David More wrote:
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<http://online.wsj.com/article/SB115490123782128151.html?mod=djemHL>_http://online.wsj.com/article/SB115490123782128151.html?mod=djemHL_
/*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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David,
OzDocsOnline have gone down a similar path, though their's is web
services or E-mail based, I think.
The difference to telemedicine, is that it usually has a clinician at
the patient end as well as the specialist at the other end. So the
'poking and prodding' Tim refers to can be done by proxy.
I wouldn't be keen to be a patient that way.
Greg
--
Greg Twyford
Information Management & Technology Program Officer
Canterbury Division of General Practice
E-mail: [EMAIL PROTECTED]
Ph.: 02 9787 9033
Fax: 02 9787 9200
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