By Megan Anderle
More than 800,000 online patient consultations will be provided this year, with upwards of 450,000 patients served, according to the American Telemedicine Association (ATA).
“Telemedicine has skyrocketed in the last year in this country and abroad,” Jonathan Linkous, CEO of the ATA, said. “We see it most commonly being used for primary care and mental health care.”
Linkous added, “It’s convenience that’s driving this trend. When you have a regular doctor’s appointment, you’re sitting in a waiting room for a good 45 minutes with other sick people before you see a doctor for a few minutes.”
That’s precisely where the idea for HealthSpot, which has 20 doctor video conferencing kiosk stations in pharmacies in California, Florida, Minnesota and Ohio, originated.
“While carting four kids to an endless array of sick visits, I created HealthSpot to offer an affordable alternative for health care to expedite the process for receiving care and to increase access to care for anyone,” CEO and founder Steve Cashman said. His company uses Dell desktop PCs, laptops, software, servers and storage products, and works with Dell OEM Solutions to deliver and support its products.
How does a HealthSpot visit work? When a patient enters the station, a doctor gathers basic information like height (the booth’s camera measures this) and weight (a scale is built into the floor.) The doctor will then instruct the patient to use tools such as a stethoscope, otoscope, magnascope, thermometer or pulse accelerometer depending on the ailment. The patient sees exactly what the doctor sees — if the doctor is using an otoscope, for instance, they can see the inside of their ear too. Visits, which cost $60 each, usually take 20 minutes. The doctor can send prescriptions to the *** instantly.
An on-site attendant is available to assist the patient throughout the session and sanitizes the kiosk after each visit.
Doctors can virtually diagnose ailments such as allergies, Bronchitis, the flu, earaches and ear infections, fevers, rashes, and sinus infections.
How patients feel about telehealth
Patients and providers have more eye contact through the medium as opposed to if the session occurred in an office, where the provider might be distracted by a computer. This has led to greater patient satisfaction, according to Dr. Theresa Lash-Ritter, MD, medical director of Cleveland Clinic’s Urgent and Express Care Clinics, which has partnered with HealthSpot to open five kiosks.
“We’ve had an overwhelmingly positive response,” she said. “Our surveys indicate 98 percent of patients who have used it would recommend it to others or return themselves. They love the convenience and that they get quality care.”
Other HealthSpot partners have reported similar findings, including Kaiser Permanente, which served 436 patients during its pilot from Oct. 2013 to July 2014. In surveys, 100 percent of patients said the quality of care at the HealthSpot was the same or better than care delivered at the doctor’s office.
HealthSpot is far from the first to offer this kind of service. Major players in the space include American Well and Teladoc, which offer 24/7 access to doctors over phone and video conferencing. The Veterans Association served more than 600,000 patients through its telehealth platform in 2013 alone.
A telehealth visit, which on average costs $40 to $50, saves an estimated $100 or more compared to an in-person visit, which can cost as much as $176, according to a study by Dale H. Yamamoto of Red Quill Consulting, Inc.
Meanwhile, providers are able to see more patients throughout the day by interfacing with patients over live video, which can lead to increased revenue. It’s an excellent option for people in rural areas with few local doctors as well as for people with conditions that require frequent follow-ups, such as stroke victims.
“Telemedicine helps to mitigate workforce shortages, supports community based access to care and reduces or prevents unnecessary travel for patients,” said Karen S. Rheuban M.D., director of the University of Virginia Center for Telehealth.
State telehealth laws
Many insurance companies, including Horizon Blue Cross Blue Shield, United Healthcare, Aetna and Cigna, have telehealth platforms or offer reimbursement. Almost every state Medicaid plan covers some telehealth services, and Medicare covers telehealth sessions in certain cases.
For patients who don’t have these insurance providers, however, only 23 states and the District of Columbia require that private insurers cover telehealth the same as they cover in-person services, according to the American Telemedicine Association.
“Reimbursement still remains a challenge in many states and limited Medicare and Medicaid reimbursement prevents the fullest integration into mainstream health care,” Rheuban said. “As we evolve reimbursement models from volume-based to value-based population health models, I expect we will see more ubiquitous use of telemedicine.”
Another issue that needs to be worked out is doctors providing care to patients in other states; medical boards require doctors are licensed in the states where the patient is located. Getting licensed involves significant costs — procuring multiple licenses may total up to $300 million a year, according to Linkous.
“We believe we ought to move to a reciprocity system where doctors won’t have to be licensed in all these other states because states would recognized that they’re already licensed,” Linkous said.
Licensure and reimbursement are the biggest obstacles to widespread adoption of telehealth. In terms of regulations, the only real restriction is providers can’t prescribe controlled substances such as pain medications during a virtual visit.
Otherwise, telehealth consultations are expected to increase significantly in the coming years.
“The future of telehealth is very bright,” Rheuban said. “We are seeing greater integration into everyday care delivery models, and a focus on patient safety, quality and population health.”