Katherine Restrepo , FORBES CONTRIBUTOR
"Thanks to telemedicine, a surge of medical professionals are effectively delivering health care to patients over long distances. Physicians are saving patients time and money by substituting an in-office visit with a virtual encounter via phone, tablet, or computer for common ailments. Hospitals are staffing “command centers” with specialty care teams who are responsible for monitoring sick patients in short-staffed rural intensive care units (ICUs).
More than 50 percent of hospitals are now caring for patients through various telemedicine initiatives and a majority of surveyed physicians are willing to incorporate it within their standard of care. Yet others remain hesitant to adopt telemedicine because certain services may not be reimbursed by private insurance carriers and government payers.
But health care providers like direct primary care (DPC) physicians aren’t letting fee-for-service payment policies dictate how they practice medicine. They’ve opted out of insurance contracts altogether, freeing themselves from the rigid structure of billing codes, modifiers, and prior authorizations. Instead, they contract directly with their patients, offering them around-the-clock access to primary care medical needs in exchange for an average $75 monthly fee. Phone calls, texts, e-mails, FaceTime, secure messaging platforms, and specialty consults – the most common uses of telemedicine - are included in a patient’s membership package.
Continuous Conversations With Patients
One of the defining characteristics of DPC is that these physicians keep their practices small so they can spend more time with their patients. Telemedicine further restores their physician-patient relationship by extending access to health care beyond the exam room.
“For a patient, life doesn’t happen in the confines of a brick-and-mortar doctor’s office,” says Dr. David Cunningham, a physician who opened a DPC practice in Massachusetts. “Communicating with patients throughout their lives can be very helpful for them. Telemedicine lets patients have that continuous conversation with their DPC physician…they have access to DPC from their pocket.”
Cunningham’s practice currently uses Spruce Health, a secure messaging platform that lets him correspond with his patients on inquiries ranging from which vitamin D tablet to buy to feedback on a diabetic patient’s reported blood sugars.
Platforms like Spruce include other features that improve physician workflow while keeping patients satisfied. For example, if a patient thinks he may have a sinus infection, he has the option to answer a pre-scripted questionnaire related to the diagnosis at his own convenience. Once completed, it is sent to be reviewed by the physician. This communication style not only caters to both the physician and the patient’s separate schedules, but it also provides for better documentation because the questionnaire and all physician notes are downloaded into the patient’s electronic medical record (EMR). Written documentation could lead to better patient adherence, given that patients tend to forget 80 percent of a physician’s verbal orders. Half of patients that do remember end up interpreting them incorrectly.
Another telemedicine benefit many DPC patients have access to at no additional cost to their membership are e-consults, or online consultations for specialty care. When physicians question whether their patient’s condition is beyond the scope of their practice, e-consults give them guidance to determine if specialist referrals are necessary.
Dr. Vance Lassey, a DPC physician located in Holton, Kansas, is a frequent user. “It's like paying a monthly fee for all-you-can-eat asynchronous curbside consults, which is really great, especially in rural areas like where I am,” he says.
For $250 a month, Dr. Lassey can seek medical advice on behalf of his patients from more than 100 different specialties through RubiconMD. The company guarantees a response time within twelve hours. Most recently, one of RubiconMD’s surgeons assisted him in removing a skin cancer from a patient’s nose. The patient, who was not financially secure enough to have it removed by a dermatologist, ended up saving thousands of dollars to have the procedure safely performed by Dr. Lassey.
While various health care professionals use e-consults, this form of telemedicine pairs exceptionally well with DPC. E-consults assist DPC physicians in fulfilling their value proposition that most health care needs can be thoroughly managed in a primary care setting. Because they can spend more time with their patients, e-consults are a tool to help them reduce the 40 percent of specialist referrals that could, in fact, be managed by a primary care physician.
Bypassing The Complexities Of Health Insurance Codes
The American Medical Association (AMA) is ultimately responsible for expanding the number of billing codes for virtual telemedicine services. Third-party payers can then decide which ones to include in the health plans they offer to policyholders. So, as the status quo waits on this process, the DPC model proves that practicing medicine is much more flexible when it bypasses the complexities associated with health insurance. DPC physicians can be creative with designing primary care membership plans that feature built-in benefits that patients will value – like telemedicine."