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Virtual House Calls Can Cut Costs Without Hurting Quality of Care
August 8, 2006 Wall Street Journal - Columnist Dr Benjamin Brewer a Rural GP who does Obstetrics etc.
The doctor will see you now -- online.
The era of the virtual house call has arrived: More small practices are putting up Web sites allowing secure communications, online consultations and treatment for simple conditions for between $30 and $50.
My practice is one of them.
We receive several calls a day from established patients who want to avoid the hassle or expense of an office visit and are seeking free care for simple problems. Or sometimes they call with a good story and an urgent need when there's an hour or two to go in the day and all remaining appointment slots are filled.
Every office experiences some of this. Some put people off until the next day or send patients to the emergency room or urgent care center, which is expensive and inconvenient. Others do too much prescribing over the phone, with poor documentation of the nature of the patient's complaints or the decision-making that went on. Most offices do some of both, but they still don't get paid for free phone care.
The online office visit solves all of these problems for the doctor's office. It also means the era of free phone care is coming to an end.
We've had our Web site going for about a year now and while only about 50 of my patients have taken advantage of our online services, they seem to like them.
Currently, my patients pay $30 upfront for virtual office visits with a credit card. The software on the Web site takes a systematic and thorough history for any of more than 3,000 different complaints. I review the information and decide who can be treated online and who needs a face-to-face visit. Patients who are referred for office care are only charged for the standard office visit.
The histories these patients generate via the Web site might sound like a waste of time, but they aren't: They go right into their electronic medical records, so I have their information ready when they come to see me. Patients like not having to repeat the same story to the receptionist, the nurse and then the doctor. I like it because it saves me time and eliminates transcription costs related to summarizing and recording what the patient told me -- instead, I can just add some nuances I picked up while talking to the patient, as well as a key note or two.
Online patient registration and insurance updates are our most-popular Web-site features, followed by secure bill payment and prescription-refill requests. (We don't charge for simple email questions or for processing refill requests.) Patients will soon be able to access their own lab results and review their records online.
My oldest patient who gets refills online is in her 80s. She's a retired teacher who has some trouble hearing on the phone, and using the computer to communicate is easier for her. Another gentleman saved me at least 30 minutes of work by entering an extensive and elaborate past history that was accurate, comprehensive and in chronological order.
The online visits can also reveal things that a face-to-face visit might not. Some people find it easier to discuss certain conditions -- erectile dysfunction or incontinence, for instance -- with a computer than with the doctor. And sometimes people sitting there at a keyboard with their own thoughts give more-honest answers. Combine that with the software automatically adjusting its questions based on patients' answers and serious problems can come to light. I know of one doctor with a patient who started taking a computerized history because of a blood-pressure condition. The computerized questions, delivered in a nonjudgmental way, soon revealed that the patient was actively depressed and had a gun at home.
Offering services online has advantages -- but it brings challenges in getting paid. Many insurers don't routinely cover online visits. Neither do Medicare and Medicaid. I've had patients on Medicare and Medicaid use the Web site, but I have those patients come in for regular office visits, which Medicare and Medicaid do cover.
If online visits were covered, the potential savings from avoiding unnecessary ER and office visits would be enormous: I estimate that about 20% of the conditions seen in the family doctor's office could be safely and effectively treated with online visits.
Some doctors seem to think that if they don't see every case of male-pattern baldness in the office Hippocrates will spin in his grave, the physician-patient relationship will be forever torn asunder and we will all collectively go straight to Hell.
But online visits aren't designed to be fly-by-night prescription mills -- they're for established office patients I already know. There are conditions I'm comfortable handling online, such as erectile dysfunction, persistent athlete's foot, and some bladder infections in women. But there are also apparently simple conditions that I know I want to investigate face-to-face, such as ear complaints or problems kids are having -- I don't want the online visits to lead to overprescribing antibiotics.
And some objections to online visits ignore the day-to-day problems of office visits: Unfortunately, many patients can't get to their doctor's office for a simple problem in a timely fashion. And when they do get in, they pay more than they should because office overhead is too high and reimbursement for complex patients with multiple chronic diseases is too low.
Meanwhile, retail health clinics are springing up in a lot of places. These clinics are dedicated to treating simple problems quickly, and they're threatening to skim the easy patients and the easy money out of the office. For doctors, online visits are a way to keep this from happening. Two weeks ago I was in a CVS pharmacy in Seattle and noticed most Minute Clinic visits cost $59. My patients get online consultations for the same sort of problems for about half the price -- and they get them from their own doctor.
Cheers
David
---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] HealthIT Blog - www.aushealthit.blogspot.com |
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