Jake DiBattista

Welcome to Medical Economics' blog section 

which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by 

, a territory manager at SimpleVisit, a video service provider for physicians

 The views expressed in these blogs are those of their respective contributors and do not represent the views of 

	Time is money, and nowhere is this truer than in the world of healthcare.

Hot Topic: How do physicians care for the digitally isolated?

	One of the early advantages of using telemedicine is time savings. Both patients and physicians are utilizing video visits to be more effective with their visits and save time. This is because when compared head-to-head with patients who have the same needs, video proves to be faster than the in-person equivalent.

	Video visits are proven to improve the efficiency at which a practice operates and reduce time spent with patients without sacrificing quality of care. Video visits are effective in saving time because they combine charting with patient analysis, reduce late and missed visits, focus on information exchange and improve physician and patient availability.

More: Bill would expand Medicare patients' ability to utilize telemedicine

	While these numbers seem to paint a positive picture, it is important to evaluate how this reduction in visit times is actually occurring. Video visits allow physicians to work more efficiently with patients by combining a physician's ability to chart the visit while streaming a live video session, which enables the doctor’s attention to remain on the screen.

	In addition, video visits are usually restricted to follow-up or acute conditions that tend to have lower visit times; nevertheless, there are several other factors to explain why this time reduction may be occurring. Due to the convenience of video visits, patients will miss fewer appointments and are more likely to show up for their visits on time. Missed visits cause lost income and productivity for physicians and the practice, and late arrivals may cause physicians to run behind, thus delaying other patient visits.

Trending: The key to making virtual visits a digital success

	The average time a physician spends with a patient in America is 

 While many physicians feel pressure to increasingly reduce visit times, they are also challenged to balance patient satisfaction and quality of care with a sense of urgency to move patients through the process faster. Telemedicine is helping physicians with this challenge, to become more time efficient without sacrificing quality of care or patient satisfaction.

	On average, telemedicine physicians are seeing a reduction on visit times by about 20%, with the average visit time in one study being 

 While this may not seem like a significant improvement, upon further exploration, the implications are far more reaching. Let’s assume under the current model an efficient physician can process 28 patients a day, which represents four patients an hour for seven hours.

Popular online: Physicians - make health IT user-friendly to improve care delivery

	Another reason physicians see time savings is the focus on information exchange that occurs during video visits. Telemedicine visits tend to be much more focused than in-person visits, as the spectrum of care physicians can provide is limited to what they can only do remotely. Telemedicine visits are often focused around screening or maintenance of the patient, allowing the physician to focus on next steps rather than troubleshooting solutions during a visit.

Next: 'A more efficient and effective healthcare system'

	Lastly, physicians are able to offer expanded hours of availability when providing video visits. Whether it is seeing patients during their lunch hour or late from home on Wednesdays, with telemedicine, physicians have more flexibility to see patients due to the reduced barriers surrounding patient and physician location. This flexibility nets significant savings when a patient who had to cancel is suddenly able to attend their normally scheduled visit time or simply move their visit to an after-hour time via the power of video.

Further reading: The digital disconnect in post-acute care

	Now, let's assume that conservatively under telemedicine, a physician can see an additional four patients a day over video visits, with an average charge of $60 per visit. Over the course of a year, this process would net the physician an additional $62,000 in practice revenue. 

 found that a practice was able to save its patients nearly $3 million in travel costs over the nine years it had been offering telemedicine, with the average patient saving four hours per year in travel time. With financial benefits available to both patients and physicians, it is no wonder why telemedicine is in such high demand.

	A doctor’s time is invaluable, and the crisis of time is no longer an expense we can afford to waste on administrative duties or inefficient patient visits. Equally, a patient’s time should not be overlooked, as the transition to urgent care shows a growing consumer demand for on-demand care.

Hot topic: 5 ways to get the most out of an IT partner

	By improving the efficiency of a visit for patient and physician, we can transition to a system of care which is more patient-centered and empowers physicians to focus on treatment and diagnosis. The televisit is enabling visits to occur faster than ever before, and as a result, will produce a more efficient and effective healthcare system.

Articles

Time is money, and nowhere is this truer than in the world of healthcare. 

Is there a real time advantage to telemedicine?

Jake DiBattistaWhile leaders in healthcare are pushing for an 

 many providers on the frontlines have remained silent observers.

Why aren't more doctors using patient engagement tools?

 in four types of small practices located across the U.S. The survey was distributed among practice types that were identified as highly likely to be using telemedicine services: primary care, house-call only and concierge-care doctors.

	Phone interviews of staff and practitioners were conducted to dig into the rate of usage, and to discover which patient demographic benefitted the most from telehealth. All practices interviewed were independent practitioners in a practice of 10 or fewer total providers.

	The first provider segment interviewed were family practitioners, who have been viewed by many as a champion of telehealth and the first layer of healthcare for most patients. Telehealth feels like a natural fit for family practitioners, who must screen patients quickly and make a variety of diagnoses.

	It was discovered that a majority of generalists interviewed view telehealth as a key asset for elderly care. However, despite a clearly identified need, less than 20% of providers interviewed currently offered their patients video visit services. While a minority did offer telemedicine services such as phone calls, texting, emailing and e-prescribing, willingness to try video visits was limited.

	The second category analyzed was providers who primarily offer house-call services to patients. A fleeting concept, the house call was once the dominant mechanism of healthcare delivery in America.

	Considering the new age house call, telemedicine appears to be a natural fit for providers who stand behind convenient care. Surprisingly, house-call doctors had one of the lowest rates of adoption amongst the provider types surveyed.

	When questioned about why they would not adopt telemedicine technology, the most common answer was “I don’t find video visits as capable of doing everything I need for my patients during a visit”. While some cases did require special attention, over 80% of house call providers said that homebound elderly patients receiving routine maintenance would benefit from telemedicine technology.

	There appears to be a likely disconnect between the limitations of telemedicine and the services patients in this segment are in need of during a visit.

	Reimbursement is often indicated as a major barrier to telemedicine implementation. With this in mind, we wanted to study how concierge, or capitation and cash based practices are utilizing telehealth.

	Rates of interest in telemedicine utilization did not fall outside the expected range in comparison to all other practice types. Many concierge practices indicated small patient bases who expected a high level of quality in their care as the biggest barrier to engaging in telehealth.

	More than 50% of the practices that we interviewed identified that few of their patients would benefit from virtual care, and utilization among practices engaging in telehealth was extremely rare.

Virtual visits boost primary care outcomes

	The perception of reduced quality of care, as a result of video visits, seems to be a common misconception amongst practice types who choose to operate outside the conventional practice style of high-visit volumes with insurance reimbursement.

	Based on the results of the field study, there remains surprisingly low adoption rates regardless of the type of practice, even though 75% of doctors recognize that a portion of their patient base would benefit from telemedicine. Yet, the same group reported about 17% in current implementation.

Further reading: Top 7 reasons physicians should consider telemedicine

	The patient segment most often identified as benefiting from telehealth was elderly patients who struggle to make it in for regular appointments. Perhaps the rise in telehealth is coming for small practice providers, but we are still in the early phases of this adoption.

	1. The study, conducted by SimpleVisit, had a 24% respondent rate from a pool of 100 physicians-6 were generalists, 6 were psych, 6 were concierge, and 6 were house call.

While leaders in healthcare are pushing for an era of digital care, many providers on the frontlines have remained silent observers.

What are small practices saying about telemedicine?

Jake DiBattistaIt’s not easy being a doctor in such a transitional period of American healthcare. Practices are pressured with consumer-driven demands from a wider patient-demographic than ever before.

Baby Boomers (those born between 1946-1964)

 often get the limelight as they take center stage in the demand for healthcare services,

 millennials (those born between 1985-2000) 

continue to drive the future landscape of healthcare. Understanding the unique needs of both segments is crucial as providers attempt to execute lasting business plans.

	Expectations among millennial consumers begins and ends with the increasingly essential smartphone. A powerful tool in the pocket of over 85% of millennials, the smartphone is too important to be ignored. When designing healthcare for millennials, it is key that physicians keep in mind solutions that engage users through the device that is at the center of their universe.

Top factors internal medicine residents look for in a job

	Mobile applications are at the core of a user’s smartphone experience. Research shows 69% of college users currently monitor their sugar intake and 66% of users monitor caloric intake using such applications. Healthcare providers would do well to utilize mobile applications as an extension of their care plan. Mobile applications are often free or low cost to download, which makes it convenient for both patients and providers to test and implement these accessible tools as a means of care.

	In a world of likes and favorites, it is easy to see just how important social engagement and approval has become in the age of millennials. It is now easier than ever to connect individuals with communities across the world, and healthcare is not immune to this phenomenon.

	Millennials are flocking to anonymous online chatrooms, such as healthfulchat.org, to bond and discuss the diseases and conditions affecting them among like-minded peers. Guiding millennials to these online communities can be another powerful tool for providers.

	When offering care to millennials, providers should keep in mind the role peers can play in influencing lifestyle choices. Eighty two percent of millennials tend to favor word of mouth from friends, family and social media when they're deciding what to buy, so if providers can focus on the social communities online that influence millennials the most, they can net a much larger impact when trying to implement lifestyle changes.

	A guiding trend in the next generation of healthcare is its unique integration with the workplace. There is nothing new to employers who pay for healthcare. What is new, however, is employers being a provider for healthcare. Large corporations are embracing the cost savings of offering healthcare in-house with 60% of the nation’s large employers now offering medical coverage for telemedicine, as of 2016.

	Understanding the role of workplace care for everyday checkups and ailments, patient preferences will be increasingly important as physicians carry the load for reducing costs and maintaining their patient population’s health. By intervening and providing care that millennials can access without missing work, providers can assure that they are delivering care to patients who cannot afford to miss a day at the office.

Next: Next time you see a patient, think about what their population's unique needs

	Regardless of generation, there is an abundance of information and services now available to patients. More than 70,000 websites disseminate health information. In excess of 50 million people seek health information online, creating a healthcare environment that is plagued by those who have a perceived doctorate from WebMD.

	When designing treatment and care plans in the modern age of care, whether your patients are old or young, it is important to carefully explain and be open to questions they may have from their searches across the vast sea of health websites and blog posts.

	While communication through the smartphone is redefining how providers care for millennials, Baby Boomers continue to demand a high amount of traditional feedback and guidance. Proper communication has been so lost in the recent shift to digital medicine that among all patient demands, a doctor that actually listens ranks the highest in patient satisfaction.

	This demand is amplified when it comes to Baby Boomers who will often have multiple providers and conditions compared to their millennial counterpart. Allowing Baby Boomers to use tools such as video visit technology, will give them more time and improved access to ask questions and express their concerns with providers. By increasing channels of communication and provider access, you can help improve treatment compliance and patient satisfaction.

	While millennial care is characterized by large online social communities, the Baby Boomers most often find support from those in their family. Figuring out new ways to engage and involve the family can help Boomers to improve their health and better understand their care plans.

	Providing patients with a caretaker that works online with the family in real time is a new approach that is shifting the landscape of care, so that family members are more informed and involved with day-to-day care. As a provider, making small steps, such as emailing visit notes to family members, can go a long way in improving the quality of care one receives after they leave the office.

	Trying to loop in and engage the families can be made easier through the use of video technology, which allows multiple parties to connect with the provider from across geographic locations.

	Moving care to the home is perhaps the biggest challenge in developing care that works for the Boomer population. As longevity of life continues to expand and this population continues to age, we can expect to see an increasing demand in the spectrum of elderly care, with a smaller and smaller pool of the population working to to pay for it.

	Due to this increase in demand and limits on payment and supply, we must shift how we think about care of the Boomers to be more at home and lifestyle focused. For home-based care, many of the principles listed before will help to ease in this transition, such as improved and new channels of communication or leaning on the family more heavily to support care.

	Developing care plans that work inside the home are critical in order to control the increasing patient flow and will lead to a reduction in the cost of care, while improving patient satisfaction.

	In conclusion, whether you are designing care for the patients of the future or just trying to figure out how to manage an aging population, the same core principles apply. Good communication and relying on the support of others can go a long way.

	So the next time you see a patient, think about what their population's unique needs are and how you can adapt to make sure they are happy and taken care of, be it engaging through the smartphone or communicating the visit to the patient's family and caretakers.

It’s not easy being a doctor in such a transitional period of American healthcare. Practices are pressured with consumer-driven demands from a wider patient-demographic than ever before.

Author | Jake DiBattista

Articles

Is there a real time advantage to telemedicine?

What are small practices saying about telemedicine?

Designing healthcare in the age of millennials, Baby Boomers