Almost one in six doctor visits will be virtual this year

Almost one in six doctor visits will be virtual this year

eVisits are expected to save $5B this year over the cost of traditional in-office physician visits
By Lucas Mearian

August 8, 2014 (Computerworld)

With an aging Baby Boomer population and broadband bandwidth improved a hundredfold from a decade ago, telemedicine is exploding as a convenient and less costly alternative to the traditional visit to the doctors' office.

This year in the U.S. and Canada, 75 million of 600 million appointments with general practitioners will involve electronic visits, or eVisits, according to new research from Deloitte.

The overall cost of in-person primary physician visits worldwide is $175 billion, according to Deloitte. Globally, the number of eVisits will climb to 100 million this year, potentially saving over $5 billion when compared to the cost of in-person doctor visits. The eVisit projection represents growth of 400% from 2012 levels, Deloitte's study showed.

Last November, The University of Pittsburgh Medical Center (UPMC) revamped its patient portal, renaming it MyUPMC, and rolling out AnywhereCare, offering patients throughout Pennsylvania eVisits with doctors 24 hours a day, seven days a week either over the phone or through video conferencing.

UPMC, an $11 billion health care provider and insurer, with 21 hospitals, and more than 400 outpatient sites, said its AnywhereCare service has an 80% satisfaction rating.
Patients love the convenience and speed of remote care, according to Natasa Sokolovich, executive director of telemedicine at UPMC.

"The new model provides a faster turnaround. Within 30 minutes ... they have the ability to get access to a healthcare provider," Sokolovich said.

An eVisit

eVisits reduce time to patient care and costs. Through electronic record portals, they can also offer physician and patient a view of the same health information, such as appointments, prescriptions, test results and complete medical histories.

Electronic visits or telemedicine is comprised of electronic document exchanges, telephone consultations, email or texting, and videoconferencing between physicians and patients.

The vast majority of eVisits, according to Deloitte, are likely to focus on capturing patient information through electronic forms, questionnaires and photos, rather than through direct interaction with a physician using Skype or some other real-time tool.

"For example, patients with symptoms of certain illnesses such as sinusitis, strep throat, allergies, bladder infection or acne would complete an online form and then receive a diagnosis and, if required, a prescription," Deloitte stated in a recent report.

While not all in-person primary physician consults can be handled by eVisits, even only 30% to 40% implies a $50 to $60 billion total addressable market, according to Deloitte.

In order to use its AnywhereCare eVisit service, UPMC patients go online and submit a symptom questionnaire and wait for a response from the first available healthcare professional. Patients also have online access to track appointments, see lab results and view the same medical information as physicians through an electronic medical record (EMR) system.

UPMC's original patient portal model allowed only patients with primary care physicians at the facility to contact doctors, and the wait time for a response could be as long as 24 hours. Now any resident of Pennsylvania can contact healthcare providers through the site. Since its launch in November, AnywhereCare has had 2,100 visits.

Those eVisits have also saved UPMC an average of $86.80 per member visit compared with the cost of an office visit.

Ultimately, Sokolovich hopes eVisits will also free up some of the pressures on primary care practices as physician shortages are anticipated grow industrywide.

A 2012 survey conducted for industry group The Physicians Foundation revealed the average age of 13,575 respondents was 54. That compares with the average age of all American Medical Association (AMA)-listed physicians of 49. Four in 10 active U.S. physicians are age 55 or older, according to the American Association of Medical Colleges.

"So we have an aging physician population. And, we know we have a nursing and primary care physician shortage," said David Collins, the senior director of the mobile community of the Healthcare Information and Management Systems Society (HIMSS).

"On the other side, we have an aging general population. Ten thousand people a day who are part of the Baby Boomer generation are turning 65," Collins added. "You do the math."

The cost of care

Another reason for the enormous increase in the adoption of telehealthcare is the Affordable Care Act (ACA). The act places an emphasis on decreasing healthcare costs while increasing quality through standardized methods of care.

"Technology is going to be the game changer there," Collins said.

The U.S. Centers for Medicare and Medicaid Services Fee Schedule, a 609-page document that details payment rules for each coming year, has for the first time dedicated a significant portion (10 pages) to how physicians should charge for telehealth or eVisits.

EVisit usage will likely be greatest in North America, where they will soon represent 25% of the addressable market, according to Deloitte.

In the US in 2010 there were 1.2 billion patient visits to physician offices, emergency departments and hospitals (for outpatient services), according to Deloitte; that's the equivalent to 3.3 visits per US citizen.

Just over half of physician visits in 2010 were to primary care doctors. Prescription refill, coughs, stomach pain, sore throat, earache and skin rash accounted for over 110 million of the office visits -- all of those requirements could have been be screened or resolved via an eVisit, according to Deloitte.

While some older patients will never be comfortable with visiting their physicians online, Collins believes the younger and more computer savvy generation will embrace it as the de facto standard.

UPMC's Sokolovich agrees.

"As the consumer becomes more aware of these platforms, they're going to start to expect them," Sokolovich said. "It will be a standard for how we access medical care for colds, coughs, pink eye and primary care-type conditions."


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