Everybody’s Warming to Telemedicine

Tired of feeling sick but worried about the cost of a doctor’s visit? A rural Minnesota woman recently logged onto an Internet site run by NowClinic Online Care, a subsidiary of health insurer UnitedHealthcare, and “met” with a doctor in Texas.  According to Kaiser Health News, after talking with the physician via text message and by telephone, the woman was diagnosed with an upper-respiratory infection and prescribed an antibiotic.  .The doctor’s “visit” cost just $45.  “I was as suspicious as anyone about getting treated over the computer,” said the woman, who did not have healthcare insurance.  “But I could not have been happier with the service.”

NowClinic, which debuted in 2010 and currently operates in 22 states, is part of the upsurge of Web- and telephone-based medical services that experts believe is transforming the delivery of primary healthcare.  The movement gives consumers easier access to reasonably priced, round-the-clock care for routine problems — often without having to leave home or work.

Insurers such as UnitedHealthcare, Aetna and Cigna, and employers such as General Electric and Delta Air Lines are getting on board, advocating telemedicine as a way to make doctor “visits” cheaper and more easily available.  Proponents also see it as an answer to a deteriorating physician shortage.  Nevertheless some physician and consumer groups worry about the trend.  “Getting medical advice over a computer or telephone is appropriate only when patients already know their doctors,” said Glen Stream, president of the American Academy of Family Physicians.  “Even for a minor illness, I think people are going to be shortchanged.”

Carmen Balber, a spokeswoman for Santa Monica-based Consumer Watchdog, is concerned that lower co-payments will cause people to see doctors or nurses online just to save money.  “People will choose the more economical option, even if it is not the option they want,” she said.

Employers are getting mostly positive reviews.  “Our employees just love the convenience, the low cost and the efficiency,” said Lynn Zonakis, managing director of health strategy and resources at Delta Air Lines, which offers NowClinic for $10 a consultation.

The global telemedicine business is projected to almost triple to $27.3 billion in 2016, according to a report by BBC Research.  “Virtual care is a form of communication whose time has come and can be instrumental in fixing our current state of affairs within the healthcare system,” said Robert L. Smith, a family doctor in Canandaigua, NY, and co-founder of NowDox, a telemedicine consulting firm.  The field developed gradually over four decades as a way to deliver care to geographically isolated patients.  That’s changed over the past 10 years thanks to the development of high-speed communications networks and the push to cut health costs.  “It’s the wave of the future,” said Joe Kvedar, director of the Center for Connected Health, founded by Harvard Medical School.

Just one major hurdle remains: Many state medical boards make it complicated for doctors to practice telemedicine, particularly interstate care, by requiring a prior doctor-patient relationship, according to Gary Capistrant, senior director of public policy at the American Telemedicine Association.  “The situation seems to be getting worse, not better.”  He cited a 2010 ruling by the Texas Medical Board that effectively blocked a physician from treating new patients via telemedicine.  The sole exception is in cases where the patient has been referred by another physician who evaluated him or her in person.  “It’s about accountability,” said Dr. Humayun Chaudhry, CEO of the Federation of State Medical Boards.  State boards insist on licensing doctors treating patients in their states so that if patients are injured, they have a state agency they can go to for help.

“We want to enable telemedicine to flourish, but at the end of the day we want patients protected,” Chaudhry said.

OptumHealth, a UnitedHealth Group subsidiary that operates the NowClinic, said it leaves it to physicians to determine if they can diagnose a patient via computer.  “This is not intended to replace the intimacy of the doctor-patient relationship,” said Chris Stidman, senior vice president.  The company did not reveal the number of people have used the service or how many physicians it employs.

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