharyngitis and low back pain, 76.5 percent got correct diagnoses, and the rate of prescribing was similar to that of in-office visits, a study published April 4 in JAMA Internal Medicine said.
Researchers noted, however, that there was "significant variation in quality" among the eight services the actors used, and adjusted for condition and company, accuracy ranged from 65.4 to 93.8 percent. But they note that quality differs in traditional medical settings, as well.
In person, doctors misdiagnose at a rate of 10 to 20 percent, other studies have shown.
The telemedicine industry has been enabled by the rapid growth of technology. One out of four Americans have smartphones, and more than a third use them for video calling through services like FaceTime and Skype.
But telemedicine extends to land lines, too. Seventy percent of consultations through one of the nation’s largest providers, Dallas-based Teladoc, are over the telephone; 30 percent are through video.
Teladoc enables virtual visits for 14 million Americans through their insurance companies and employers, said Henry DePhillips, the company's chief medical officer. Their clients include companies like Bank of America, Home Depot, Shell and Costco, who provide the service as an employee benefit.
"The customer satisfaction associated with telemedicine is off the charts. People who use it love it. They love that they don't have to leave work; they can access care on their own terms," DePhillips said, noting that mothers with children at home are one of the largest subsets of users.
The company does not seek to replace family physicians, but to supplement them, he said. "We don't want to step on the toes of existing patient-physician relationships, but when you can't get to your own primary-care physician, we become an option for you," DePhillips said.
At another company, Boston-based American Well, video visits prevail, with 90 percent of clients seeing their doctor on a video link over a phone or computer, according to Amanda Guisbond, director of communications and public relations.
American Well has seen virtual-care visits triple in each of the past two years, thanks in part to big businesses embracing the technology, Guisbond said. Blue Cross Blue Shield, Bon Secours Health System and the Cleveland Clinic are clients of the company, which offers both telemedicine technology and services.
The company also offers consultations direct to consumers. Anyone, regardless of their insurance (or lack thereof), can see a doctor through the American Well website. The cost is $49 for a basic video visit, which some insurers will cover.
In comparison, a typical office visit for a sore throat or sinus infection costs between $130 to $180 (before insurance) at a Blue Cross Blue Shield of Massachusetts provider, according to that insurer's website.
The price of a telemedicine visit is attractive to consumers, most of whom are accustomed to paying $30 to $40 for an insurance co-pay, said Dr. Eric Topol, a California cardiologist who wrote a book about the changing dynamics in health care, "The Patient Will See You Now."
But equally important is the ease and speed of getting an appointment.
“It takes 2.6 weeks to get an appointment with a primary-care provider. Now you can do it in 2.6 seconds,” Topol said.
If telemedicine was slow to take off, it's partially because the health-care industry, as a whole, was among the last to go digital. It caught up between 2010 and 2015, thanks to a $30 billion investment from the federal government, part of the $700 billion stimulus package enacted in 2008.
“We’ve gone from a paper-and-pen industry to an electronic industry in a very short time,” Wachter said.
Still, telemedicine providers and insurance companies continue to haggle over payments, and some states are friendlier than others to telemedicine companies. (Arkansas and Texas are the worst, according to the most recent rankings compiled by the American Telemedicine Association.)
Medicare covers virtual doctor's visits only when the patient lives in an area the government says has shortages of medical professionals, or lives in a rural area. States set their own policies on Medicaid reimbursement, in what the Telemedicine Association calls a "checkered board" of coverage. And state medical boards have their own rules, too.
"Some states only allow telemedicine in situations in which an ongoing physician-patient relationship exists. Others require that a virtual visit occur by videoconference (rather than telephone or webchat), despite a lack of evidence regarding the optimal mode of virtual visit communication," the JAMA Internal Medicine report said.
None of this matters to Kelly Gutensohn, a Florida mother of 10 who found American Well's consumer service, Amwell, on a Google search in her laundry room at 6 a.m. last October. Ten minutes later, she had a diagnosis for pain that had plagued her for weeks — a sinus infection — and she had picked up a prescription before her local doctor’s office opened.
It was, she said, the “best medical experience I’ve ever had in my life," and Gutensohn said she will continue to use the service and pay for it out-of-pocket.
“I’ve never gone to a doctor’s appointment that didn’t cost me a whole morning. This was efficient and quick, no sitting on a cold table with your clothes half off,” she said.
'The emancipated consumer'
Telemedicine is still in its infancy, and at this point, is basically a video chat, said Topol, the cardiologist who is also director of the Scripps Translational Science Institute in La Jolla, California.
But that will soon change. “In the future, it will be a data-exchange platform. It’s rudimentary now compared to what it will be," he said.
For example, Topol has used his smartphone to take an electrocardiogram and diagnose a heart attack in the middle of a flight. Another time, he took a high-resolution ultrasound imaging of a fellow passenger’s heart to determine that the condition was not life-threatening and it would be okay to continue the flight without interruption.
One day, patients will be able to take similar readings of what's happening in their bodies and transmit them to their doctors through their computers or smartphones, making virtual visits even more effective, and helping to create what Topol calls “the emancipated consumer.”
But even as both doctors predict a significantly changed landscape for both health-care providers and patients, Wachter says there will always be waiting rooms and emergency departments.
“There will always be a level of sickness above which you still need to see a clinician working within an infrastructure that includes an operating room and a radiology suite,” he said.