As shutdowns have forced physician practices to close their doors, doctors are increasingly turning to virtual visits and the private market is responding with new technologies and service platforms.
Moving to virtual visits, or telehealth, has become easier since the Centers for Medicare & Medicaid Services removed federal payment barriers to virtual and telephone visits in an effort to support those practices and protect patients and health care workers from infection (see article on page 1).
Benefiting Public Health
Telemedicine provides public health benefits, says Darcy Bryan, M.D., an obstetrician and gynecologist at Women’s Care Florida in Tampa, Florida and a senior affiliated scholar with the Mercatus Center at George Mason University.
“In the face of a highly contagious disease, limiting the potential for the disease to spread by keeping the infected but mildly ill at home has obvious benefits,” said Bryan. “Telemedicine gives the patient access to a provider while limiting the spread of the virus by keeping the patient in the confines of their own home.”
Telemedicine is not just live video conferencing but also a conduit for transmitting medical images and data. It can be diagnostic as well as prescriptive, says Samant Virk, M.D., chief executive officer and founder of MediSprout, a telehealth platform for physicians and their established patients.
“It’s mostly diagnosis, but there can be treatment, too,” said Virk. “When you get connected to a doctor who knows you, they generally will know what your health condition is, whether it’s blood pressure, or a rash, or diabetes. If you connect with them remotely over the video and say, ‘Hey, this is happening; this is what I’m feeling; here’s what my blood sugar has been,’ the doctor can recommend treatment options for you, as well.”
Exploring New Avenues
Telemedicine can perform many services in addition to conversations between patients and their doctors, says Virk.
“Telehealth and telemedicine are words for remote health care,” said Virk. “When you say the word ‘telehealth’ and ask people what it is, you get ten different answers. It can be everything from virtual devices to a video call with a doctor.”
Virk says telemedicine can and should take new forms.
“It could be, like when you go to an Apple store and they have that whole section of healthy-living devices, those devices are considered telehealth devices as well,” said Virk. “Patients go home, they use them, their information gets pulled into a cloud account, and that information can be utilized for a variety of purposes.”
Making Reforms Permanent
Bryan says one of the biggest obstacles to telehealth until this point has been lawmakers’ and insurance companies’ use of outdated models and incorrect assumptions.
“The main barrier [had been] coming up with a good payment model,” said Bryan. “Primary care is already struggling with thin margins of profitability. Will insurance companies take the work performed by the provider remotely via telemedicine and heavily discount reimbursement? Probably, with the argument that a physical exam wasn’t performed so somehow the job was ‘easier.’ However, as a working clinician, I can testify that the cognitive and administrative workload is not less just because it is performed by videoconferencing.
“Payment models, such as direct primary care, should make integrating this technology possible and profitable,” said Bryan.
Bryan says there are other barriers governments could remove to bring down costs and improve access, such as rules requiring a third party be in the room during a video conference, restricting prescribing abilities of telemedicine providers, and requiring that the patient and doctor meet in person before a telemedicine visit.
Comparing to Online Banking
Virk compares the future of telemedicine to past consumer-friendly innovations by banks.
“The analogy I love to give is online banking,” said Virk. “Everyone used to go to the bank to do everything: cash checks, look at the bank statement, whatever. What the banks did was figure out which services people came in for that they don’t need to come in for, and they virtualized those so the services became more valuable and they could spend more time with their clients.”
Like online banking, telemedicine is consumer-friendly, says Bryan.
“It is flexible, mobile, and responsive to patient needs,” said Bryan. “A lot of health care is cognitive and procedural. You can come to some solid decisions without requiring an in-person physical exam, by taking a good history and knowing the right questions to ask to differentiate between a life-threatening problem versus a garden-variety problem and asking the patient to take their own temperature or blood pressure or count their pulse, if needed.”
Getting the Vitals
An innovation receiving renewed attention as telehealth expands is MedWand, a palm-sized recording device created in 2014 to help patients give physicians their vital statistics from home.
MedWand, which costs $399, can listen to the heart, measure heart rate and conduct an EKG, listen to the lungs and measure respiratory rate, measure blood oxygen levels, take the patient’s temperature, listen to the abdomen, look inside the nose, throat, mouth, and ears, and inspect skin for abnormalities, the company says.
In an April 8 interview, MedWand founder and CEO M. Samir Qamar, M.D., told Startup TV the coronavirus has made telemedicine much more important.
“We were forecasting that telemedicine for consumers may be adopted on a wider scale three to five years from now,” said Qamar. “Well, it’s been adopted. Everyone wants telemedicine; nobody wants to be exposed to this dreadful virus. And so, we have moved up our timeframe to consumers.”
Before the pandemic, MedWand Solutions had been waiting for FDA approval for its device. The company has since refiled that application under Emergency Use Authorization, made possible by the Trump administration’s emergency declaration.
Jesse Hathaway (think@heartland.org) is a policy advisor for The Heartland Institute. AnneMarie Schieber (amschieber@heartland.org) is managing editor of Health Care News and contributed to this article.
