The Journal Gazette
Thursday, December 03, 2015 1:04 am

State joins national telemedicine trend

Sherry Slater | The Journal Gazette

Dr. John Shufeldt asks questions and listens carefully when he diagnoses patients.

That’s often enough, he said, to allow him to confirm common illnesses, including flu, sinus infections, sprains, rashes and bronchitis. But he does have another trick in his medical bag.

When necessary, Shufeldt asks patients to lean toward the camera, open their mouths and say, "Aaahh."

Shufeldt built MeMD on real-time, interactive doctor appointments using video technology. Founded in 2010, the Scottsdale, Arizona, health care provider now offers services 24 hours a day, seven days a week in all 50 states. 

Beginning this month, Indiana residents can go to MeMD’s website and pay $50 to consult one of its 300 doctors. The doctor must be licensed and practice in the state but doesn’t need to have an established relationship with the patient, according to terms of a pilot program approved in late April by the Indiana Board of Medicine. 

Before the pilot, which allows MeMD’s competitors the same access, state medical officials allowed virtual appointments only between doctors and patients they had previously treated in person. Officials expect to decide this fall whether to change that rule, based on results of the pilot.

Interest in telemedicine is steadily increasing as video technology becomes widespread and people grow comfortable using it. Convenience and savings are listed among its top selling points. The American Telemedicine Association estimates that about 450,000 patients will see a doctor through the Internet this year for a primary care consultation.

Last week, Walgreens said that it will offer a smartphone app that links doctor and patients virtually in 25 states by the end of the year. Blue Cross-Blue Shield insurer Anthem previously announced plans to make its own non-emergency telemedicine services available to about 40 million more people by next year.

After just five years in existence, MeMD has almost 1 million potential patients, based on contracts it has signed with employers. The service provider had conducted about 18,000 patient visits this year as of the end of June. Only about 5 percent of those visits were with repeat patients.

But even proponents acknowledge the option has limits. Anyone who suspects he’s having a heart attack or stroke needs to get to an emergency room, for example. And, of course, procedures such as biopsies and blood tests can’t be conducted virtually.

Skeptics wonder how a doctor could properly examine a patient by sight alone and how the patient would know whether an unfamiliar doctor was properly trained and certified. Professional guidelines also set strict parameters to ensure patient privacy.

Growing acceptance

This month, the American Medical Association is tackling even more ethical issues associated with virtual doctor visits during its annual meeting in Chicago. 

"Rather than a blanket prohibition against diagnosing and prescribing, a more nuanced and sustainable approach would permit physicians utilizing telehealth/telemedicine technology to exercise discretion in conducting a diagnostic evaluation and prescribing therapy within certain safeguards ... ," reads a portion of proposal.

The guidelines are necessary, AMA officials said, because of growing demand for the service. A recent survey found that 64 percent of participants would be willing to have a virtual doctor visit.

American Well, a provider of online medical care, hired Harris Poll to conduct a nationally representative survey last December. The poll of 2,019 adults found that at least 70 percent of consumers would rather have a live video visit with a doctor to get a prescription than go to their doctor’s office.

Doctors can write antibiotic and other prescriptions – except for controlled pain medicines – for patients they diagnose online. 

Video visits are considered ideal for older patients on maintenance medications such as prescriptions for diabetes and high blood pressure. A virtual chat allows them to avoid being exposed to sick patients in the doctor’s waiting room. The survey found the option is also embraced by parents with sick kids, especially when symptoms such as a recurrent earache strike in the middle of the night.

Even so, telemedicine isn’t widely available in northeast Indiana. The region’s two largest providers – Lutheran Health Network and Parkview Health – are monitoring the growth of virtual doctor visits and exploring potential strategies but aren’t offering them yet.

Geoff Thomas, Lutheran’s spokesman, said telemedicine’s potential "could be significant." Multiple people within the network are keeping close tabs on the latest developments nationwide.   

Eric Clabaugh, Parkview’s spokesman, said the local health care provider is evaluating the option.

"We want to meet our patients where they are, but we must also perform our due diligence to identify what is best for patients, not necessarily rush to do something," he said in an email.

Insurance benefits

UnitedHealthcare, a major health insurance provider, recently announced it is expanding coverage for virtual doctor visits.

Self-funded employer health plans can now opt for the coverage. Self-funded employers are large companies that pay claims from the pool of money they would otherwise pay to an insurance company. Many hire a company, such as UnitedHealthcare, to process the paperwork.

Next year, UnitedHealthcare will expand the virtual visit coverage option to employer-sponsored and individual plan participants, making it available for up to 20 million insured lives by the end of 2016.

Karen Scott, senior director of product and innovation for UnitedHealthcare, said employers and consumers have shown a growing interest in video doctor appointments in recent years.

Video interactions allow employees to save time spent driving to and waiting in a doctor’s office. Those are precious minutes – or hours – that can be spent at work or doing something else.

Cost also factors heavily into the demand. Care delivered for the same illness various widely, depending on the setting where it is delivered, Scott said. 

A virtual visit typically costs $45 to $50, she said. Get the same condition treated in a doctor’s office and the bill averages $80. Double that to $160 if you go instead to an urgent care center. And treating the identical illness costs up to $650 in an emergency room, Scott said.

How much a patient pays of that total bill depends on deductibles and an employer’s co-pay structure, she said. It’s a given, however, that employee groups with high medical costs one year can expect to pay higher premiums the following years. That in itself can serve as incentive to keep costs down.

Employers also have the discretion to assess lower co-pays for virtual doctor visits, Scott said. 

UnitedHealthcare officials are waiting to see how much money the insurer might save by making telemedicine benefits available. They realize some of the expected savings might be offset by more people seeking care based on convenience.

Still to come

Experts say telemedicine will become increasingly common.

Walgreens started testing its app last December on smartphones and is expanding it to both tablets and personal computers.

Anthem Inc. started its LiveHealth Online service in 2013 by offering it to a few thousand people. It now provides the service in 44 states and also expects 20 million of its customers to have access by next year.

Dr. Shufeldt expects such virtual doctor visits will become even more effective as patients invest in their own medical equipment. 

Some patients already have invested in their own stethoscopes – medical devices used to listen to hearts and lungs – and otoscopes – devices used to look into ears, noses and throats – that can be plugged into a computer’s USB port, he said. 

When combined with information from activity trackers, such as Fitbit devices, home medical devices can provide physicians with sufficient hard data to confirm various diagnoses, he said. Virtual diagnosis is quickly moving beyond just the information the patient chooses to tell the doctor, he said.

In the future, it might become common for patients to draw their own blood or collect urine and conduct instant analysis at home, bypassing a trip to a lab, he said.

Shufeldt, 54, said that as far back as the 1920s, people were imagining that someday doctors would be able to diagnose patients without seeing them in person.

In those early days, the theory was that the interaction would happen over the radio. 

It was just a matter of waiting for technology to catch up, to make those dreams a reality for a future generation of doctors.

Even so, Shufeldt said, "I never in a million years thought it would be me." 

The Associated Press contributed to this story.

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