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Telemedicine poised to treat more patients in health care reform era

Samantha Fletcher felt the symptoms coming on — the difficulty breathing and headache associated with chronic sinusitis, a condition she has had for five years.

But instead of driving to her doctor's office, Fletcher contacted a company called MDLiveCare, and within minutes the Tampa paralegal was connected to a licensed Florida physician. Within an hour, she picked up her prescription for an antibiotic at a local pharmacy.

More Americans are turning to technology for their health care, to companies like Sunrise-based MDLiveCare, which allows patients to receive care from doctors through video conferencing, e-mail or telephone.

Though telemedicine isn't new, it has taken on added significance as those charged with carrying out the country's new health reform law grapple with how to provide coverage to more people, while also reducing costs.

"It's the wave of the future," said Dr. Carmen Alfonso, a Miami physician and one of MDLiveCare's estimated 800 providers in 50 states. Eventually, she says, more doctors will incorporate telemedicine into their practices.

Its acceptance is growing. Medicare and Medicaid now reimburse providers for certain types of care through telemedicine. More insurance plans are covering it, and many companies include it in employee benefits packages as a way to reduce overall health costs.

But it's not for everything or everyone. Telemedicine is used for treating common conditions such as pink-eye and bronchitis. It can help patients manage some chronic conditions. But MDLiveCare doctors will usually tell you to see a doctor in person if you have chest pains or chronic pain. And some bay area doctors are uncomfortable with telemedicine if the doctor and patient don't already know each other.

"It doesn't replace the need to have a primary care physician," said Randy Parker, MDLiveCare's chairman. "It supplements that."

• • •

A visit with MDLiveCare begins in much the same way as going to a doctor's office, Parker said. Patients complete a questionnaire that includes a detailed medical history. They're treated by doctors licensed in their state.

For video conferencing, patients need a web camera, microphone and high-speed Internet connection. Or they can communicate by phone. Parker said doctors are available 24-7, along with technical support personnel.

Patients pay $59.95 a visit, or pay a monthly membership fee of $9.95 (individual) or $19.95 (family), in which the per-visit cost is reduced to $39.95.

The service has become attractive to companies struggling to find ways to deal with rising costs of employee health insurance, Parker said. About 80 percent of MDLiveCare's business comes from people whose employers offer it as part of their health benefits.

When the service was introduced to Fletcher's workplace this year, employees were offered two free visits. After that, they would be charged a co-pay of about $30, she said.

Fletcher, 37, decided to try it when her sinusitis symptoms developed in July. "I knew it wasn't something more than that, so I figured it was safe to try it out," she said.

She came away pleasantly surprised. "I felt I would have gotten the same care from my primary care physician."

Dr. Alfonso, who works in an urgent care clinic in Miami, said many minor ailments can be treated without a face-to-face visit.

But what about checking a patient's vital signs? Alfonso said many patients are able to check their temperature or weight from home; some also can check their blood pressure.

In a case where she would normally listen to a patient with a stethoscope, she instead asks detailed questions. If she's trying to determine whether a patient has pneumonia or a cold, she'll ask how long they've been coughing, what color is their phlegm, whether they have fever, or are able to take in liquids or solids. She also relies on the patient's medical history included in the questionnaire.

But she may also refer that patient to get an X-ray, or ultimately ask that patient to see a doctor in person.

Bottom line: If she's not able to accurately diagnose the patient online, she says she won't.

• • •

Telemedicine has clear limitations. Those who practice it acknowledge it's not ideal for more serious or complex issues. And while MDLiveCare doctors can prescribe medications such as antibiotics and antihistamines, they can't prescribe controlled substances like oxycodone.

"This is not where you're going to get your pain medication," Alfonso said.

A local practice, Tampa-based LoCicero Medical Group, limits the use of its 2-year-old "virtual house call" service to patients who have been seen in person in the group's offices in the past three months, and it's used only for non-urgent health issues or to review lab and diagnostic test results, said Nick Galantino, practice administrator for the medical group.

"We limited the scope of services so that we can maintain the quality of what we're doing," Galantino said.

He said while telemedicine will likely grow in popularity and use, doctors will always be limited in what they can do without direct contact with the patient.

"It's not a way to provide services on a long-term basis," he said.

• • •

Parker and others see telemedicine as a way to deal with the realities of the new health reform law, particularly when it comes to reducing costs. Online visits cost less than typical in-person office visits, and Parker said the service can also help reduce unnecessary and costly trips to hospital emergency rooms.

Some note that the technology can also help doctors provide care for the millions more Americans expected to receive health coverage under the new law.

The number of companies providing telemedicine services is growing. MDLiveCare was among the first when it started several years ago; now there are more than a dozen, including RelayHealth, SwiftMD and American Well.

But others worry about how far telemedicine will go in this regard.

Dr. Larry Glazerman, medical director at USF's Carol and Frank Morsani Center for Advanced Healthcare, is concerned mostly about the absence of the doctor-patient relationship.

"I worry about how effectively a new doctor-patient relationship can be established online," he said. "Would I prescribe anything, even an antibiotic, to someone I've never laid a hand on? That doesn't sit right with me."

Times researcher Shirl Kennedy contributed to this report. Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330.

Telemedicine poised to treat more patients in health care reform era 12/01/10 [Last modified: Wednesday, December 1, 2010 10:56pm]

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