Telemedicine is a tool: it is not a substitute for medical touch


Before the pandemic, it was vital to see doctors on platforms like Zoom or FaceTime when face-to-face appointments posed risks of coronavirus exposure. Insurers were forced, often for the first time, to reimburse all kinds of virtual medical visits and, in general, at the same price as face-to-face consultations.

In April 2020, a national study found, telemedicine visits already accounted for 13% of all medical claims compared to 0.15% the previous year. And the covid had not yet seriously affected much of the country. In May, Johns Hopkins ’neurology department was in charge 95% of patients visit virtually compared to just ten of those weekly visits the year before, for example.

Covid-19 left virtual medicine out of the bottle. Now it’s time to tame him. If we don’t, there is a danger that it will sneak into a pillar of our health care. Deploying it too widely or too quickly risks poorer attention, inequality, and even more outrageous charges in a system already famous for big bills.

The pandemic has shown that virtual medicine is ideal for many simple visits. But many of the new types of telemedicine promoted by emerging companies more clearly benefit the pockets of providers and investors, rather than providing more convenient, high-quality, and cost-effective drugs for patients.

“Right now there’s a lot of focus on shiny objects (ideas that look great) instead of solving problems,” said Dr. Peter Pronovost, a national medical innovation expert at the University of Cleveland Hospital Medical Center. who has written about the search for the value of virtual medicine. “We know very little about its impact on quality.”

Still, the financial world is full of investment opportunities. In the first six months of 2020, telehealth companies increase records of financing, with five start-ups each increase more than $ 100 million.

There are now telehealth applications targeted at specialty markets such as mental health of pregnant women. Others provide medications, such as HIV prevention pills, after a virtual consultation with their doctors. You can even make an eye digital appointment, meet with your dentist virtually to monitor your oral health and the evolution of orthodontics, and send the dermatologist a photo of a suspicious mole.

With telemedicine generously reimbursed, many practices offer: even encouraging – patients to visit virtually. But, intentionally or unintentionally, this choice becomes an income multiplier, which adds to the patient’s spending.

When he noticed a curious rash, a relative was first directed to the telemedicine portal for a consultation and billed him $ 235 for a five-minute video appointment. Because rashes are often difficult to assess in two dimensions, he was told he needed to see a doctor in person for diagnosis and was then charged $ 460 more for that visit. I’m concerned that pandemic-era reimbursement practices have received traditionally free selection calls and exchanged them for billed visits, with no added value.

In the future, some types of virtual tours deserve insurance coverage. Consider follow-up appointments to check your blood pressure or an arrhythmia, where measurements can now be collected at a pharmacy or at home and transmitted digitally to your doctor.

For most patients, face-to-face visits were needed largely because it was the only way a doctor could bill. But they are a colossal time and they are a difficulty for people with disabilities. After a head injury last April, when I still couldn’t drive, I appreciated some insurance-reimbursed virtual visits with doctors and physiotherapists.

But there are things that virtual medicine can lose, according to studies.

One study showed that commercial telemedicine services they were much more likely prescribe antibiotics for childhood respiratory infections than a primary care physician on a face-to-face visit. This is partly because, for example, if you cannot see in the ear to observe a pumped hype, it is safest to treat excessively, although it is contrary to prescribing guidelines designed to prevent antibiotic resistance.

An internist depresses the tongue and looks for pus in the tonsils to detect possible streptococci. A surgeon suspects appendicitis by pressing on the abdomen to see if there is pain with rapid release.

Can psychiatrists develop a therapeutic relationship with a new patient equally superior to Zoom? In some cases, for sure. But a better diagnosis of my own gait problems after the injury required visits to the office with practical maneuvers, such as checking my reflexes and feeling my joints move.

“There’s still real value in being in the same room, in contact, in the laying on of hands,” Dr. Pronovost said. Studies show that these interactions build trust, increasing the likelihood that patients will comply with treatment.

Telemedicine also raises new issues of equity. While it promises improved access to people in rural and underserved areas, video viewing requires high-speed Internet, which is less common among the groups themselves. Alternatively, will the poor get mostly telemedicine clinics (cheaper as no reception staff are needed), while people with good insurance have easy access to medical offices?

Insurers are already going back their willingness to pay before the pandemic for telehealth visits. And providers and insurers are fighting on reimbursement levels. Is a video call worth a doctor’s visit in person? If a commercial telemedicine-only physician determines that a patient requires a personal evaluation, is the fee discounted or waived? And how is a smart referral made if this telemedicine provider is thousands of miles away?

There are many things to solve and quickly, with scientific evidence and hopefully doctors push decisions. If we allow the market to make the choice, we risk preserving telemedicine services that make money for companies and providers (or save them for insurers) and lose those that benefit patients the most.

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