Telemedicine Offers a Convenient but Narrow Window of Care
Your next doctor’s visit could be through your smartphone.
In a world where convenience is king, telemedicine offers a stay-at-home experience for basic medical care. The service gives patients a chance to discuss their symptoms via video chat or email with a board-certified doctor for less money than a clinic visit.
Demand for the service is growing quickly. According to the American Telemedicine Association, more than 15 million Americans received some kind of remote medical care in 2015—a 50 percent increase from 2013. The trade group expects the number to jump another 30 percent in 2016.
Teladoc—the nation’s oldest (2002) and largest telemedicine provider—will “see” an estimated 940,000 patient visits this year. It’s easy to understand the appeal: no travel, no traffic, and little wait time. The whole experience takes about 30 minutes, according to Dr. Henry DePhillips, chief medical officer for Teladoc.
“People love the convenience, the technology, and they love the fact that the care comes to them, instead of them having to go find care,” DePhillips said.
Teladoc was originally available only to people who worked for a company that provided the benefit. In the last few years, however, major insurers are getting on board, and more are expected to follow suit, thanks to new state parity laws that require insurers to reimburse doctors who work remotely.
Compared to typical doctor’s fees, telemedicine is a bargain: The Teladoc fee is $45 a visit, and several competitors charge even less. But the service is only successful if patients use it, so providers do their best to make it cheap for consumers. DePhillips says companies who carry his service have very low or no co-pays “because they don’t want any financial disincentive for the use of the telemedicine benefit.”
Cigna and New York-based Oscar Health now provide coverage for Teladoc services, and Aetna is expected to join soon. However, when insurers pull their support, it can have a devastating effect on a company. Last year, when health insurer Highmark decided not to renew its contract with Teladoc, shares fell by more than a fifth.
Another big hurdle in the growth of telemedicine has been the widely varying state laws governing what conditions are ethically appropriate for remote doctors to treat.
After three years of deliberation, in June 2016, the American Medical Association (AMA) approved new ethical guidelines for telemedicine. The guidance aims to help remote physicians “exercise discretion in conducting a diagnostic evaluation and prescribing therapy, within certain safeguards.”
“What matters is that physicians have access to the relevant information they need to make well-grounded recommendations for each patient,” said AMA board member Jack Resneck, M.D., in a statement.
Technology can certainly improve the convenience of health care, but it’s still a long way from a virtual physician who can completely replace face-to-face doctor’s visits. Due to its remote nature, telemedicine can only provide a very narrow window of care. Hands-on services such as bloodwork, X-rays, surgery, or physical therapy are obviously out of the question. And care for chronic or complex diseases are out too.
According to DePhillips, Teladoc physicians will only touch “common, uncomplicated medical problems that are very easy to diagnose and treat.” These are conditions that people can typically figure out on their own: bronchitis, ear infection, and sore throat.
DePhillips says that patients with complex symptoms are encouraged to see a physician in person—but this only happens in about 4 percent of cases Teladoc receives.
“Influenza really lends itself well to telemedicine because there’s a very classic series of symptoms that can be accurately conveyed by the patient either telephonically or by video, that would lead you to be highly competent of the diagnosis. And the treatment is very straightforward,” DePhillips said.
Critics say that doctors peering at patients through their phones lack a critical eye, and can miss red flags that an in-person visit would be more likely to catch.
In a study published in the July 2016 edition of JAMA Dermatology, researchers contacted 16 telemedicine websites that offered services to California residents. They simulated patients using pseudonyms and submitted photos of inflammatory and infectious conditions for remote doctors to assess.
Among the 62 dummy cases, researchers found that most patients were assigned a clinician without any choice. Only 26 percent of the remote doctors disclosed information about clinician licensure, and some used internationally based physicians without California licenses. A diagnosis was given in 77 percent of cases, and most included prescription medication.
The big news of the study is what telemedicine missed. Researchers found that remote doctors had good batting averages when photos alone were adequate to make a diagnosis.
“But when basic additional history elements … were important, they regularly failed to ask simple relevant questions and diagnostic performance was poor,” the study said.
“Major diagnoses were repeatedly missed. … Regardless of the diagnoses given, treatments prescribed were sometimes at odds with existing guidelines.”
Even so, given America’s culture of convenience, and that so much of the modern medical model is geared toward the bottom line, the future looks good for telemedicine. Although services are limited, funneling all the easy-to-diagnose cases to remote physicians appears to save everyone enough time, money, and hassle to make for a potentially profitable business model, while easing the strain on the health care system.
Studies conducted by Teladoc have demonstrated that its service provides easy access to care at a lower cost, with higher customer satisfaction. Most importantly, access to telemedicine results in fewer unnecessary visits to the emergency room, where resources are thin and bills can add up fast.
“We estimate that we saved our clients $387 million in medical costs in 2015. That number will go up substantially this year after our business and volume continues to grow,” DePhillips said.