Tuesday Jan 22, 2019
We're Working to Make Sure Telemedicine Is Real Medicine
"Maybe someday your name will be in lights saying 'Johnny B. Goode tonight.'"
-- Chuck Berry
Like many of you, my first exposure to videoconferencing and digital interactions came via the Back to the Future trilogy.(www.youtube.com) Let's be honest, before Back to the Future II hit theaters in 1989, who would have ever imagined a world that included videophones, biometric personal devices or wearable technologies? Sure, there was The Jetsons, but that was a cartoon. Michael J. Fox's portrayal of Marty McFly, however, was very real and very relatable.
Thirty years later, we find ourselves on the leading edge of a digital transformation in health care that may well bring to life many of the technological innovations visualized in the Back to the Future films.
It is important to remember that the latest and trendiest Silicon Valley product or gadget likely isn't going to be the one item that transforms U.S. health care. However, each of these products contributes to an evolutionary process that revises and culls technology, ultimately producing products that are scalable in terms of impact and distribution. As technology becomes scalable, its real-world impact becomes clearer. This is the where we find ourselves today with respect to telemedicine and other digital health platforms.
In recent years we have seen an explosion in telemedicine-related policies and business lines. According to the Kaiser Family Foundation Employer Health Benefits Survey,(www.kff.org) 74 percent of employer-sponsored health plans covered telemedicine in 2018 -- up from 39 percent in 2016. A majority of states require parity between eligible health care services provided in person or via telemedicine. In the past two years, the Medicare program has expanded coverage for the following telemedicine services:
- virtual check-in,
- remote evaluation of pre-recorded patient information,
- interprofessional internet consultation,
- remote patient monitoring, and
- removal of originating site restrictions in end-stage renal disease and "Telestroke."(www.mayoclinic.org)
Now, I want to be clear that I do not subscribe to the whole "technology is going to replace primary care" mantra that flows from the technology venture capital crowd. However, I do think technology will alter primary care significantly, creating opportunities for greater connectivity and a more expansive scope of practice for family physicians. We know that a longitudinal relationship with a primary care physician is the one thing that demonstrably improves health for individuals and populations and most appropriately manages resource (money) utilization.
As delivery and payment models continue their progression away from being episode-based to being population-based, there likely will be an emphasis on the implementation of technologies that expand connectivity between patients and their family physician and primary care team. We are now in an environment where brick-and-mortar family medicine practices can add telemedicine services, which in return may allow family medicine practices to
- increase timely and convenient access to the practice for patients, creating stickiness/loyalty;
- provide a platform for co-production (patient compliance/engagement) of health care with your patients;
- facilitate continuity and coordination in a cost-efficient manner;
- generate revenue for the practice; and
- stop leakage of patients to urgent care, retail clinics or direct-to-consumer telemedicine platforms.
Now, I also want to be clear that I recognize there are companies, like Teladoc, that do not share my vision and are aggressively pursuing business models that are disruptive and appear to be based on maximizing encounters and profits versus providing continuous, coordinated and comprehensive primary care. Last fall, I went on a two-day Twitter rant about an Aetna/Teladoc mailer(twitter.com) that made a trip to a primary care physician sound worse than having a root canal on a boat during a storm. I am feeling much better now, but I am still strongly opposed to telemedicine being used as a point of entry into primary care. Telemedicine should be a resource that enhances continuity, comprehensiveness and capacity for primary care practices and their attributed patients -- not a direct-to-consumer platform or service. Period.
The AAFP will continue to be vocal in our opposition to the Snapchat-for-antibiotics version of primary care promoted by these companies, which are basically Tinder for health care. We should raise our collective voices in opposition to this purely transactional version of care.
One of the best ways to push back against this transactional, direct-to-consumer use of telemedicine is for family physicians to incorporate telemedicine into their practices. This is why the Academy launched AAFP Virtual Care last year. (Editor's Note: This program has since been discontinued, but the AAFP continues to offer members a plethora of information and resources on telemedicine and telehealth online.)
Posted at 06:00AM Jan 22, 2019 by Shawn Martin