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    The key to making virtual visits a digital success

    Ami Bhatt, MD, a cardiologist at Massachusetts General Hospital, had her first video visit three years ago, with a patient who lived on the island of Nantucket. The man, who had atrial fibrillation and a long surgical history, found it difficult to travel to Boston for checkups.


    Further reading: Virtual visits boost primary care outcomes


    Bhatt found it disconcerting to treat the patient remotely at first. But after a few video visits with him and his family, Bhatt discovered that she felt comfortable with the setup. The patient was able to come into the office for tests, she notes, but it was much easier for him to do the follow-ups from home.

    Since then, virtual visits have become a regular feature of Bhatt’s practice. She does two to seven of them per week—and some of her colleagues at the hospital have followed suit. 

    “The patient satisfaction for virtual visits has been through the roof,” says Bhatt, director of outpatient services for cardiology and head of the department’s telemedicine program. “And the physician satisfaction we’ve seen here has been great as well…Telemedicine is not a replacement for in-person visits, but it’s definitely an addition to our armamentarium of how to care for patients.”

    Telemedicine made a splash in the consumer space via services that let people consult with doctors other than their own from their smartphones. Now it is poised to sweep through major healthcare systems.

    While few private practice doctors are doing virtual visits with their patients yet, it is a trend they should be aware of, because the competition from hospital-employed doctors is about to get a lot more intense in some areas as the latter start using telemedicine.

    Here’s what’s happening in this burgeoning field, where it’s going and what independent physicians need to know about it. 


    Evolving landscape

    For decades, telemedicine was mainly used to connect patients in rural areas with specialists in metropolitan regions, using audio-visual equipment in their primary care doctors’ offices. 

    Later, as smartphones became ubiquitous, commercial telemedicine services—often contracted by employers or health plans—began to enable people everywhere to have video consults with doctors hired by the services. Patients often pay for this service out-of-pocket, but in 32 states insurance companies are now required to cover virtual visits, which cost $40 to $50 each.

    Healthcare systems that offer virtual visits usually contract with one of the telemedicine services, such as American Well, MDLive, Doctor on Demand and Teladoc. The healthcare system brands the telemedicine platform under its own name and may use its own physicians to provide virtual visits during some portion of the day. 

    At other times, a consumer who has downloaded the virtual visit app onto his or her phone or tablet will get one of the telemedicine service’s doctors.


    Related: Top 7 reasons physicians should consider telemedicine


    To a large extent, observers say, healthcare organizations are using these services to build market share by attracting new patients who may later make appointments for office visits or lab tests. Some healthcare systems are also marketing their telemedicine services to established patients, including employees. 

    Yet it’s unclear how fast virtual visits will spread. Joseph Kvedar, MD, vice president of connected health at Partners Healthcare in Boston, cites data from the American Telemedicine Association showing that there were 800,000 online consultations in 2015—a fraction of 1% of all outpatient visits. Even if that increases 50% a year, he says, it would represent a very small percentage of patient encounters five years from now.

    Internist John Jenkins, MD, chief clinical officer for connected health at Cone Health, a multi-hospital system in Greensboro, North Carolina, has a more bullish view. Within three to five years, he predicts, a quarter of Cone’s ambulatory-care visits will take the form of secure email consults or video visits.


    Options for private practices

    Small private practices often lack the technical infrastructure for telemedicine, and most commercial services are interested in contracting only with large healthcare organizations. 

    But one service, HealthTap, provides mobile apps with its concierge telehealth service, which enables independent physicians to perform virtual visits with their own patients. And American Well is starting to cater to doctors who want to add telemedicine to their private practices as a means of extending office hours virtually.

    Peter Antall, MD, chief medical officer of American Well, says early adopter physicians are performing a variety of tasks using telemedicine. Some practices are using it just to increase patient access. 

    This approach might spare some patients a trip to the ED, thereby reducing healthcare costs for which the practice assumes financial risk under certain contracts. Other practices have integrated it into their cash-only concierge models.

     In rural areas, certain specialists such as orthopedists are using telemedicine to cover geographically multiple emergency departments (EDs), he notes. 

    Private practice physicians can join the network of one of the commercial telemedicine services if they wish to earn extra money by doing virtual visits. All they have to do is apply on a service’s website, complete a credentialing application and take some brief telehealth training before being connected with the telemedicine platform to start seeing patients virtually.

    On average, they will make about $25 per visit. So the telemedicine services take nearly half of the $40 to $50 that patients pay for virtual visits.

    To perform telemedicine visits across state lines, physicians must be licensed in the state where the patient resides. However, the new Interstate Medical Licensure Compact, which so far includes 18 states, will soon make it easier to obtain licenses in other states. This compact streamlines the process of physicians applying for licenses in multiple states by having the medical board in their home state attest to their qualifications.

    Next: "I can take consults while driving in the car with my wife"


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