It was 11:45 a.m. and physician Christopher Bailey’s laptop was chirping, indicating a patient was on the line.
“Hi, this is Dr. Bailey. Can you hear me?” Yes, the female patient said, she could. She’d been coughing for days and was losing her voice, she explained. Her eye had turned red and she couldn’t sleep.
Bailey took a peek at the patient’s swollen throat as she said “ah” to her webcam and had her tap her forehead to determine how much her sinuses hurt before diagnosing her condition: an upper respiratory infection. Bailey prescribed cough medicine and an antibiotic, and he offered some practical advice – use a neti pot to flush her sinuses, keep talking to a minimum, take Tylenol for the aches and pains.
“That was great, very informative,” the patient said after the 17-minute consultation. “Thank you so much.”
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Patients are bidding adieu to crowded, germy waiting rooms, opting to video chat with a doctor on their phone, tablet or computer within minutes of making the request.
About 400,000 patients had appointments with doctors via webcam in 2014, and experts expect that number to double this year. Large employers also have started offering the virtual doctor visits, via phone or Web, according to Mercer data. The growth is driven by the fact that people feel more comfortable with technology than ever before, experts say, and insurers are starting to pick up the tab.
Consulting firm PricewaterhouseCoopers data estimate that nearly 39 percent of adults would be willing to have an appointment with a physician via smartphone, representing a potential $42.1 billion market. About half of the doctors surveyed by PwC’s Health Research Institute said more than 10 percent of patient office visits could be replaced by e-visits. About 37 percent said one-third of visits could be done virtually.
Several companies have popped up in recent years to facilitate e-visits between doctors and patients. Bailey, with a specialty in family medicine, works for Chicago-based Doctor on Demand, co-founded by a cancer radiologist and a technology entrepreneur in 2012 and backed by TV personality Dr. Phil.
The Doctor on Demand app has been downloaded a few million times since it launched nationally about a year ago. Six or seven doctors in Chicago are online each day, part of a nationwide team of 1,400. Combined, the physicians handle as many as 1,000 patient calls a day nationally, which last an average of 10 minutes. If doctors work full time, usually from home in eight- or 12-hour shifts, they can make $150,000 to $200,000 a year. The cost to patients is $40, a figure that’s sometimes covered by insurance or employers, said Pat Basu, Doctor on Demand’s co-founder and chief medical officer.
The evolution of virtual doctor visits has been inevitable, experts say.
Smartphones and tablets that make doctor e-visits so convenient have become popular in the past few years. Today people feel not only comfortable with technology, experts say, but dependent on it.
If patients can take a picture of a goopy eye or shine a webcam down their throats to avoid a trek to the doctor’s office, they’re increasingly willing to do so.
Basu said his doctors diagnose and treat 95 percent of the patients who call. The other 5 percent are referred to specialists or in rare instances the emergency room.
Insurers are also more willing to cover part or all of the cost.
“I can tell you from our discussions with many of the nation’s insurers – if they’re not providing it, they’re setting up a mechanism to provide it,” American Telemedicine Association CEO Jonathan Linkous said. “I don’t know any insurer who’s said no. They’re going to have to if all of their competitors are doing it.”
Medicare covers some types of telemedicine services, usually for veterans or people who live in rural areas, but that is expected to expand, Linkous said.
Some obstacles facing the industry are rooted in regulations. For example, patients have to talk to doctors who are licensed in the state from which the patient calls. Doctors working for telehealth companies clamor to get dozens of licenses so they can treat patients from across the country, an expensive endeavor.
About 26 percent of doctors have licenses in more than one state, Linkous said.
Linkous said his organization has come up with an accreditation process for telehealth companies offering virtual doctor visits. So far 110 organizations have applied and he expects to hand out the first accreditations by the end of the month.
He said the goal is to push beyond simply providing assurances that doctors have valid licenses in the appropriate states. He wants these companies to conduct thorough background checks to make sure doctors haven’t had any form of discipline in the past, or had licenses revoked in one state only to gain a license in another.
“It’s a need,” Linkous said of accreditation. “You need to have some code, some way of finding out that these people are not quacks.”
Another obstacle: Some states – Arkansas, Idaho and Alaska – don’t allow doctors to prescribe medicines on a first-time video appointment.
And then there are privacy concerns. How do we know those videos are safe, never to be shared or leaked to YouTube?
Basu says friends at Google helped engineer Doctor on Demand’s security platform. The company doesn’t record video from the visits, uses encryption during the video calls and stores patient health information on secure servers that meet federal health insurance requirements.