The idea of web-mediated virtual patient visits is so logical that I am constantly amazed that the deployment of this technology is not more widespread (see: The Virtual Visit May Expand Access to Doctors). A recent article about this topic was worrisome but for an unexpected reason. Below is an excerpt from it:
Americans could soon be able to see a doctor without getting out of bed, in a modern-day version of the house call that takes place over the Web....OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic, a service that connects patients and doctors using video chat, nationwide next year. It is introducing it state by state, starting with Texas, but not without resistance from state medical associations. OptumHealth believes NowClinic will improve health care by ameliorating some of the stresses on the system today, like wasted time dealing with appointments and insurance claims, a shortage of primary care physicians and limited access to care for many patients. But some doctors worry that the quality of care that patients receive will suffer if physicians neglect one of the most basic elements of health care: a physical exam. “This is a pale imitation of a doctor visit,” said David Himmelstein, a primary care doctor and associate professor at Harvard Medical School. “It’s basically saying, ‘We’re going to give up any pretense of examining the patient and most of the nonverbal clues that doctors use.’ ”Others, including Rashid Bashshur, director of telemedicine at the University of Michigan Health System, say online medicine is a less expensive way of providing routine care.“The argument that you need the ‘laying on of hands’ to practice medicine is an old and tired argument that simply has no credibility,” he said. “There are two constants in medicine: change and resistance to change.”....For $45, anyone in Texas can use NowClinic, whether or not they are insured, by visiting NowClinic.com. Doctors hold 10-minute appointments and can file prescriptions, except for controlled substances. Eventually they will be able to view patients’ medical histories if they are available.The introduction of NowClinic will be the first time that online care has been available nationwide, regardless of insurance coverage.
I, like Rashid Bashshur, am tired of the constant whining from physicians like Dr. Himmelstein about the "impracticality" of virtual patient visits. Here's a pop quiz designed specifically for him. When a plumber comes to your house to repair a leaky pipe and opens his tool box, how many different tools do you think that he will bring with him? [Answer: Many] That's right, Dr. Himmelstein. There are various tools designed specifically for various tasks. The virtual patient visit is certainly not suitable for a new patient with multiple acute problems and who will certainly require a physical examination and close attention to non-verbal clues. However, when such a patient is stable and needs a drug refill or has a minor problem, a virtual visit may save both you and the patient time and trouble. Please don't set up a straw man argument that you can then easily refute.
Now, Dr. Himmelstein, if you really want to get nervous, think for a moment about entrusting UnitedHealth and its subsidiaries, OptumHealth and NowClinic, with the responsibility of managing a large number of patient encounters, virtual or otherwise. This is a company that has been caught before misusing clinical information for its own financial gain (see: UnitedHealth Settles Suit with New York Attorney General Cuomo). Here's an excerpt from that note:
As a health insurance company, [UnitedHealth] was required to reimburse its policy holders about 70-80% of the local "usual and customary" costs of out-of-network medical services. However, it turned out that UnitedHealth also owned the database company, Ingenix, that was developing and maintaining the databases that were used across the health insurance industry to determine the level of these usual and customary costs. And guess what? It was setting those levels inappropriately low in order to reduce the amount of money required to reimburse claimants.
As a result of this settlement, United agreed to pay $50 million to fund a nonprofit organization to create a new, independent database to replace Ingenix’s and “educate health care consumers more directly about market prices for health care services.” So we now have a situation in which NowClinic, and its parent UnitedHealth, will be responsible for delivering direct patient care and have ready access to complete patient histories. This should provide some interesting new opportunities for UnitedHealth. I hope that the New York AG Cuomo is paying attention although he may be the governor of the state before much happens.
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