Video Medicine and Concierge Care

One of the hot topics in medicine today is "video medicine." Who benefits when care is delivered by video as opposed to seeing a provider face-to-face?  Is this a service that patients and doctors should welcome or not? What does it mean to patients and to concierge members as well?

Physicians in our delivery environment function in a tiered system. Urgent care, emergency medicine, primary care, visiting care, and every type of first interaction with a patient involves triage - the determination of the extent of the problem, and assessing what and who should address the condition.

When a person reaches out to most physicians by phone to explain their symptoms, the most common response is, "come into the office." When something sounds simple, it usually is - but not always. That is why almost every physician is trained to examine the patient in person. To touch them, look at them, feel them, palpate, and use tools to gather information in order to make a diagnosis.

But patients like the convenience of getting their health concerns handled without having to visit the doctor, especially in today's healthcare environment that relies heavily on prescription medications. Patients want to just call their doctor and say "Just give me the antibiotic (or the cream, or the eye drops, etc.) that you gave me before!"  Of course it isn't that easy. If the doctor's diagnosis is wrong, the results can be devastating to the patient.

However, today's technology is allowing for more flexibility in telemedicine. Physicians are no longer limited to just what they hear from patients. Now patients can transmit pictures, video, or even chat live on screen, allowing the physician the opportunity to hear the symptoms, see physical conditions, and even assess the patient's reactions and distress.

This kind of remote medicine holds significant appeal, especially for patients who cannot easily travel to see their physician, such as those in remote locations or with very busy schedules.  Some patients are disabled or live in facilities that can also make travel more difficult.  And today, home visits are not the norm. The doctor's time is valuable, so taking time to travel becomes very expensive for the doctor.

But how will this style of medicine fit into the current healthcare landscape? Who pays for this kind of office visit?  Especially when, despite the ability to see and hear the patient on screen, many remote visits reveal complications that will still require an in-office follow-up before the physician can diagnose and treat the patient?

Currently, most insurance and government programs do not regard a telephone conversation with a patient as a visit, and thus, not reimbursable. Should a video chat be treated the same?

If it is not considered a visit by the payer (and therefore not reimbursable), then the doctor may determine his fee for the service (if allowed), and it is an amenity that patients can elect to pay for by themselves. If it is covered, then the third-party payer can control its use and define its reimbursement. Various entities are considering making it a covered service, but currently there is tremendous potential for misuse that still needs to be sorted.

How could video medicine fit into a concierge program? Of course, physicians in full-concierge programs vary from very busy to modestly busy. Some may have the additional time to offer a video service, some would not be willing to devote time to this approach.

But the real question for concierge care and traditional medicine is does video interaction really negate the need for an in-office visit? Or is it just a preliminary screening, before the actual visit?  In concierge care, physicians have a deeper, personal knowledge of their patients and their health history. In a video chat, this allows the physician to use not just what they see and hear on screen, but to combine it with what they know of their patient's past health information and experience, enhancing their ability to diagnose and treat the patient remotely.

So then, is this approach good for concierge medicine?  Concierge care focuses on strengthening the doctor-patient relationship. And while video medicine may be more convenient, is it more or less personal?  My hunch is that it will grow in concierge care at the same pace it grows in traditional medicine. Video chats may soon roll into the mix of services, but nothing can replace the face-to-face relationship that patients share with their doctor.