Online connections to let some central Ohioans see the doctor from home
Oct 19 2015
The Columbus Dispatch
By Ben Sutherly
Screening might soon take on a whole new meaning for you and your family doctor.
Starting Nov. 2, four OhioHealth-employed doctors will see a small number of their established patients for primary-care visits via video and online consultations.
Telemedicine is well established in central Ohio. For years, it’s been the means by which doctors at OhioHealth and Ohio State University’s Wexner Medical Center care for stroke victims at outlying community hospitals across the state.
But the technology now is just beginning to reshape primary care here, and its advocates say that could have ramifications for a wide range of patients. The technology, for example, might head off a three-hour interruption to your workday just to drive to and from your doctor’s office and wait to have your high blood pressure rechecked.
“I think it will provide really outstanding access for homebound patients,” said Dr. Mark DeWalt, whose practice is in Hilliard and who is one of the four doctors who volunteered for the project’s experimental phase. The other doctors have practices in Pickerington, Lancaster and the Bexley area.
Telemedicine is steadily expanding across the country, with an estimated 1.25 million physician consults with patients expected to take place through the Internet this year, mostly for primary care, according to the American Telemedicine Association. That’s up from about 800,000 two years ago.
“This is overwhelmingly what consumers want,” said Jonathan Linkous, the association’s CEO.
Elsewhere in Ohio, the Cleveland Clinic announced in June that it is partnering with the telemedicine company American Well to offer around-the-clock care for urgent matters. Consumers pay $49 per visit to access that care through a mobile device, desktop computer or tablet.
OhioHealth’s approach of using its own physicians rather than contracting with a telemedicine company is becoming a trend, Linkous said, in part because of a perception that telemedicine companies are siphoning patient care away from physicians.
OhioHealth will deploy technology in two ways for its primary-care patients.
For non-urgent issues, established patients can opt for an “e-visit.” They go on their electronic health record and indicate whether they’re experiencing a range of 10 conditions, such as back pain, a cough, urinary-tract problems, fatigue, headache, heartburn or red eyes.
If so, the patients answer 18 to 24 additional questions. Doctors use those answers to help determine whether the patient should be seen at the office or can be treated sight unseen for conditions such as indigestion, heartburn, a headache or diarrhea. That could include a prescription for certain drugs.
Patients also can choose a “video visit” and schedule an appointment to consult with their doctor via video feed without coming to the office.
OhioHealth said an e-visit initially will cost $20, charged directly to the patient instead of his health insurance. Video visits will be billed at the same rate as a face-to-face office visit.
For e-visits, patients should expect to hear back from their doctor within a business day, though the goal is to have physicians respond within two hours, said Dr. David Applegate, OhioHealth’s chief of primary-care transformation. To measure effectiveness, officials will track how many online patients require an office visit within three days.
For both e-visits and video visits, patients must be at least 18 and signed up to access their OhioHealth electronic health records through MyChart.
Each of the doctors will be expected to see 10 patients via video and complete 30 e-visits during the pilot period.
“I am interested to see what the logistics of it are,” DeWalt said. “How that will fit into my busy schedule, I’m not exactly sure.”
To a large extent, OhioHealth’s foray into primary-care telemedicine has been made possible by the hospital system’s recent $230 million conversion to a new electronic health-record system.
The Columbus Veterans Affairs outpatient center also is planning by year’s end to make greater use of primary-care telemedicine for patients who have had inpatient surgery elsewhere. These video consults between patients and their primary-care doctor in Columbus will focus primarily on coordinating post-surgical care, VA officials said.
Other central Ohio hospital systems are still sizing up their options.
Wexner Medical Center recognizes that “what’s convenient for the provider isn’t always convenient for the patient,” said Karen Jackson, director of telehealth.
But the hospital system’s focus on making primary care more convenient has focused instead on partnering with Little Clinics at Kroger stores and establishing an after-hours clinic. Still, “we’r e actively exploring (telemedicine),” Jackson said.
Nationwide Children’s Hospital uses telemedicine for consulting in cardiology and neonatology, and in certain cases for psychiatric and neurology patients in the area around Ironton, Ohio. The hospital currently doesn’t use the technology for primary care.
“Our hope is that ... these initiatives, as well as technologies that align with our goal of serving patients that travel long distances for care, will help inform a larger telemedicine strategy for us in the future,” the hospital said in a prepared statement.
Meanwhile, Mount Carmel Health System is planning to launch by year’s end a round-the-clock nurse hotline that patients can call about both primary-care and more urgent health-care needs. That hotline will feed into a “rapid-response team” that the hospital system has been assembling. Individuals from the team will be dispatched to the patient’s home and will have some provider-to-provider and provider-to-patient telemedicine capabilities.
Spokesman Jason Koma said Mount Carmel’s parent, Trinity Health, has a strategic goal to add telemedicine across the entire enterprise.
Central Ohio Primary Care worked with Dublin-based HealthSpot to develop some of the clinical utilities of the company’s telemedicine kiosks in 2013. Doctors from the large practice saw about 300 patients through the kiosks, said Dr. William Wulf, the practice’s CEO.
The practice found that about a dozen health conditions are easily handled through the use of telemedicine, including upper respiratory infections and earaches, Wulf said.
And there was another discovery, he said. While officials expected young physicians would be most adept at using the technology, they found that those doctors with the most experience seeing patients face-to-face were most comfortable in using the technology.
“There are conditions that can and should be offered” through telemedicine, Wulf said.
Central Ohio Primary Care plans to use telemedicine eventually, but it is still identifying which technology it wants to use. Wulf said it’s important that primary-care doctors have an established relationship with any patient that they see using telemedicine.
“Having the patient’s medication and medical history is invaluable,” he said. “Without that existing medical record, delivering quality care would be challenging.”
Telemedicine’s use likely will expand as uncertainty lifts around how its providers will be paid. Ohio Medicaid, for example, began reimbursing for telemedicine visits under certain circumstances; the patient and primary-care doctor, for example, cannot be at home.
Medicare only reimburses for telemedicine if the care is provided to patients who live in rural areas.
And commercial health-insurance companies aren’t required in Ohio to pay for telemedicine services, though those companies often reimburse providers for the service or provide their own telemedicine services to their members.
“Payers want to preserve the ability to decide when they pay for certain telehealth services,” said Reem Aly of the Health Policy Institute of Ohio.
As the basis for pay shifts from volume to value, “telemedicine will be used to increase the efficiency and effectiveness of the care-delivery model,” Ohio State Medical Association spokesman Reggie Fields said in a prepared statement.
The focus, he said, will be more on reducing the overall cost of a “bundle” of care that physicians provide to patients, and less on whether a single service provided through telemedicine is reimbursed.
“How quickly this shift will occur is the largest gray area,” he wrote.
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