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Opinion |  Telemedicine is a tool.  Not a replacement for your Doctor’s Touch.


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

In April 2020, a national study found that telemedicine visits already accounted for 13% of all medical claims, up from 0.15% a year earlier. And Covid had yet to seriously hit much of the country. In May, for example, the Johns Hopkins Department of Neurology made virtually 95% of patient visits. There had only been 10 such visits per week in the previous year.

Covid-19 let virtual medicine come out of the bottle. Now is the time to tame it. If we don’t, there is a risk that it will stealthily become a mainstay of our medical care. Deploying it too widely or too quickly risks reducing care, inequalities and even more outrageous costs in a system already infamous for big bills.

The pandemic has shown that virtual medicine is ideal for many simple visits. But many of the new types of telemedicine being promoted by start-ups are more clearly benefiting the pockets of suppliers and investors, rather than providing more convenient, high-quality and cost-effective drugs for patients.

“Right now there’s a lot of emphasis on shiny objects – ideas that sound cool – rather than problem solving,” said Dr. Peter Pronovost, national expert in medical innovation at Cleveland University Hospitals Medical Center, who wrote about the discovery of virtual medicine value. “We know very little about its impact on quality.”

Despite this, the financial world is full of investment opportunities. In the first six months of 2020, telehealth companies raised record funds, with five start-ups each raising more than $ 100 million.

There are now telehealth apps that target niche markets like pregnant women’s mental health. Others provide drugs, such as HIV prevention pills, after a virtual consultation with their doctors. You can even make a digital eye appointment, virtually meet your dentist to monitor your oral health and orthodontic progress, and send a dermatologist a photo of a suspicious mole.

As telemedicine is generously reimbursed, many practices offer, or even encourage, patients to go virtually. But, intentionally or not, this choice becomes a revenue multiplier, adding to patient expenses.

When he noticed a curious rash, a relative was first directed to a practice’s telemedicine portal and charged $ 235 for a five-minute video appointment. Since rashes are often difficult to assess in two dimensions, he was told he had to see a doctor in person for the diagnosis, and then he was charged an additional $ 460 for that visit. I’m concerned that the reimbursement practices of the days of the pandemic took traditionally free test calls and rebranded them as billed visits, with no added value.

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

For most patients, in-person visits were necessary in large part because it was the only way a doctor could bill. But these are colossal delays, and for people with disabilities, they create difficulties. After a head injury last April – when I couldn’t drive yet – I was grateful for some insurance-reimbursed virtual tours with doctors and physiotherapists.

But there are things virtual medicine can miss, studies suggest.

One study found that commercial telemedicine services were much more likely to prescribe antibiotics for children’s respiratory infections as the primary physician during an in-person visit. Partly that’s because if you can’t see into the ear to observe a bulging drum, for example, the safest solution is to overtreat – even if this is against prescribing guidelines intended to prevent resistance. antibiotics.

An internist depresses the tongue and checks the tonsils for pus to check for possible strep throat. A surgeon suspects appendicitis by pushing on the stomach to see if there is quick-release pain.

Can psychiatrists develop a therapeutic relationship with a new patient as well as Zoom? In some cases, of course. But better diagnosing my own walking problems after injury required office visits with hands-on maneuvers, like checking my reflexes and feeling my joints move.

“There is always real value in being in the same room, in touch, in the laying on of hands,” said Dr Pronovost. Studies show that such interactions build trust, increasing the likelihood that patients will comply with treatment.

Telemedicine also poses new questions of equity. While this promises better access for people in rural and underserved areas, video tours require high-speed internet access, which is less common among these same groups. Alternatively, will the poor primarily have telemedicine clinics (cheaper, as no reception staff are needed), while those with good insurance will have easy access to doctors’ offices?

Insurers are already reversing their willingness at the start of the pandemic to pay for telehealth visits. And providers and insurers compete for reimbursement levels. Is a video call worth the same as a visit to the doctor? If a commercial doctor who specializes only in telemedicine determines that a patient needs an in-person assessment, is the fee reduced or waived? And how do you make a smart referral if this telemedicine provider is thousands of miles away?

There is a lot to be resolved and quickly, with scientific evidence and hopefully doctors guiding the decisions. If we let the market choose, we risk preserving the telemedicine services that make money for businesses and providers – or keeping it for insurers – and losing those that benefit patients the most.



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