Brian Miller, MD, an ED physician at Cone Health, does virtual visits for MDLive in his spare time, taking calls from patients in both North Carolina and Texas, where he is also licensed.
“I can take consults while driving in the car with my wife; I can take them while sitting home watching a football game. It’s very convenient for the provider,” says Miller.
Each of these visits, he says, averages 7-10 minutes. In total, they generate a significant amount of additional income for him. Between 5% and 10% of the patients have problems that are more serious than he can handle in a virtual visit. In those cases, he tells them to visit the ED or an urgent care center or see their own doctor.
American Well and HealthTap offer mobile apps that enable doctors to conduct video visits with their own patients.
But even if physicians set aside time for such visits, “the nature of many telehealth visits is on-demand,” notes Jennifer Gingrass, MS, a healthcare consultant with ECG Management Consultants. “You can’t have a physician who has patients who are seeing him in person and have people waiting for him or her to log on when they’ve got other patients in their office.”
Antall disagrees. By using a platform like American Well, he says, patients can make an online request for a visit and can wait in a virtual waiting room so that doctors can see them when they have the time.
Overall, he points out, there is a lot more that goes into a video visit with a patient than using Skype or video chat on a doctor’s computer or smartphone.
Besides the appointment and waiting room features, he says, a telemedicine service supplies workflow features such as having patients document their current symptoms and medical histories in advance, opening and closing visits, post-visit documentation, claims submission, direct billing of patients and providing notices of what kinds of symptoms are appropriate for a virtual visit. The platform is also secure, unlike ordinary video chats on smartphones, he notes.
Efficiency, quality and liability
Kvedar says it remains unclear whether virtual visits promote efficiency.
“It separates you [from the patient] in place but not in time, and the amount of time I have to deliver care is fixed,” he notes. “If you sat me in front of a computer for the time of a virtual visit, I wouldn’t be any more efficient than I would be if you came into my office.”
However, he says, there is evidence that virtual encounters can reduce the number of ED visits. That saves money for payers and can also enhance the bottom line of healthcare organizations that are at risk for the cost of care, he says.
More to the point for private practice doctors, virtual visits make it more convenient for patients to receive treatment. Not only can this enhance patient satisfaction, it can also increase the likelihood that people with medical problems will seek help.
Many patients who initiate virtual visits would not otherwise have seen a doctor, notes Robert Fortini, RN, MSN, chief clinical officer of the Bon Secours Virginia Medical Group in Richmond, Virginia, which is offering video visits to a small cadre of Bon
Secours physicians and nurse practitioners.
“Telemedicine is valuable, especially if you’re capturing an audience that would otherwise be noncompliant,” he says.
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Whether or not a virtual visit can provide the same quality of care as an in-person encounter is a matter for debate. Kvedar cites a paper by a dermatologist who found a “staggering lack of quality” and missed diagnoses in video visits.
In Kvedar’s view, there are strict limits to what doctors can do in virtual visits, even for minor acute problems, so patients are trading quality for convenience.
Jay Sanders, MD, a consultant who is also the founder and the former president of the American Telemedicine Association, agrees, noting that diagnostic testing is impossible in virtual visits.
However, he adds, that may soon change with the adoption of devices such as portable stethoscopes and portable EKG devices that work with smartphone apps. Already, a wide range of exercise apps and related devices provide data on heart rate and activity, he adds.