Retail clinics and urgent-care centers offer patients flexible hours and convenience, but telehealth may be poised to take over as the easiest way for patients to get answers, advice and prescriptions for their routine ailments.
But even as the idea gains favor among providers and consumers, its spread could be slowed as the companies that provide the service get bogged down in getting their remote clinicians licensed in the states where clients do business.
Catholic Health Initiatives, a not-for-profit hospital system based in Englewood, Colo., is getting behind a new service giving patients access to doctors and nurses via webcam or telephone 24 hours a day, seven days a week.
KentuckyOne—a Louisville-based system in which CHI holds a majority stake—is about to launch the Anywhere Care service, providing statewide access for a flat $35 fee. A similar service will be available this month to the system's employees.
The Kentucky system is partnering with Seattle-based Carena, which offers the same service with Franciscan Health System, a CHI affiliate based in Tacoma, Wash. Franciscan piloted the service with its employees. The system is now an investor in the company, as well.
Common conditions dealt with include urinary, sinus and upper respiratory infections, and allergies, rashes and pink eye, according to a news release. Anywhere Care providers can prescribe drugs or recommend over-the-counter remedies, but cannot refill prescriptions or prescribe controlled substances. Patients using the service interact with providers from a Seattle company called CareSimple.
Travis Burgett, KentuckyOne director of strategy, said the CareSimple providers are licensed and credentialed in Kentucky. “They have all completed that process and are ready to go in our state,” he said.
Ralph Derrickson, Carena president and CEO, wouldn't say what other states his company may be working in next, but said it is company policy to have CareSimple providers obtain the appropriate licenses first. “That's the way we do it,” he said. “We err on the side of doing exactly what the local medical board wants.”
Derrickson said state licensing has been a barrier to the expansion of Carena. It's not only the administrative burden, but state budget shortages are leading to higher licensing fees and staff cuts that make licensing take longer. “If I could waive my magic wand, we'd have a common license,” he said. “It's probably time for us to start doing it on a national basis and look for ways to standardize.”
Carena piloted its telemedicine services with Franciscan Health employees before officially launching its telemedicine business in May.
Franciscan Health spokesman Scott Thompson said the service was well received and garnered a 92% satisfaction rate. He added that it was estimated that, over the course of about two years, 276 emergency department visits were avoided among the system's then 8,500 employees. (Because of recent growth, Thompson said Franciscan now has about 12,000 employees.)
Patients are charged a $35 fee for the virtual visit, but if they are referred to the emergency room or to a primary-care doctor, the fee is waived, Thompson said.
Thompson added that the service is currently available in Franciscan's established service area, but there are plans to expand. “It provides our system with another access point,” he said. “Our hope is we'll get those folks who don't have a primary-care doctor.”
Burgett said Franciscan Health's success was one reason that led KentuckyOne to choose Carena, and the company's business relationship with CHI was another. “Carena has a great relationship with our sister system in Tacoma, Wash.,” he said, adding that CHI now has an equity investment in the company as well. “It started as a vendor-client relationship and grew into an investment relationship and a business partnership.”
While telemedicine services are sometimes offered as an employee or health plan member benefit, Burgett noted that KentuckyOne is offering its service to the general public.
HealthPartners, a Bloomington, Minn.-based health plan, began offering a similar service in 2010. The cost for using its virtuwell system is $40, though it can be lower depending on the patient's insurance. In a study published by Health Affairs in February, HealthPartners researchers analyzed claims data between May 1, 2009, and April 30, 2012, for patients using virtuwell and traditional care settings. They found that cases handled via virtuwell were generally $88 cheaper and resulted in an estimated time savings of 2.5 hours for the patients.
While Anywhere Care and virtuwell address minor concerns, telemedicine is also being used to address more serious issues. But as telemedicine patients' conditions become more complex, so do other issues related to the technology.
Critical access, rural and community hospitals in underserved areas are paying annual subscriptions to consult with Mayo Clinic experts. Dr. Bart Demaerschalk, director of the Mayo Clinic stroke center in Phoenix as well as director of the Mayo telestroke and teleneurology networks, said technology allows him to remotely look into patients' eyes or use a stethoscope to approximate the experience of a physician exam. He generally works with institutions that have one or no neurologists.
As remote physicians provide more complex care to patients in other states, medical licensing issues come into play.
“It's a real tricky issue,” Demaerschalk said. “Licenses to practice medicine are still held and regulated state by state.”
If Mayo decides to expand its telemedicine or “connected care” network, he said it can take up to a year for licensing issues to be worked out. Demaerschalk said he has licenses to practice in Arizona, Nevada and New Hampshire—with the latter being exclusively for telemedicine purposes.
While obtaining these additional licenses can be burdensome, “it's the most rigorous and proper way to go about it,” Demaerschalk said. “I think it's best for the patient and both institutions.”
There is a bipartisan bill (PDF) in the U.S. House of Representatives sponsored by Reps. Devin Nunes (R-Calif.) and Frank Pallone Jr. (D-N.J.) that would allow Medicare beneficiaries to be seen by a remote provider licensed in any state. The measure has been endorsed by the American Telemedicine Association.
The Federation of State Medical Boards, however, is not endorsing the bill, arguing that it reverses the current generally held principle that the practice of medicine occurs where the patient is located and not the other way around.
“That bill would redefine it to be where the physician is located for Medicare beneficiaries,” Jonathan Jagoda, FSMB director of government relations, said, adding that his organization prefers “time-tested” solutions that rely on a network of state-based regulatory systems that ensure close monitoring of medical professionals.
“Telemedicine continues to grow and expand, and the state medical board community is aware of the potential benefits, but there is also a lot of concern,” Jagoda said.
He added that there is awareness of how time consuming it is to apply for and be issued multiple state licenses, so work is in progress to make licensing “easier and less burdensome, not only for the physician, but also on the state medical boards.”
These efforts include creating new telemedicine standards and developing a database of verified physician information that can be used by doctors seeking multiple state licenses. Jagoda said it is the FSMB's “hope and intention” to have the new standards ready for the organization's House of Delegates to vote on in April at its annual meeting in Denver.
It might pay for the FSMB and other states to look to Kentucky. Burgett said they didn't find licensing CareSimple providers all that burdensome and the process was over relatively quickly.
Follow Andis Robeznieks on Twitter: @MHARobeznieks
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