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Wednesday Jan 06, 2016

Telehealth Is Family Medicine’s Next Big Opportunity

Perhaps, like me, you've noticed that telehealth really hasn't lived up to its promise here in the United States. Although you may find the technology in niche markets, like satellite hospital consultations, there is hardly a transformative, mainstream movement of consumer access to family physician services online or by smartphone. 

Yet the trends are unmistakable:

  • Estimates vary, but perhaps 20 percent of what family physicians do in the office could be accomplished remotely. I would even go so far to say that much of what is happening now in retail clinics could be safely performed as a telehealth visit. (Will retail health be disrupted next?)
  • Although the fee-for-service model has barely paid for telemedicine, the advent of new models such as direct primary care and accountable care organizations could create a sustainable funding source for services that were previously not paid for.
  • Regulators at the state and national level are continuing to modernize the laws around telehealth and telemedicine(www.ncsl.org) to encourage physicians to engage patients remotely within clear boundaries that are safe and have utility to consumers.
  • The proliferation of Bluetooth-enabled biosensors that can communicate with smartphones and sync data to cloud-based health information exchanges allow for remote monitoring of patients. These patients are empowered to decide with whom they will share that information. For some patients and family physicians, this might allow for a novel telehealth visit with vitals.

So what does the United States need to do to start participating more? Well, according to the American Telemedicine Association, we are about halfway there(www.americantelemed.org). State legislatures and policymakers must continue to remove regulatory barriers such as only requiring insurers to pay for telehealth for rural patients, because suburban and urban areas also have health care disparities and access problems.

Family physicians should not be required to document a barrier to an in-person visit before a health benefit plan covers telemedicine. And nothing should require the use of telemedicine when in-person care by a participating physician is available within the member’s geographic area, or when a family physician determines it is inappropriate. In other words, actual plan networks cannot be remote.

I am amazed at how many patients in this economy may have a tablet computer or a smartphone, but not an automobile. Moreover, just as we use Skype and Facetime with friends and family more than with strangers, I predict the strongest future for telehealth will be between family physicians and their long-time patients, not between strangers connecting to chat.

John Bender, M.D., M.B.A., is a member of the AAFP Board of Directors.

Posted at 05:04PM Jan 06, 2016 by John Bender, M.D., M.B.A.

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