The troubling questions surrounding telemedicine


What I’m about to tell you is based on good insider information. But I also disclose that this is an amalgamation of a few reports of teledoc companies to me and their crony insurance companies, not a thorough analysis of the entire industry. I just assume there are other business models out there that look a little different, but I suspect the bottom line impact is about the same.

Most large insurance companies are now offering teledoc services to their employer customers. An employee for a company who is out of town on a business trip and starts to feel bad can call a teledoc and be virtually seen right away. While this might sound like a good thing at first glance, it raises many troubling questions.

The teledoc is a stranger to the patient. These doctors are often ER doctors making a little extra money on their off days. As I explained in the previous post, the quality of care for evidence-based treatments is awful, with every incentive in place for the doctor to do the wrong thing, i.e., prescribe antibiotics to demanding patients so that the doctor’s satisfaction score is maximized.

Why don’t these patients just call their family physicians? It’s very simple. The family physician is not paid for that work, but the teledoc is. This is an outgrowth of a flawed Medicare policy that says physicians can only bill for clinic work if they see a patient face to face. The insurance companies are not innovative. They just parrot the Medicare payment rules.

I believe Medicare has proposed a new fee for a doctor or his/her staff to call a patient for a telephone visit. I think the proposed payment is something like $14. How does this compare to the teledoc services? There are several different models. Some teledoc services cost $50 to $75 that the patient pays for the call. The insurance company gets about half of that. Other services are free to the employees or low cost. A capitated fee I’ve heard from several sources is that the insurance company charges the employer about $6 per member per month for the service and only passes along $3 of that to the teledoc company. Either way, and this is no surprise, Medicare wants to pay doctors a lot less than the market is saying the price should be. (And I just assume that the documentation/billing requirements for Medicare will be much more onerous than the private companies.)

Either way, the bottom line is that the insurance company is directly adding to its profits by undermining continuity and a long-standing family physician-patient relationship. Why do they do this (beyond the obvious answer of increasing profits)? It’s a combination of they are ignorant, and they don’t care about creating a more efficient health care system. They are ignorant of the decades of studies that find that increasing continuity is associated with better health, lower costs, fewer ER visits, etc. Or, if they actually understand these realities, but absolutely do not care about supporting a family medicine foundation for their customers.

A family physician colleague of mine who mostly works in ERs, and who occasionally signs up for teledoc shifts, says that almost all the calls to him are for patients with chronic diseases who ran out of the medicines, but who can’t be seen by their family physicians for weeks. What a stupid waste of the patient’s time and worry. When the feds and the insurance companies don’t support family physicians, this is what happens.

Richard Young is a family physician who blogs at American Health Scare.

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