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Does Tele-Medicine Really Work in Primary Care?

Posted Thursday, August 31, 2017 by Gene Moen

We have several blogs discussing the advent of tele-medicine, which can mean anything from remote reading of radiology films to ”virtual” medical visits via a computer. The latter aspect seemed to offer a great deal of promise, because it would encourage preventive medicine by making it easier for patients to bring their medical concerns or problems to their physician without the delays occasioned by setting up an actual visit. And doctors would spend less time in responding to those concerns. It seemed to offer great promise to both patients and their doctors.

A recent study in Management Science questions whether those assumptions are working out. It found that e-visits are leading to more office visits and more phone consultations, and more physician time spent in providing care, and less income to physicians. Study leader Hassam Barfa, PhD, of the University of Wisconsin School of Business, noted that encouraging patients to reach out to their physician, even with minor problems, put doctors in a bind. Health care providers felt that ignoring the signal was a risk, so more patient visits were set up that were not actually needed.

The study used five years of data from a large health care system with multiple hospitals. Over 140,000 patient encounters were included in the study. The results were surprising to many: office visits after online contact with physicians increased by 6%. Physicians were spending an extra 45 minutes more on those visits each month.

Critics of the study, including the president of the American Telemedicine Association, said the findings did not include many patients who benefited by the experience, and actual patient improvement in health was not studied. From a business viewpoint, observers are considering various pricing mechanisms, such as a subscription fee for electronic access, or even a charge for each individual “visit.” One commentator said that tele-medicine has the potential to change the way primary care medicine is practiced: “Think Uber versus taxis, or what Amazon has done to purchasing products.” But much of that promise is yet to be realized.

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