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Phil Galewitz: Your doctor will see you at the kiosk

By PHIL GALEWITZ

For Kaiser Health News

WEST PALM BEACH, Fla.

On the day abdominal pain and nausea struck Jessica Christianson at the office, she discovered how far telemedicine has come.

Rushing to a large kiosk in the lobby of the Palm Beach County School District’s administrative building where she works, Christianson, 29, consulted a nurse practitioner in Miami via two-way video. The nurse examined her remotely, using a stethoscope and other instruments connected to the computer station. Then, she recommended Christianson seek an ultrasound elsewhere to check for a possible liver problem stemming from an intestinal infection.

The cost: $15. She might have paid $50 at an urgent-care center.

The ultrasound  that Christianson got later that day confirmed the nurse practitioner’s diagnosis.

“Without the kiosk I probably would have waited to get care and that could have made things worse,” she said.

Endorsements such as  Christianson’s demonstrate how technology and positive consumer experiences are lending momentum to telemedicine’s adoption in the workplace.

Less than a decade ago, telemedicine was mainly used by hospitals and clinics for secure doctor-to-doctor consultations. But today, telemedicine has become a more common method for patients to receive routine care at home or wherever they are — often on their cellphones or personal computers.

In the past several years, a growing number of employers have provided insurance coverage for telemedicine services  letting employees connect with a physician by phone using both voice and video. One limitation of such phone-based services is physicians cannot always obtain basic vital signs such as blood pressure and heart rate.

That’s where telemedicine kiosks offer an advantage. Hundreds of employers — often supported by their health insurers — now have them installed in the workplaces, according to consultants and two telemedicine companies that make kiosks, American Well and Computerized Screening, Inc.

Employers and insurers see the kiosks as a pathway to delivering quality care, reducing lost productivity due to time spent traveling and waiting for care, and saving money by avoiding costlier visits to emergency rooms and urgent care facilities.

Jet Blue Airways is adding a kiosk later this year for its employees at John F. Kennedy International Airport in New York. Other big employers providing kiosks in the workplace include the city of Kansas City, Mo.

Large health insurers such as Anthem and UnitedHealthcare are promoting telemedicine’s next wave by testing the kiosks at worksites where they have contracts.
“This technology should make it more affordable for employers of many sizes,” Jesser said.Anthem has installed 34 kiosks at 20 employers in the past 18 months. John Jesser, an Anthem vice president, said kiosks are a good option for employers too small or disinclined to invest hundreds of thousands of dollars in creating an on-site clinic with doctors and nurses on standby.

Kiosks are typically used for the same maladies that lead people to see a physician or seek urgent care — colds, sore throats, upper respiratory problems, earaches and pink eye. Telemedicine doctors or nurse practitioners can email prescriptions to clients’ local pharmacies. Employees often pay either nothing or no more than $15 per session, far less than they would pay with insurance at a doctor’s office, an urgent care clinic or an emergency room.

Despite kiosks’ growing use in telemedicine, it’s unclear whether they will be supplanted as smartphones, personal computers and tablets enable people toaccess health care anywhere with a Wi-Fi connection or cell service. Some employers already offer kiosk and personal device options, including MBS Textbook Exchange in Columbia, Mo., which has 1,000 workers.

Workplace kiosks’ appeal is they are quiet, private spaces to seek care. Consumers can get their ailments diagnosed remotely because the kiosks are equipped with familiar doctors’ office instruments such as blood pressure cuffs, thermometers, pulse oximeters and other tools that peer into eyes, ears and mouths. The instrument readings, pictures and sounds are seen and heard immediately by a doctor or nurse practitioner.

“The kiosk gives the doctor more tools to diagnose a wider range of conditions,” Anthem’s Jesser said.

The downside is that the machines cost $15,000 to $60,000 apiece, which may still be too much for some employers.

“Telemedicine kiosks look promising and may still take off, but I don’t see explosive growth,” said Victor Camlek, principal analyst with Frost & Sullivan, a research firm.

While kiosks are now found in more workplaces, usage is still relatively low because employees are not sure how they work, said Allan Khoury, a senior consultant with Willis Towers Watson.

Employers’ experiences are mixed.

Officials in Kansas City, Mo., estimate that the kiosk placed in city hall almost a year ago has saved the local government at least $28,000. That’s what Kansas City hasn’t spent because employees and dependents chose the telemedicine option instead of an in-person doctor visit. The city also estimates it has gained hundreds of productive work hours — that’s the time employees saved by not leaving work to see a doctor.

In contrast, fewer than 175 of the 2,000 employees at the Palm Beach County School District headquarters have used the kiosk there in its first year, said Dianne Howard, director of risk management.

Howard remains hopeful: “This is the future of health care.”

The district’s kiosk was supplied at no cost by UnitedHealthcare, as part of a test also involving two other employers in Florida.

Those kiosks connect employees to nurse practitioners at Nicklaus Children’s Hospital in Miami. The hospital employs an attendant at each kiosk location to help workers register and use some of the instruments, such as the stethoscope.

Other telemedicine kiosks, such as those made by America Well, are designed to be totally self-service for employees. They also offer users immediate access to a health care provider. American Well has deployed about 200 kiosks and is in midst of rolling out 500 more, mostly to employers, the company said. It also places kiosks in retail outlets and hospitals.

Telemedicine’s increasing sophistication is winning over some traditional-minded physicians.

The WEA Trust in Madison, Wis., a nonprofit that offers health coverage to public employers, installed a kiosk for the benefit of its 250 workers last fall.

Tim Bartholow, M.D., a family doctor by training and chief medical officer for the trust, said he was cautious about physicians treating patients they haven’t seen in person. After observing employees using it, Bartholow is convinced it can help them get good care.

“I don’t think telemedicine is making a doctor being on site quite agnostic, but it is certainly reducing the premium on being in the same space as the patient,” Bartholow said.

Insurers declare they are moving carefully, too, recognizing that telemedicine has its limits and they must depend on practitioners to tell patients when they have to see a doctor — in person.

“We have to rely on their experience and judgment,” Jesser said.


CVS plowing ahead in medicine on demand

CVSminuteclinic

Andrew Sussman, M.D., executive vice president and associate chief medical officer of CVS Health, discusses how the huge drugstore chain will continue to expand in an age of retail medical care as provided in its MinuteClinics.

As this Hospitals & Health Networks piece reports:

“Telehealth is one growth area that CVS is warming to as a way to provide low-cost services, and consumers are, too. Oliver Wyman’s study estimates that 57 percent of consumers are now familiar with the concept of a health and wellness visit conducted remotely via voice or video chat. Some 95 percent of CVS customers said they thought a telehealth visit was ‘just as good’ or ‘better’ than the traditional model, Dr. Sussman added.”

“CVS has partnered with three players in the telehealth space — Doctor on Demand, American Well and Teladoc — aiming to build out its capabilities. Pilots tied to those partnerships include making telehealth services available through the CVS app, having one company beam its doctors into CVS telehealth clinics to look at rashes and other superficial ailments or sending patients from a telehealth provider’s app into MinuteClinic if further in-person consultation is required.”


States can’t keep up with telemedicine rush

Telescreen

Governing magazine looks at  how some states are dealing with the telemedicine revolution.

“Despite the momentum, there are still plenty of gaps and question marks when it comes to telehealth policy. The 21 states without a parity {on provider reimbursement} law aren’t uniformly liberal or conservative. Kansas, South Carolina and Utah don’t have one, but neither do Illinois or Pennsylvania. Massachusetts, a state known for progressive healthcare policies, doesn’t have a parity law. It currently only covers telemedicine under Medicaid with certain managed care plans, and not for fee-for-service payments.

“Even among states that do have parity laws, the patchwork of policies can vary widely from one state to the next. Texas, for example, requires insurers to cover telehealth, but it mandates that a patient’s first appointment with a new doctor must be an in-person visit. Within Medicaid programs, about half of the states require that a patient be in a medical facility for telehealth appointments, rather than at home. The differences among states can be frustrating for telemedicine providers. Kofi Jones, vice president of public relations and government affairs for the telehealth company American Well, says she has 30 binders in her office filled with state-by-state regulations and legislation. …”

“Traditional health-care providers can be slow to integrate new technology. After all, almost half of doctor’s offices polled in 2013 still used paper records, according to a survey from the U.S. Department of Health and Human Services. Other recent surveys have found that only 2 percent of patients nationwide have access to video visits with their primary care physician. Less than half — 45 percent — even receive a traditional phone appointment reminder.”

 


Making telemedicine a career

 
MedCity News reports that two big names  in digital health for healthcare professionals want to make the “online doctor” a  full-time career path. Physician social network Doximity and telemedicine service provider American Well are joining in an initiative to offer physicians the option of  specializing in practicing medicine remotely.

 

 


FCC’s ‘net-neutrality’ ruling and healthcare

celltower

The Advisory Board Company looks at how the Federal Communications Commission’s decision on ”net neutrality” will affect the healthcare sector. Among the reactions:

“Mike Putnam—senior vice president of American Well, a telehealth provider—said he supports FCC’s net neutrality rules, noting his company has seen an increase in provider visits over mobile networks since releasing an app that enables patients to speak with doctors through the video functions on their phones.

“Matthew Douglass, vice president of Practice Fusion, praised the decision, saying ‘Reclassification of [Internet service providers] under Title II ensures that product features, pricing, and functionality are the drivers of innovation and choice in our healthcare technology market, unimpeded by whether a new company can simply afford to reach their customers.'”

“Ryan Radai of the Competitive Enterprise Institute said FCC’s plans to regulate mobile networks will be counterproductive for technologies that rely on high-speed Internet.”

“IT Now Executive Director Joel White described the rules as ‘unprecedented and dangerous.’ He said his organization ‘fears that hampering the Internet economy with heavy handed regulations will slow the development and expansion of new innovative medical technologies that rely on broadband.”‘

 


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