In the midst of a recent East Coast blizzard, when many physicians had to cancel office visits, Dr. Paul Fenyves, a primary care doctor at Weill Cornell, in New York, had a list of patients to treat. Rather than reschedule his appointments for a different day, Dr. Fenyves knew he had the option to offer treatment via video, also known as telehealth.
One of his patients was a 47-year-old man who had ear pain for several days. In a traditional office visit, Dr. Fenyves would grab his otoscope. Instead, he went for a different tool: a computer camera.
Without ever actually seeing the patient in office, Dr. Fenyves offered a diagnosis, suggestions for over-the-counter relief options, and discussed a potential follow-up appointment. He conducted the entire visit through a computer camera, part of an effort to launch a telehealth program through UnitedHealthcare.
“In order to promote continuity of care and improve management of chronic conditions, UnitedHealthcare was interested in seeing telehealth implemented by traditional primary care practices. At Weill Cornell Medicine, we are working with UHC to integrate telemedicine into our office based practice,” said Dr. Fenyves. “We're really just getting started -- we're getting our feet wet.”
Over a six month period, Dr. Fenyves helped develop the telehealth system and overcame the learning curve of working within a virtual environment. He realized the importance of proper lighting, camera placement, and the need to create structure going in to each visit.
“Your whole office visit routine gets disrupted and it is easy for the visit to become unstructured. It takes some practice and making a conscious effort to impose some structure on the visits,” he said.
More importantly, Dr. Fenyves implemented and refined a digital visit that created little interruption into his current workflow.
“The telehealth visits are streamlined into my daily schedule. I might go to see a patient in an exam room, and then the next patient is a telehealth visit -- it's like a virtual exam room," he said.
Dr. Fenyves admits he was skeptical of this virtual frontier in medicine. But, after learning about recent studies that show one in five patients are willing to switch from their current doctor to one who offers video visits, he saw the value in this technology. The UnitedHealthcare project was also appealing because it addressed one of the biggest obstacles preventing widespread adoption among family practice physicians: reimbursement.
"UnitedHealthcare agreed to pay for telehealth visits as if they were regular office visits,” said Dr. Fenyves. “A patient can see me in the office or via telehealth, and in terms of reimbursement, it's identical."
With a payment structure in place, he began treating patients with less complicated ailments via telehealth on a regular basis. The convenience was undeniable as patients no longer had to block out hours for an in-office visit.
"From start to finish, the patients are gone from their desk for only twenty minutes. No need to take a cab, check into the office, and then spend 15 minutes in the waiting room reading a magazine. A traditional office visit can easily occupy three hours of patient's time," said Dr. Fenyves.
Yet, accessibility has its challenges. Dr. Fenyves noted the ease of scheduling a telehealth visit may condition patients to become less likely to self-treat or wait out their symptoms which, at times, may be the best course of treatment.
"If you make it too easy to see a doctor, you might induce a lot of unnecessary and inappropriate care. Often a little time and some chicken soup is all that is needed," said Dr. Fenyves.
He also pointed out that, depending on the ailment, a visit by video can result in a follow-up office appointment. Telehealth may streamline the ability to diagnose a patient with a cough or cold, but there are times when it becomes clear that a patient is too sick and must be treated in-person.
It’s ultimately why Dr. Fenyves believes the telehealth visit with a primary care doctor may find the greatest success through full integration into an Accountable Care Organization model, where the focus is not on fee-for-service. In an ACO, collaboration between the primary care provider and health plan payer allows for an emphasis on overall patient health, continuity and outcomes, whenever or wherever a patient needs medical attention.
"I can imagine an excellent use for telemedicine as a first line treat-or-triage for acute conditions. Simple matters could be handled immediately by telemedicine, while patients with more complicated conditions could be given office visits or referred to the emergency department,” he said.
By launching a telehealth program, medical professionals, like Dr. Fenyves, can actually see how the technology gets streamlined into a primary care setting. While widespread use of the virtual visit may be a long-term goal, for now, it’s allowing doctors to provide access and convenience to patients….even in a blizzard.
"This telehealth pilot is an important endeavor. I wouldn't say that telehealth is the future of medicine, but I certainly believe it is part of the future. Being flexible and available to patients is important,” Dr. Fenyves said.