The virtues of virtual visits

Rush-Presbyterian Medical Center’s Virtual Integrated Practice (VIP) is more evidence that remote health care can improve health outcomes.

At Rush, a team has been refining the VIP model for the past four years. The VIP’s objective is to improve chronic disease management for older people by deploying aninterdisciplinary team using communications technology.

The main challenges in primary care for VIP’s target patient population are:

  • Multiple chronic problems
  • Polypharmacy
  • Physical disability
  • Functional impairment
  • Economic stressors

The Holy Grail here is that when these patients are optimally-managed, VIP can identify missed opportunities for primary prevention and avoid eventual disability.

As the population ages, more chronic conditions ensue. Traditional
institutionally-based care in hospitals and nursing homes is based on
synchronous, face-to-face care. VIP disrupts that institutional model by embracing a team-based, asynchronous co-located model.
Clinicians on the patients’ team interact in the medical record and
enhance ongoing team communication about the patient’s progress.

The VIP team consists of a nurse, a social worker/case manager, a
physician, a pharmacist and a physical therapist. Here’s the
"co-located" part: They’re in different settings, and they relate to
the patient at different times. But they’re coordinated via information
technology — the electronic patient record.

One of the most important lessons the team learned in its four-year
study is that patients expect the professionals on care teams to
communicate with each other. This is typically not a streamlined,
efficient or effective process in traditional primary care.

Toolkits are available here for several health issues: diabetes, nutrition, urinary incontinence/overactive bladder.

The study is funded by the John Hartford Foundation of New York.

Jane’s Hot Points: The critical success factor with VIP is that
the patient is at the center of the process. The team emphasizes
self-management training in all interactions, and establishes
monitor-able goals throughout the encounters. Messages are triggered to
team members and to adjacent professionals as needed, which may include
a nutritionist, an ophthalmology, or a podiatrist, for example. With
the patient as an integral member of the virtual team, outcomes are
improved. It’s not about the technology per se — which clearly enables
this concept — it’s the process: the right caregiver at the right time
using the right technology.

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2 replies »

  1. There are 4 new CPT codes for 2008 for “non-face-to-face Physician Services”: 99441, 99442, 99443 and 99444.
    The first 3 are for telephonic evaluation and management services not related to a previous E&M service, and based on time. CPT 99444 is for an online evaluation and management service using the internet or e-mail. Please note that Medicare and most insurance companies will not pay for these services when routinely billed by physicians.
    Sure, go ahead and do all the virtual visits you’d like, but don’t expect to get paid for them. But if you want to get paid, your patient needs to make an appointment, take time off work, drive to the MD office with gas at $4/gal, wait, pay her copay and let the doc bill an office visit code.
    Commercial insurers can’t pay for such services…they’re too busy giving $40 million comp packages or $800 million in stock options to their CEOs.
    When will employers wake up and demand an end to this craziness by commercial insurers?

  2. It would be interesting if the study provided the technological cost associated with the project. What was the ROI? What was the adoption rate of technology for disease management across the various demographics (i.e. young, old, lower, middle and etc.)?
    I would have also like to seen a comparative study where non technological driven methods of care (i.e. continuous health education and patient peer support groups) may have on quality outcomes vs. clinician and technology driven practices.