- Regulatory compliance: will Medicare rescind the telemedicine restrictions previously in place?
I assume you mean reinstate, not rescind (which means to take away, but you can’t take something away if it was previously in place, because it is no longer in place). This doesn’t seem like an argument to skip investing. Just one to watch. The landscape today is what we know and what is real. I wouldn’t invest hoping for regulation changes and this is the other side of that coin. I wouldn’t NOT invest because a regulation may come later when we have no evidence to support that it will.
Medicare preciously did not cover telemedicine calls. They stated they would pay on an emergency basis at the same rate of face to face office visits. Once the emergency is over, the lack of reimbursement will be resumed.
- Having to wait to wait until the patient gets onto the call. It maybsiund simple but going from room to room, and then stopping to check your virtual waiting room in your office is a hassle. Physicians are not paragon of efficincy.
I’ve seen this argument a couple of times and it doesn’t make sense. You have virtual waiting rooms (Zoom has them). If there is no one in the waiting room you skip the call, just like real waiting rooms.
Physicians usually have 3 exam rooms and an office with their computer in it. Some will have computers in each room that do not have internet capability (just intranet using thin clients). The exam rooms get filled and the doctor goes from room to room. Walking back to your office to check in on a patient will disrupt flow.
A lot of physicians have been using whatsapp to do face to face. Some are using doxy. These are fairly easy to use but don’t integrate well with many EMS. Doxy does have a premium feature that does integrate with some of the larger EMRs. So now you are asking physicians to pay to be able to see some patients at lower reimbursements.
- Inertia: doctors are very slow adaptors and rarely do something unless forced. These visits may have gone up while the pandemic was at its peak because there was no other choice. The alternative was not getting paid.
You can’t have it both ways. If they were already forced to do it due to the pandemic, then they have already adopted the tools. Slow adopters simply didn’t have visits. This is in the past, not the future.
Doctors were forced to pay rent and payroll, so they accepted telemedicine visits due to no revenue coming in. Medicare allowed FaceTime and whatsapp to be used on an emergency basis. They will not allow it once emergency is over.
- Documentation: sounds relatively simple but doctors are not sure how to document visits. This is important for payments and medicolegal justification.
Sounds like an integration or product expansion opportunity. If there is a need I’m sure it will be addressed. SaaS is great at this sort of thing.
Sure. But it’s going to be for those who continue to use it. And polls that doctors are using it dont account for the number of patients that they will see with it (I haven’t seen number of patients seen by those whom are still using it.)
- Reimbursement is lower than face to face. Usually by 10-20%. Why would a physician accept that?
I believe the assumption is that cost savings and/or patient acquisitions make up the difference. If these visits are more efficient you can do more of them. If you offer this and others do not you may win more patients and multiply the effect of efficiency. I know I would pick a doctor offering this over another. Regardless I would be shocked if a doctor couldn’t do 10% more visits in the same amount of time. Just guessing here but seems logical to me.
Your assuming that doctors don’t have a busy schedule as is. Doctors are not efficient. Sitting down and asking the same 50-100 questions lends itself to creating systems that can capture these questions on preprinted questionnaires. You can even further specialize each questionnaire based on symptoms. You can then have the entire intake done by nurses who can input everything into the EMR before the doctor enters room. You can also have the nurse fill out your assessment and plan based on symptoms.
You can even have all this done online prior to the patient showing up online at home. Even better, you can have AI that asks questions based on review of symptoms and create assessment and plans with labs & radiological tests to order before the patient is even seen. Physical exam is then inputted into computer to modify plan (which in adults is useful only 10% of the time).
This is all available now (except AI…IBM is working on it with Watson). How many here have had their doctors give online login to fill out intake history for a scheduled visit?
Doctors are very slow adopters. Those on teladoc now are docs trying to supplement their practice as it grows or slows down. Or the national specialist that deals with a rare disease.
- Medicolegal: will juries remember why we were doing telemedicine to begin with and why face to face visits werent offered. Because patients will.say they requested in person visit and doctor refused if something goes wrong.
I don’t get this one. Seems flimsy.
You would think so. Just finished reading an article explaining the importance of physicians to document that Covid is occurring now because juries will not remember the panic in 2-5 years. Found it ludicrous, but so many medicolegal cases are. The patient that says they wouldn’t have had surgery if they had known a colostomy was a rare possibility, but the consent form says understands risk of hemorrhage, paraplegia, blindness, and death.
Lawyers are creative.
- Physical exams: how are you going to do a gynecological or colorectal exams? Or listen to heart and breath sounds. Will patients forego face visits for convenience and clicial signs are missed?
I don’t see how this is different before, during, or after the pandemic.
Doctors weren’t doing telemedicine before the pandemic for this reason, they made an exception during covid, and will revert after it’s over. Most doctors want an exam documented every 3-6 months. (It justifies the higher level codes for reimbursement).
The biggest reason this won’t go back to the volume from before is that PATIENTS WANT IT and doctors who adopted it are more attractive now and know how to do it. I’m sure volume will subside a bit but how much is anyone’s guess. My guess is it won’t be all the way back. I can tell you I will definitely be seeking out a doctor with remote capabilities. I always hated the idea of giving up rest when I am most sick to travel to a waiting room where I sit with other sick people, suffering sitting up, just to be told there is nothing to be done; or given an prescription which then requires another trip. I’d rather stay home in bed and have a prescription delivered to me, if possible. I assume there are services that do this.
I appreciate this point. But telemedicine was available before covid and it wasn’t being offered. Those reasons haven’t changed.
Patients can demand, but they rarely pay.
Reimbursements have not gone up in over 20 years. The first thing a practice management consultant will tell you is to stop giving prescriptions and lab results over the phone or to charge for it. The amount of lost revenue on a yearly basis can be in excess of $20,000 per physician. Patients want the convenience of a prescription called in but they won’t pay for it. And neither will insurance. So doctors have patients come in.
Telemedicine might help bridge that gap. That’s the only usefulness I see with telemedicine. Capture lost dollars. But it all goes back to reimbursement.
I wish you luck finding a doctor that is forward thinking enough to provide those services for you.
Some state laws mandate exams before new prescriptions are given and once a year exam to refill a prescription. Anaphylaxcgic reaction to a medicine prescribed over the phone without an exam is a suit for your policy limits.
Medicolegal is a word:
med·i·co·le·gal. adjective. Of, relating to, or concerned with both medicine and law, as when medical testing or examination is undertaken for a legal purpose.