Primary care physicians are a critical component of our healthcare system, dating back to the family doctor’s home visits in colonial times.
But in recent years, these physicians are pressed to care for an ever-increasing number of patients due to factors such as millions of newly insured Americans and an aging population. The Association of American Medical Colleges projects that by the year 2025, physician demand will outpace our nation’s supply by a range of 46,000 to 90,000. This projection includes a shortfall of 12,500 to 31,100 primary care physicians.1
As a result, patients often experience long wait times for appointments with primary care providers. The 2013 Massachusetts Medical Study revealed this state’s average wait time for a new patient appointment with a primary care physician is 39 days.2 When patients experience an urgent care need such as a minor sports injury or the onset of flu-like symptoms, they can be frustrated by such delays. But when the alternative is waiting at the hospital emergency department (ED) and possibly incurring more costs and testing, what should patients do?
One solution is the use of telemedicine for unscheduled, urgent care, which offers benefits to both parties. Physicians can practice medicine with the benefits of telecommuting, which offers flexibility and a less stressful work environment. In turn, patients can receive expert care while avoiding delays associated with making appointments, or the hassle and potential costs of visiting a hospital ED for urgent rather than emergent care needs. With this solution, though, comes providers’ responsibility to stay abreast of state telehealth regulations while adhering to best practices that promote better outcomes.
Video: A Critical Piece of the Telehealth Equation
While telemedicine seems like a good answer, its application – and therefore, its effectiveness – varies widely from provider to provider. Although state telehealth regulations vary, a prevalent theme is video utilization. Currently, 46 state Medicaid programs reimburse for some form of live video telehealth treatment.3
Video is a critical part of the telehealth experience for both physicians and patients.
For physicians, a video consultation gives them the ability to visually assess their patients. Through physicians’ extensive training, experience and skill set, they are able to draw conclusions based on their observations alone. Audio-only telehealth consultation removes this crucial component of a consultation, forcing the physician to rely upon what the patient says.
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For patients, a face-to-face visit can foster more meaningful interactions and help replicate a more intimate doctor-patient relationship achieved by in-person consultations. Much like the millions of people who use video conferencing to communicate with family and friends, physicians and patients can have a more in-depth and meaningful exchange via video.
This seemingly soft benefit is quite significant.
According to the telehealth guidelines established by the Federation of State Medical Boards (FSMB), if a doctor-patient relationship doesn’t already exist when using telehealth, a physician must take appropriate steps to establish one. FSMB outlines this relationship as a critical component of telehealth, stating, “The health and well-being of patients depends upon a collaborative effort between the physician and patient.” This relationship and collaboration are why numerous states require a video visit before a physician can prescribe medications.
Meeting HIPAA requirements and ensuring patient privacy and security requires different processes and technology for telehealth providers. The virtual nature of the physician appointment along with use of mobile technology requires an advanced level of privacy and security. In addition to the patient’s electronic records, audio and video sessions must be securely transmitted and archived, if retained.
A good example of how telehealth security differs is patient identification verification. Patients cannot be verified in persons with a physical form of identification as they would at a physician’s office. Consequently, telehealth providers must be able to identify patients in other ways.
In the telehealth world, the proper identification must be securely transmitted from a trusted party, which is typically the employer or its benefits administrator. Such information can be transmitted via a real-time EDI 27x session or an eligibility file. Confirming patient identification electronically is a telehealth best practice because it provides a high standard of security and privacy while also enabling the provider to determine patient coverage.
Diagnosis and Care Through High Clinical Standards
Just as telehealth regulatory standards vary widely from state to state, the level of care offered by telehealth providers is also varied. Some telehealth providers use registered nurses or physician’s assistants. Others use a variety of physicians, who may be board-certified in areas ranging from obstetrics to pediatrics. As telehealth evolves, the ideal board certification is emergency medicine. A board-certified emergency physician not only has exemplary skills at assessing and diagnosing the types of cases presented in an urgent care situation, but can care for patients with more complex conditions and easily determine if the patient requires additional treatment at a hospital.
Another best practice for telehealth providers is having a dedicated team of physicians rather than contract or temporary physicians. This model replicates the primary care provider model, where physicians are close colleagues and follow similar styles of clinical practice. This collegial relationship allows for a more consistent patient experience. Lastly, a close-knit team of physicians will feel more vested in the practice and can collaborate with leadership regarding how to improve service.
Keeping the Doctor-Patient Connection Paramount
With the advent of the Affordable Care Act, providers are incorporating more technology into their organization than ever before. These technologies can fulfill various strategic initiatives, but one vital component of the patient experience can never be replaced: the personal connection between a physician and patient. As telehealth emerges as a solution for unscheduled, urgent care, telehealth providers must not only comply with state regulations, but also employ the best practices that can help their physicians develop the optimal doctor-patient relationships. In turn, these relationships – whether for one patient encounter or 100 – can facilitate better outcomes and better patient experiences.
Andrew Wagner is chief medical officer at StatDoctors.
1. Physician Supply and Demand through 2025: Key Findings, American Association of Medical Colleges. Accessible online at https://www.aamc.org/download/153160/data/physician_shortages_to_worsen_without_increases_in_residency_tr.pdf
2. MMS Study Shows Patient Wait Times for Primary Care Still Long. Accessible online at http://www.massmed.org/
3. State Telehealth Policies and Reimbursement Schedules – September 2014,” Center for Connected Health Policy. Accessible online at http://cchpca.org/