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TELEHEALTH: How many telehealth claims? Not many!

In this study, researchers analyzed the claims database of the Health Care Cost Institute – which has commercial data from Aetna, Humana, Kaiser Permanente, and United Healthcare, as well as Medicare Advantage data.  The objective was to look at utilization and reimbursement trends.  The number of telehealth claims submitted by primary care physicians was miniscule – about 6500 out of a total 96 million in the 4-year period studied.  Family physicians were the specialty most likely to submit telehealth claims.

Number of Claims: Primary Care Physicians: US 2009-2013

  •            6,506 telehealth claims
  • 95,900,000 non-telehealth claims

PCPs’ Most Frequent Use of Telehealth to Diagnose (in descending order of frequency)

  • Diabetes
  • Depression
  • Acute sinusitis
  • Biopsy of the lymphatic structure
  • Obstructive sleep apnea

Source: Wilson, F.A., Trout, K., Rampa, S., and others. (2016). An examination of private payer reimbursements to primary care providers for healthcare services using telehealth, United States 2009-2013. Issue Brief [Health Care Cost Institute].  Click here for full text: http://www.healthcostinstitute.org/files/HCCI-Issue-Brief-Examination-of-Private-Payer-Reimbursements.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

New Uber-Like Start-Ups Providing Medical House Calls

An article in this week’s Wall Street Journal looks at start-up firms that are providing medical house calls through an Uber-like model. The article features these companies offering on-demand visits to the patient arranged through an online app:

  • Heal serving San Francisco, Los Angeles and Orange County
  • Pager serving New York City and San Francisco
  • MedZed serving New York City and Atlanta
  • RetraceHealth serving Minneapolis, North Dakota and Wisconsin
  • True North Health Navigation [changing its name to Dispatch Health] serving Denver

Pager [using Uber] and Heal both dispatch a doctor or nurse practitioner to the patient’s home or office. RetraceHealth provides an initial video consult with a nurse practitioner and goes to the patient’s location only if hands-on care is needed. MedZed sends a nurse for the initial exam and then connects remotely to a doctor for a treatment plan. True North is offered as a lower-cost, on-location care option for 911 callers when they have a minor, nonemergency health issue.

The health care system Centura Health is collaborating with True North to reduce its emergency room use and to lower medical costs for employees and members of its health plan.

Visit charges cited currently range up to about $200, and may or may not be covered by health insurance plans. Some worry that these services will further fragment care and damage patient-provider relationships. Upon request, however, the companies will send reports to a patient’s primary care physician. One hospital ER physician interviewed indicated she enjoyed the extra time she could spend with a patient when working on a Pager shift.

A New York Times article earlier this year also looked at Go2Nurse serving Chicago and Milwaukee and Curbside Care in the Philadelphia area, both making house calls. Telemedicine apps providing virtual visits or consultations are also covered, including Doctor on Demand, Teladoc, American Well, HealthTap, MDLive, Spruce and Maven.


Beck M. Startups vie to build an Uber for health care. Wall Street Journal, Aug. 11, 2015. http://www.wsj.com/articles/startups-vie-to-build-an-uber-for-health-care-1439265847

Jolly J. An Uber for doctor housecalls. New York Times Blog, May 5, 2015. http://well.blogs.nytimes.com/2015/05/05/an-uber-for-doctor-housecalls/

Related books:

Wachter R. Digital doctor: hope, hype, and harm at the dawn of medicine’s computer age. McGraw-Hill Education, April 1, 2015. http://www.amazon.com/The-Digital-Doctor-Medicines-Computer/dp/0071849467

Topol E. The patient will see you now: the future of medicine is in your hands. Basic Books, Jan. 6, 2015. http://www.amazon.com/The-Patient-Will-See-You/dp/0465054749/ref=pd_sim_14_1?ie=UTF8&refRID=0N4GNJHP11JZ3FHF3XJ3

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FUTURE: Virtual house calls, virtualists, Skyping doctors

I have to admit that when I don’t feel well, I am more inclined to dive back under the covers than drag myself out and sit in the waiting room at the doctor’s office.  (“Go away!  Just let me alone!”)  So, I would probably be a candidate to be an early adopter of virtual housecalls.  It would be nice to be able to hobble across the room to the computer and Skype with a primary care physician about worrisome symptoms.  This is a concept that insurers are starting to pay for and is probably going to be a competitive battleground between retail providers and health systems.

One system, CHI Franciscan Health, that studied utilization patterns has found that the key demographic is women aged 25 to 55.  (I wonder if women older than 55 are just not as comfortable using Skype and Facetime?)  The most typical diagnoses include bladder infections, pinkeye, and upper respiratory problems.  Not surprisingly, the virtual visits tend to take place on nights and weekends, when doctors’ offices are closed.

Source: Goodnough, A. (2015, July 12). Modern doctors’ house calls: Skype chat and fast diagnosis. The New York Times, A1, A21. http://www.nytimes.com/2015/07/12/health/modern-doctors-house-calls-skype-chat-and-fast-diagnosis.html?_r=0  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FUTURE: Mercy develops first telehealth virtual care center

Mercy (Chesterfield, Mo., 31 hospitals) plans to open what is billed as the world’s first virtual care center in Chesterfield, Mo., in the summer of 2015.  Staffed by 300 physicians, nurses, and other specialists, the Mercy Virtual hub will be open 24/7 and use telehealth technology to link to a far-flung network of “spokes,” smaller community hospitals, outpatient providers, and patients’ homes.  The center will also include remote ICU monitoring capability, which is already provided within the system.  Planners expect that Mercy Virtual will handle 3 million telehealth contacts over the first 5 years after start-up.

Source: Hale, T., and Moore, R. (2015, Jan.-Feb.). Mercy virtual: connects with a new model of care. Health Progress, 96(1), 13-17. Retrieved from https://www.chausa.org/docs/default-source/health-progress/mercy-virtual-connects-with-a-new-model-of-care.pdf?sfvrsn=0 Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Clinical integration of pediatric services at Mercy Health

Development of a regional integrated system for pediatrics services by Mercy Health (Chesterfield, MO), a multi-institutional system operating facilities in Missouri, Kansas, Arkansas, and Oklahoma, is described in this article.  Mercy Children’s Hospital, with inpatient care locations in St. Louis and Springfield, MO, is working with the large multi-specialty Mercy Clinic to create this integrated network.  Among the goals are strengthening the physician referral network and coordinating the delivery of pediatric care.  Initiatives include the establishment of a telemedicine network, and of a POINT (Pediatric Outpatient and Inpatient Navigation Team), composed of a nurse practitioner, RN, and social worker, which is tasked with care coordination for NICU patients and other children with complex issues.

Source: Mercy adapts services to region’s needsHealth Progress;92(3):21-23, May-June 2011.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org