CVS, the largest drugstore chain in the USA, has announced that it is expanding its telemedicine program by working with three of the largest telehealth companies, American Well, Doctor On Demand, and Teladoc.
Before 1950, American doctors used to make house calls, coming out to visit their patients at home. Telemedicine offers the next best thing in the modern era, by providing a Skype or webcam connection with a physician from a convenient location such as a corner drugstore.
The giant drugstore chain CVS, with "Minute Clinics" staffed by nurse practitioners in 7,800 locations nationwide, will start offering video connections to doctors in almost all of its stores in 2016. Not everyone, however, thinks this is a good idea.
How Telemedicine Works
Let's suppose you wake up at 3 in the morning with a puffy face and pain around your nose. You had sniffles earlier in the evening, and you think it might be sinusitis. You can't get an appointment with your primary care provider for at least two weeks. If you haven't met your insurance deductible for the year, that can cost $200 to $500. You could get up, get dressed, and drive to the minor emergency center, but that would take several hours and cost at least $100 to $200 that your insurance won't pay. You could go to a hospital emergency room, but you would probably have to wait for hours, maybe eight or more hours, and the bill would run well over $1,000. On top of all that, there's no one you can call to take care of your kids.
Instead, you power up your laptop and log into Skype. You request a virtual consultation with a doctor, after you give a credit card number to the doctor's service.
A few minutes later, you have a diagnosis of sinusitis and the doctor has already faxed a prescription for antibiotics to a nearby all-night pharmacy, which will have your medicine waiting when the kids wake up. Your cost? Just $50.
The Advantages Of Telemedicine
Many tech-savvy patients love telemedicine. You don't have to leave your home. You don't have to get dressed. You don't have to sit in a waiting room where you can catch something from other patients. You don't have to make an appointment, and the whole procedure is over in just a few minutes.
Many doctors favor telemedicine, too. Because they don't have the cost of office rent, a receptionist, or nurses, they can make money even though they charge much less for a virtual visit. They can work anywhere they can use their tablet or smartphone. Moreover, they have healthier and happier patients because they get their treatment faster. However, not every doctor is in favor of this rapidly growing system.
Less Expensive Per Visit, But Not Necessarily Lowering Total Medical Costs
One objection to telemedicine is that it just seems less expensive. One telemedicine provider, Seattle-based Carena, which employs 17 physicians and nurse practitioners who see patients in 11 states, says that the most common diagnoses are urinary tract infections, upper respiratory infections, and pink eye. Corporate bean counters say that people would otherwise just stay at home and deal with problems like this, so online treatment is more costly. Medicare, in particular, has objected to the cost of online providers.
Telemedicine: Is the Doctor In, Or Just Online?
A more serious concern is that the doctor doesn't get the same kind of information from an on-line interview as from seeing the patient in person. It's nice that doctor doesn't have someone knocking on the door and saying, "Doctor, we need you in another room," but there's something impersonal about a doctor diagnosing a patient from a computer screen.
Many doctors, especially older doctors, will tell you that diagnosis begins before the doctor and patient begin to talk. The doctor may notice how the patients conduct themselves in the waiting room, how they walk into the examination room, whether their clothes are clean or dirty or their shoes are untied.
There is value to feeling a pulse or a rash or a bump or a pulled muscle. Just being a trustworthy face on a screen, a large number of physicians insist, isn't enough to establish a relationship of trust.
Legal Limitations On Telemedicine In Some States
Many healthcare providers are a little slow to stick their toe into the waters of telemedicine. The Mt Sinai Healthcare system in New York City is offering televisits only to established patients. The Jefferson Hospital system in Philadelphia restricts telemedicine exams to follow-up care after in-office visits to internists, urologists for urinary tract infections, and ear, nose, and throat specialists. The Mercy Healthcare system in St Louis recently completed a $54 million system to provide primary care to highest-risk patients.
Some state boards of medical examiners (who regulate what doctors can and can't do) have fought telemedicine in the courts.
The Texas State Board of Medical Examiners, for example, voted in June of 2015 to require doctors to have an a visit with the patient in person before offering diagnosis and treatment online. The State of Texas maintained that they did not want doctors to be able to prescribe dangerous drugs without physically examining a patient, but the fact that the major provider of telemedicine services in Texas, Teledoc, was competing with Texas doctors and offering medical care at substantially lower prices.
In its suit, the telemedicine company asserted that restrictions imposed by the Texas Board of Medical Examiners would lead to "higher prices, reduced choice, reduced access, reduced innovation and reduced overall supply of physician services." The courts agreed, and allowed Teledoc to continue providing services, even to first-time patients, in the state.
Rapid Expansion Expected
The 7800 telemedicine terminals at CVS, largely for people who aren't comfortable using Skype on their own, are just part of a huge expansion of virtual medicine in the USA. Already there are 75 million online visits with doctors every year in the USA. By 2018, there are expected to be 300 million. Moreover, if you get your health insurance through your employer, you will more than likely be seeing your doctor over a computer screen at least some of the time. The National Business Group on Health predicts that 74 percent of large employers in the USA will "offer" telemedicine to their insured employees.
Still, it is a good thing to establish an in-person relationship with a primary care provider you trust. When you do, telemedicine can save time and money and help you get better faster.
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