TELEMEDICINE HAS
BEEN MOVING SLOWLY TOWARD ACCEPTANCE, BUT A NEW STUDY SHOWS THIS CONCEPT IS ON
THE VERGE OF TAKING ALL OFF AS INSURES AND EMPLOYERS BEGIN TO TAKE NOTICE.
Welcome to the clinicians roundtable on ReachMD XM 157,
the channel for medical professionals. I am Bruce Japsen, the healthcare
reporter of the Chicago tribune and with me today is Dr. Devon Herrick, senior
fellow at the National Center for Policy Analysis. Dr. Herrick is a healthcare
economist specializing in such issues as empowering patients, smart shopping
for prescriptions, Internet-based medicine, consumer-driven healthcare, and
innovative medical care providers. He has been quoted widely in the media. He
does also contribute his own articles as contributing editor of healthcare news
and his work has also appeared in Business Economics, Health Insurance
Underwriter, Washington Times, and the Journal Of American Physicians And
Surgeons and he joins us today from National Center for Policy Analysis offices
in Dallas, Texas.
BRUCE JAPSEN:
Dr. Devone Herrick, welcome to ReachMD XM 157.
Dr. DEVON HERRICK:
Well Bruce, thanks for having me.
BRUCE JAPSEN:
Well, it is great to have you here and I know that from time
to time this issue comes up in my reporting and I am sure in your analysis
relative to Telemedicine, so tell us where we are at and tell us about this
analysis that you all did and where we are headed and how this is becoming more
legitimate.
Dr. DEVON HERRICK:
Well, just think about it. I mean it seems like medicine is
the only area where we are not wired and connected as we are in all other areas
of our work life and home life. But, yet, a doctor does not really like to
talk to you on the phone because if you have insurance, often times your
insurance company may not want to reimburse for that. So, you can just think
what that means, that means I have to take time off from work, drive across
town, make an appointment well in advance, wait in a crowding waiting room,
just get the simplest question answered. So, this is a what is just moving
into the information age.
BRUCE JAPSEN:
And so tell us where a lot of physicians generally want to
know and certainly consumers would have a better understanding, where are we
with reimbursement. I mean, is it still kind of in the pilot stages or are we
seeing more commercial insurance, Medicaid and Medicare doing this.
Dr. DEVON HERRICK:
Well, it is a nearly stage just like in fact we began
outside of the third party payment system. But as insurance companies began to
see, well this actually was a very efficient way to provide care and the
patients like it and they were not actually increasing the cost by calling for
trivial reasons or substituting costlier office visits. I am beginning to see
quite a few insurance companies now at least to have pilot projects to try
this, I mean of course Kaiser Permanente, this is one was the first, now we
have various Blue Cross plans, I think Signa in some areas, I think Aetna some
areas have at least some plans to reimburse with this.
BRUCE JAPSEN:
And some of the good news there would be for consumers and
providers is that some of the folks that the insurance companies that you write
it off there are providing coverage. What kind of coverage are they providing
and you know how are they paying for this?
Dr. DEVON HERRICK:
See, it is typically a reimbursement that is between 25 to
35 dollars per a phone consult or an electronic consultation. I think really a
better idea will be if may be your physician, your personal and family
physician, would give you the choice that you can have an in-office visit or
you can have an e-visit for this things and they do not need to be in the
office to see the doctor in person.
BRUCE JAPSEN:
What would the phone consultation involve and would there be
a difference in cost? Because it would seem that perhaps the physician might
not have to take as much time and the patient would be able to save a lot of
money by not having to drive into the office and wait and all sorts of other
things.
Dr. DEVON HERRICK:
Well, absolutely, you know certain conditions are if you
just made followup care, maybe you want to get a couple prescriptions renewed
or a new prescription for something even on for a while or maybe you actually
have a chronic condition, but you could get lab test, have those send to your
physician and maybe talk to the physician on the phone and you know why do you
need to be there for every single visit and it is more efficient, for example I
can say a lot of places will reimburse 25 to 35 dollars which is far less than
the average in-person visit.
BRUCE JAPSEN:
That is real cost savings and would the Telemedicine could
be as simple as an Internet connection between a patient and a doctor, could be
something that they could do after hours or could you walk me through a
scenario here that would be pretty common for a physician and the patient.
Dr. DEVON HERRICK:
Well, if you are at Kaiser Permanente where they have
electronic visits, they would have a secure web server as part of their system,
but if it is say a phone consultation, then it might be a simple. For example
TelaDoc, I actually have access to TelaDoc through my health plan. Members
have to find it in advance so your medical history can be online so that
whatever doctor takes that call can actually review your medical history online
and you would call them and request a consultation easily within say 25-30, typically
less than an hour a physician calls you back and they can pull a few medical
records online, look at the medications you are on and then you can discuss
what your problem is, what your question is, and of course they would never
prescribe narcotics, but if you are out of town, maybe you had a start getting
a scratchy throat on the plane or you coming down with a flu, they might be
able to give you the Tamiflu or whatever. Would not replace your primary care
doctor, but it is a great avenue if you need access to a doctor quickly when
you are away from home.
BRUCE JAPSEN:
And tell me about the setup, I mean are physicians doing
this also outside of the insurance arena, are they setting things up and saying
"hey if you are insured or if you have extra money sort of the kind
concierge-type situation, is that going on and can doctors do that? I mean can
they just say "hey you know what; I am going to set up a telephone
consultation practice."
Dr. DEVON HERRICK:
I think that it actually began outside of the third party
payment system simply because, you know, an insurance company does not really
look for new ways of spending plenty of their money, but yeah there are doctors
doing that. For example Dr. Allen Depen that is in Virginia area. Few years
back, he changed his practice over to where, you know, of course you can still
go into the office to see him, but he realized a lot of times he did not need
to see you in the office and so it was the case that you expected to pay for
time and service, but it was much cheaper than say a traditional office visit.
In fact all you need is a prescription renewed, you can get somewhat like up to
5 prescriptions renewed for around 18 to 20 dollars.
BRUCE JAPSEN:
And he can do that all by an Internet connection or does he
do it over the phone.
Dr. DEVON HERRICK:
I think it is mainly over the phone, but he also has
e-mail. Of course the limitation is, you know, I am in Texas and I could never
call him because he is licensed in Virginia and of course we have all these
state laws where you cannot call across state lines and treat a patient.
BRUCE JAPSEN:
And so, do you see this elsewhere where some entrepreneurial
doctors may be doing this or is there even something legislatively that would
sort of allow this to be done a lot easier so you would have more of these
types of physicians outside of Virginia and elsewhere doing this.
Dr. DEVON HERRICK:
Well, I think there are physicians who are becoming very
interested in this and sometimes it is on a case-by-case basis where they have
a long-time patient and they just agree as you think, you can call up and you
know, I will charge for my time. Often times, it is as simple as that it is
not a reimbursement code, I am charging for my time even how much as you are,
but you pay proportionally for that time, and I really do think it is a great
idea and I have heard that some doctors are a little bit leery though because
there is always the concern about privacy and HIPPA and so on.
BRUCE JAPSEN:
Tell us kind of where this might be going. How do you look
at this in the future? When will all patients have access to this? Will all
doctors be interested in this?
Dr. DEVON HERRICK:
Well, I sure hope so. What I am seeing is that the younger
patients especially are demanding accessed to their physicians electronically
simply because they are used to texting their friend, so used to e-mailing
their friends and of course everyone has a cellphone now. Many doctors are
looking for ways of integrating this into their practice. You know of course
there are some that are a little bit worried, like I said earlier, about the
potential for privacy violations and things like that and of course there are
the factors of state borders limit the ability to call patients that are in one
state with the doctor's license to another state, but I think it will vastly
increase access to physicians, simply because we, you know, sometimes you get
sick after hours or on weekends, and there are physicians out there who would
be willing to talk to you on the phone on weekends, but they really do not want
to be in the office on the weekends.
BRUCE JAPSEN:
And some of these folks when they do do these Telemedicine consultations
or an Internet consultation, the cost could may be what, 25 dollars, something
like that?
Dr. DEVON HERRICK:
For example, I have access to TelaDoc, it is a 35-dollar fee
each time I call and if you think about your physician would not need to have a
waiting room nearly as large or an office nearly as large, so they save on the
overhead, they could actually be at home doing this from the privacy of their
home office. So, I think it is appealing to a lot of doctors.
BRUCE JAPSEN:
Can you figure the cost of gas getting to the office,
waiting in line, and I suppose if the physician knows the patient well enough,
they can figure out whether indeed they need to come into the office, just
based on the symptoms that they are being told.
Dr. DEVON HERRICK:
Well, I think it is especially important if you have a
family doctor that would offer this type of benefit. Of course sometimes you
need to be in the office, present to the office, be in front of the doctor, but
there are a lot of times that really just an inconvenient the doctor does not
need to physically have you in the office and could just talk to you on the
phone. They say that abruptly 55% of emergency room visits are for conditions
that really were not urgent or at least emergency. In many cases what happens
is someone, maybe their child get sick after hours on weekends and they really
just need information if this is serious enough to go to the emergency room.
If they could reach a doctor, the doctor could probably tell them whether this
is serious or may be this is not serious. So, I really think we could reduce
some of the unnecessary ER visits if people had access to a doctor by phone.
BRUCE JAPSEN:
You have mentioned Teladoc and you had said that I believe
they are one of the first providers online to do phone medical consultations
and their subscriber base has apparently taken off since January. Where are
they and what other companies are we hearing about this if physicians are
listening and consumers listening and they want to be a part of this?
Dr. DEVON HERRICK:
Well, I first talked with Teladoc about a year ago and they
were anticipating at that time reaching their millionth member sometime in the
fall, you know, of 2007.
BRUCE JAPSEN:
That is a lot of people.
Dr. DEVON HERRICK:
Yeah that is a lot of people with access to a doctor by
phone. When I talked to him, I guess it was in July or August to see if they
have increased that. They had increased by about 60% in about 8 or 9 months
and really now you know initially it was people who did not have the coverage
or the insurance company would not pay for it. Now, they are working with a
lot of health plans simply because health plans are beginning to see this is
something that might save an unnecessary ER visit or this is a benefit we can
give to patients and might be only slightly more than the regular cost sharing
and it might actually save a lot of money in terms of you get a quick answer to
your question as opposed to I got to drive across town, go see my physician,
spend maybe 100 dollars on various tests or what you have when really just a
simple discussion that last 10 to 15 minutes, the cost 35 will be more
efficient.
Well, this has been very interesting, so physicians and
consumers listening, this Telemedicine is certainly something that could very well
be a part of your health plan and your health coverage and something that your
doctor may soon be enrolled in. With that, I would like to thank Dr. Devon
Herrick who has been our guest. He is with the National Center for Policy
Analysis in Dallas, Texas. I am Bruce Japsen of the Chicago Tribune. I have
been your host and you have been listening to ReachMD XM 157, the channel for
medical professionals. If you have comments or suggestions, please call us at
888MD XM 157 and I would like to thank you today for listening.
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