Chris Lawton has an article in Thursday’s Wall Street Journal called (wait for it) Cough, Cough. Is There a
Doctor in the Mouse?
It’s a good general run down of American Well, TelaDoc & SwiftMD, which are the leaders in synchronous web-based care. Of course there’s also lots of asynchronous care going on online. In particular Kaiser Permanente has shown a huge amount of online communication between its clinicians and members, and RelayHealth has a similar service in which several health plans are paying doctors to communicate online with patients.
And this is all starting to come together and have an impact. The Health 2.0 Hawaii chapter will be having a meeting about this very topic on March 26.
Lets recognize the private market (BCBS Hawaii, American Well, Microsoft) for innovation in healthcare delivery and leadership.
The broader healthcare community will all learn from these efforts. The product / service will no doubt be refined as utilization grows and the feedback from the docs and the patients can be harnessed. If this service improves access to care, reduces cost (fewer unnecessary ER visits), and compensates physicians fairly, it will no doubt be adopted elsewhere, perhaps eventually by Medicare.
And I don’t see Medicare beneficiaries as the target patients. Electronic doctor visits will be adopted by those generations more adept at the Web 2.0 world.
There was a new CPT code in 2008 (99444 Online evaluation and management by physician). Unfortunately, Medicare does not consider this a covered benefit and does not price it in their fee schdule. Almost all large HMOS do not currently reimburse this code either. It is very difficult for physicians to move to providing more care via the web if their services are denied payment by most large payors. This is but one example of the glaring discrepancies is what get paid (often services of little or no benefit) while services that can save money (not having to take off work and drive to the doc’s office) are denied. Let’s stop rewarding HMOs for denying care and mandate that they pay for efficient services.