Imagine using Skype to contact your physician for a consult.

In the midst of this rapidly progressing technologic era, our delivery of medical services is being transformed by health information technology (HIT), electronic medical records (EMR), and advanced telecommunications.  In meeting criteria for “meaningful use,” physicians are driven to use these technologies to empower patients with communication through electronic medical records.  A primary goal is to allow patients to obtain electronic copies of their medical records and share their health information securely over the Internet with their families.  An overarching  goal is to increase patient accessibility and communication with a physician to bolster continuity of care.

Communication.  It all comes down to communication.  This accessibility for patients to immediately communicate their worries of symptom or illness to a physician.  The opportunity for physicians to instantaneously respond.  As we embrace these technological opportunities of communication, physicians are open to new modalities for health care delivery – office visits can be supplemented not only by telephone calls, but now email, Skype, Gchat, or any other imaginable resource or emerging technology.

Under the current Medicare payment system, a physician can only be paid for seeing a patient in the office.  On my clinical rotations, I have witnessed an increasing number of physicians who respond to patient emails through secure health care portals.  These emails promptly and conveniently enable a physician to address patient concerns.  In the event that an email is not satisfactory to do so, the physician simply asks the patient to schedule an office visit.  Our physicians should be reimbursed for this time.

CPT codes exist for non-face-to-face services, including telephone calls, but these codes are not included in payment models through Medicare.  Further, there is currently no established method of payment for any advanced telecommunications counseling or physician interaction.

Online physicians counseling has been increasing in the past five years – charging around $25 for a five minute consultation – with the ability to provide personal prescription.  These sort of interactions may be able to address simple patient questions, but really may go a long way towards harming the bond of the patient-physician relationship.  Interactive care simply cannot be coordinated within the confines of a five minute video chat.

However, I believe that there is an ever-increasing potential for the integration of these video chats, and other counsel through advanced telecommunication, as a compliment to the traditional office visit.  Imagine the typical family physician that holds normal office hours for patients throughout the day.  Suppose that from, say, 1-2pm each day that physician also chose to hold online “office-hours” for any of the patients within his practice.  During this time, patients could address basic questions, initiate follow-up issues, or discuss health maintenance.  Just think of the wonders of diabetic counseling!  A family doctor would have the accessibility to voice chat with a difficult or non-adherent patient once each week for five minutes, with appropriate reimbursement for time spent.

Nothing can truly supplant the face-to-face relationship between a doctor and patient.  That bond and the value of that interaction can not be underestimated.  Nor do I believe that proper diagnosis or treatment can be duplicated across a platform like Gchat.  However, with ever-rising patient needs and increasing accessibility issues, physician time is increasingly valuable.  Patients too may struggle in regularly scheduling and attending office visits.  Ultimately, utilizing these technologies would be cost-saving, efficient, could reduce preventable hospital admissions, expedite the identification of acute care instances and decrease time to treatment.  For those patients that choose to embrace this modality, this could improve quality and patient satisfaction.

Aaron George is a medical student who blogs at Future of Family Medicine.

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