By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    healthcare cybersecurity
    4 Helpful Tips on How to Protect Your Medical Practice Against Cyber Attacks
    October 24, 2021
    Health Check Diagnosis Medical Condition Analysis Concept
    6 Health Woes With Online Remedies
    January 19, 2022
    Eight Things Men Should Know About the Male Menopause
    Eight Things Men Should Know About the Male Menopause
    April 24, 2022
    Latest News
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
    The Hidden Impact Of Stress On Your Body’s Alignment And Balance
    May 22, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Does Insurance Cover the Cost of Therapy?
    June 14, 2022
    mental health loss loved one
    Covering Your Own Medical Issues After Losing a Loved One
    July 21, 2024
    healthcare SaaS
    Venture Capital Trends for Healthcare SaaS Platforms
    May 24, 2024
    Latest News
    Cigarette Makers Sue the FDA Over New Labeling Rules
    July 8, 2025
    End-Use Verification: Simple but Potentially Powerful
    July 8, 2025
    How Much do Financial Incentives Matter to Physicians?
    July 8, 2025
    NanoViricides Reports Positive Anti-viral Effect of HIV Drug
    July 8, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Despite the Penalties, Physician Visit Innovation Is Progressing
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Technology > Medical Devices > Despite the Penalties, Physician Visit Innovation Is Progressing
eHealthMedical DevicesMobile HealthRemote DiagnosticsTechnology

Despite the Penalties, Physician Visit Innovation Is Progressing

tkilpatrick
tkilpatrick
Share
7 Min Read
telehealth
SHARE

telehealthOne morning, Arthur Tyson woke up with a nose bleed at his home in rural North Carolina. He otherwise felt fine. Tyson, a 70-year old heart attack survivor, lives with heart failure and diabetes. Tyson continued his morning routine, which included strapping on his blood pressure cuff which communicates his vital signs to a remote monitoring system.

telehealthOne morning, Arthur Tyson woke up with a nose bleed at his home in rural North Carolina. He otherwise felt fine. Tyson, a 70-year old heart attack survivor, lives with heart failure and diabetes. Tyson continued his morning routine, which included strapping on his blood pressure cuff which communicates his vital signs to a remote monitoring system.

Within minutes, a telehealth nurse rang his phone to advise Tyson to call 911 immediately. The nurse saw that Tyson’s heart rate had fallen below 40 beats per minute and his blood pressure had spiked to a dangerous level. It turned out that Tyson’s heart was blocked. He was able to receive a life-saving pacemaker. This was one of the telehealth case studies presented at the Consumer Electronic Show earlier in January.

While this seems like an obvious service for patients living with heart failure and diabetes, Medicare and most other insurance companies do not reimburse providers for this.  No wonder our healthcare costs are so high and it is not delivering our desired outcome.  “We Ask Physicians To Lower Cost, Then Penalized Their Innovation.”

More Read

Stage 2 Meaningful Use NPRM Now Available
5-Point Digital Health Checkup
A “secret shopper’s” perspectives on the EHR and clinical workflow
PCI Compliance Status & Data Breaches
Sales of Sealants, Hemostasis, Other Closure a Large, Shifting Market Worldwide

Medicare and most insurance companies only pay for face-to-face visits.  Since many physicians need to see 25 patients a day to make a living, it would be hard for them to make physical house calls. That leaves the office visit, for many physicians, as their only source of income.

A recent study comparing e-visits to in-office visits for sinusitis and urinary tract infection (UTI) demonstrates differences, yet shows they are both effective. The study did not measure the effects from patients skipping physician visits altogether or from conditions deteriorating while they worked out the scheduling and logistics.  There will always be differences between e-visits and physician office visits, yet it may be better for patients to choose rather than having options eliminated by an antiquated reimbursement system .

Despite the penalties, market research firm IHS Technology expects the telehealth business to be 10 times what it is today by 2018.  Here is how physician visit innovation is progressing:

1. Concierge Medicine – Patients pay concierge physician practices a monthly fee that covers their services including emails, phone and video calls. Most concierge services like Qliance and Atlas MD do not accept insurance reimbursement, so practices are free to focus on patient needs rather than what gets reimbursed.   Concierge service One Medical is trying a hybrid style that includes insurance reimbursement and a smaller monthly fee as well as mobile apps to triage conditions like sinusitis and UTI.  People that are already paying a lot for health insurance typically cannot afford the additional cost of concierge medicine, thus concierge patients are more affluent.

2. Physician e-Visit Services – Physician e-visit services like Grand Rounds, 2nd.MD, MDLive, Teledoc and Virtuwell offer e-visits for a one-time fee such as $50. There are also specialized services for dermatology such as DematologistOnCall, Direct Dermatology or YoDerm to diagnose your lesion or mole. To prescribe medicine or treatments, physicians need to be board certified in the local state of the patient. Some of these new services do have a network of physicians in each state. Again, they typically do not accept insurance reimbursement.  They may not have access to the patient’s medical records or know the patient, thus requiring developing a new relationship each time.

3. Insurance Product innovation – A new startup called Oscar began in October 2013 with a new insurance offering on the New York State Healthcare Exchange.  Oscar co-founder Joshua Kushner wants “to create an experience like having a doctor in the family.”  The insurance plan still charges deductibles and monthly payments, yet offers free generic drugs, free calls to doctors and free primary care appointments to make life easier. They also offer apps to help steer patients to doctors that best suit their needs.

4.  Traditional Insurance innovation – Aetna, Humana, United Healthcare, Wellpoint and local Blues are experimenting with physician e-visits and triage apps. BlueCross BlueShield of South Carolina covers telemedicine for high-risk pregnancies, strokes and mental health. Aetna offers members 24/7 Teledoc service for phone consultations with a physician. WellPoint offers members e-visits via American Well. UnitedHealth Group’s offers telemedicine services for virtual office visits by Web or telephone. Humana offers an e-visit suite for members too busy to go to their physician office.

5. Legislation – Although states do not have jurisdiction over Medicare, they are legislating telemedicine for private insurance and Medicaid.  There are 21 states that mandate telemedicine visits for private insurance and another 9 with pending legislation. 9 States have laws enacted for Medicaid with 5 more having pending bills.  The Federation of State Medical Boards (FSMB) recently received kind words from a group of U.S. Senators by proposing an interstate medical licensing that will enable physicians to provide services across state lines.

6. Medicare  – reimburses for some live consults for patients in rural areas. Medicare began in January 2014 reimbursing providers for Transitional Care Management e-visit consults. Medicare is expected to begin reimbursing for additional e-visit consults beginning in January 2015.

7. Performance Programs (ACOs, Bundled Payments) – Providers are beginning to experiment with e-visits for patient within performance programs (Accountable Care Organizations, Bundled Payments). These providers are testing ways to more effectively and efficiently manage patients care as they are at risk for the overall cost of the episode of care (Inpatient stay plus 90 days) and for a patient population (total cost over 365 days).

(telehealth / shutterstock)

TAGGED:telehealth
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Health Care Buzz Today
Business
July 8, 2025
As We Mature (age), Things Change…
Orthopaedics
July 8, 2025
FDA Approves Roche (Genentech) Skin Cancer Drug–Zelboraf
Business
July 8, 2025
Smart Money on Pfizer?
Business
July 8, 2025

You Might also Like

Why a “Switzerland Approach” Might Become a Key Part of Wearable Health Platforms

June 30, 2014

The Power Of Embryonic Stem Cells

July 8, 2025
Is Working in Telemedicine a Good Option for You?
DiagnosticseHealthRemote DiagnosticsWellness

Is Working in Telemedicine a Good Option for You?

May 6, 2016

Preventing Alzheimer’s Before Disease Onset: A Key Expert Weighs In

June 15, 2012
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?