Telemedicine—Ready or Not the House Call Goes Digital

Imagine you decide to go to the Emergency Department or even an acute care clinic right now. How far would you have to travel, what would you need to bring, what comforts would you leave behind for a harried, hurried trip to a waiting room? And just how much would this trip cost? On the other hand, how long would it take you to set up a FaceTime chat?

Instinct and data both tell us the emergency room is unlikely to offer convenience or savings. The average emergency room visit costs $2168, about twice as much as monthly rent and much higher than the $155 for a common acute care visit. Oh and patients wait on average 2 hours and fifteen minutes before being sent home.  The average telemedicine visit takes ten minutes to set-up and costs $40-50. So for the right patients, telemedicine can reduce total cost, cost per patient, and cost per visit with less time, staff, labs and diagnostics. The value proposition is bracingly obvious, if technology can manage to soothe the worries of patients and providers.

In the new world of telemedicine the Emergency Room could be saved for emergencies. The doctor’s office could be saved for new diagnoses or major decisions. Medication management, minor urgent care, birth control counseling, chronic disease monitoring and even specialty consults may all become easier, faster, safer. A recent survey by TechnologyAdvice Research found that 75% of people said they would trust a virtual diagnosis less than an in person one. On the other hand 65% said they would be comfortable with a telemedicine appointment if they had already seen the doctor in person. A similar survey, found that over 70% of patients would “strongly” or “somewhat prefer” to seek care online for minor medical issues, especially if it meant avoiding the Emergency Room.

And more importantly, many people who need care simply can’t access it. Right now people with the right insurance in the right location can access doctors. Unmet needs unbound in mental health, consider that the Department of Health and Human Services estimates over 4,000 mental health professional shortage areas, where there are over 30,000 people per psychiatrist. Not to mention, 10 million Americans have serious mental health disorders lined up against at most 40,000 psychiatrists.  Unsurprisingly, 1/3 of adults with “severe” mental illnesses like schizophrenia or bipolar disorder have received no treatment in the last year.  Telemedicine means psychiatric evaluation can happen everywhere. Secure video conferencing opens up access to care for patients secluded by geography or circumstances: prison inmates, the home-bound disabled, nursing home residents or the traveler.

Physicians stand to gain quite a bit too. Telemedicine offers flexibility, new revenue and new patients while saving office visits for more complicated cases. On many major networks, back-office transactions are all handled in the background.  Doctors see patients and get paid, while network software sorts through co-pays, deductibles, CPT codes and even malpractice coverage.  As much as many bemoan an impending physician shortage, too few have yet to embrace the possibilities of telemedicine.  Technology may help extend the supply curve. Telemedicine offers one way for physicians and other providers like nurse practitioners, physician assistants and other staff to reach more patients.  

Most importantly, good telemedicine will require good data. Currently, patient demand already outstrips the supply of physicians in offices, hospitals and emergency rooms. A recent survey by Deloitte predicts that one out of six doctor visits could soon become virtual.  Meanwhile, the use of devices, peripherals, and apps is growing at a vertiginous speed. According to InMedica, 1.5 million patients will be using wireless in-home monitoring for chronic conditions by the end of 2017. Practices with the ability to manage the demand and data seem poised to start answering the call and making eVisits.

William Rusnak, MD's picture

William Rusnak, MD

Medical Information Advisor

William Rusnak, MD (@RusnakMD) is a resident physician in diagnostic radiology, financial investor, writer, and entrepreneur. He writes about topics such as healthcare information technology, data science, biotechnology, and prevention of chronic disease. With his involvement in several emerging healthcare companies, he is actively attempting to bridge the gap between medicine and information technology.

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