Peter, how do you read this mail? Do you get my top message first, or do you get straight to Greg's prior posting?
jh On Wednesday 09 August 2006 2:00 pm, Greg Twyford wrote: > David More wrote: > > __ > > <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 > > > > > > ------------------------------------------------------------------------ > > > > _______________________________________________ > > Gpcg_talk mailing list > > [email protected] > > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > > 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 -- MIKE: [gets a stare from Helen] I know what you're thinking, baby. And if I was the telly, you'd think I was talking in centimetres. _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
