Advertisement
  1. Archive

Hey Alexa: Please don't charge me an arm and a leg for health care

Virtual medicine outlets like the kiosks popping up at many grocery stores are becoming more prevalent. But the lack of human contact has its drawbacks. [Times 2018)]
Published Jun. 5

Amazon has opened a new health care frontier: Now Alexa can be used to transmit patient data. Using this new feature — which Amazon labeled as a "skill" — a company named Livongo will allow diabetes patients — which it calls "members" — to use the device to "query their last blood sugar reading, blood sugar measurement trends, and receive insights and Health Nudges that are personalized to them."

MORE HEALTH NEWS: New report shows Florida lags in health coverage for pregnant women

Private equity and venture capital firms are in love with a legion of companies and startups touting the benefits of virtual doctors' visits and telemedicine to revolutionize health care, investing almost $10 billion in 2018, a record for the sector. Without stepping into a gym or a clinic, a startup called Kinetxx will provide patients with virtual physical therapy, along with messaging and exercise logging. And Maven Clinic (which is not actually a physical place) offers online medical guidance and personal advice focusing on women's health needs.

In April, at Fortune's Brainstorm Health conference in San Diego, Bruce Broussard, CEO of health insurer Humana, said he believes technology will help patients receive help during medical crises, citing the benefits of home monitoring and the ability of doctors' visits to be conducted by video conference.

But when I returned from Brainstorm Health, I was confronted by an alternative reality of virtual medicine: a $235 medical bill for a telehealth visit that resulted from one of my kids calling a longtime doctor's office. It was for a five-minute phone call answering a question about a possible infection.

Virtual communications have streamlined life and transformed many of our relationships for the better. There is little need anymore to sit across the desk from a tax accountant or travel agent or to stand in a queue for a bank teller. And there is certainly room for disruptive digital innovation in our confusing and overpriced health care system.

But it remains an open question whether virtual medicine will prove a valuable, convenient adjunct to health care. Or, instead, will it be a way for the U.S. profit-driven health care system to make big bucks by outsourcing core duties — while providing a paler version of actual medical treatment?

ALSO READ: Thousands of Florida children have no health insurance. A new infusion of money aims to help.

After all, my doctors have long answered my questions and dispensed phone and email advice for free — as part of our doctor-patient relationship — though it didn't have a cool branding moniker like telehealth. And my obstetrician's office offered great support and advice through two difficult pregnancies — maybe they should have been paid for that valuable service. But $235 for a phone call (which works out to over $2,000 per hour)? Not even a corporate lawyer bills that.

Logic holds that some digital health tools have tremendous potential: A neurologist can view a patient by video to see if lopsided facial movements suggest a stroke. A patient with an irregular heart rhythm could send in digital tracings to see if a new prescription drug is working. But the tangible benefit of many other virtual services offered is less certain. Some people may like receiving feedback about their sleep from an Apple Watch, but I'm not sure that's medicine.

And if virtual medicine is pursued in the name of business efficiency or just profit, it has enormous potential to make health care worse.

My doctor's nurse is far better equipped to answer a question about my ongoing health problem than someone at a call center reading from a script. And, however thorough a virtual visit may be, it forsakes some of the diagnostic information that comes when you see and touch the patient.

A study published recently in Pediatrics found that children who had a telemedicine visit for an upper-respiratory infection were far more likely to get an antibiotic than those who physically saw a doctor, suggesting overprescribing is at work. It makes sense: A doctor can't use a stethoscope to listen to lungs or wiggle an otoscope into a kid's ear by video. Similarly, a virtual physical therapist can't feel the knots in muscle or notice a fleeting wince on a patient's face via camera.

More important, perhaps, virtual medicine means losing the support that has long been a crucial part of the profession. There are programs to provide iPads to people in home hospice for resources about grief and chatbots that purport to treat depression. Maybe people at such challenging moments need — and deserve — human contact.

Of course, companies like those mentioned are expecting to be reimbursed for the remote monitoring and virtual advice they provide. Investors, in turn, get generous payback without having to employ so many actual doctors or other health professionals. Livongo, for instance, has raised a total of $235 million in funding over six rounds. And, as of 2018, Medicare announced it would allow such digital monitoring tools to "qualify for reimbursement," if they are "clinically endorsed." But, ultimately, will the well-being of patients or investors decide which tools are clinically endorsed?

So far, with its new so-called skill, Alexa will be able to perform a half-dozen health-related services. In addition to diabetes coaching, it can find the earliest urgent care appointment in a given area and check the status of a prescription drug delivery.

But it will not provide many things patients desperately want, which technology should be able to readily deliver, such as a reliable price estimate for an upcoming surgery, the infection rates at the local hospital, the location of the cheapest cholesterol test nearby. And if we're trying to bring health care into the tech-enabled 21st century, how about starting with low-hanging fruit: Does any other sector still use paper bills and faxes?

__________

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

ALSO IN THIS SECTION

  1. Hillsborough County Tax Collector Doug Belden told employees Wednesday morning that health problems have forced him to step down at the end of his fifth term, in January 2021.
    After 21 years in the job, Belden plans to retire when his term ends Jan. 3, 2021
  2. Firemen and ambulance attendants remove a body from the Sixteenth Street Baptist Church, where an explosion ripped the structure during services Sept.15,1963 . Associated Press
    Fifty-six years ago, a bomb blew apart the Sixteenth Street Baptist Church, killing four girls and injuring dozens more.
  3. Danielle Harris of Pinellas Park leans against a large photo of Terri Schiavo and her mother, Mary Schindler, during a vigil outside the Woodside Hospice Villas in 2003. Associated Press
    “Terri Schiavo is now a martyr,” one then-state representative said upon learning of her death.
  4. Taylor Bland-Ball, 22, posted this photo and open letter to Judge Thomas Palermo to her Instagram account on September 10, the day after she lost custody of her 4-year-old son Noah McAdams. The boy's parents wanted to treat his leukemia with natural health care remedies instead of chemotherapy. [Instagram] ANASTASIA DAWSON  |  Instagram
    The couple refused chemotherapy for their son, instead seeking alternative treatments including dietary plans, alkaline water and THC and CBD oil treatments
  5. Joe Walsh. [Associated Press]
  6. The U.S. Coast Guard and other agencies have been searching a wide area of ocean between Cape Canaveral and Jacksonville. [Associated Press]
  7. Congressman Charlie Crist (D-St. Petersburg) and Congressman Gus Bilirakis (R-Palm Harbor) recite the Pledge of Allegiance during a Bipartisan Congressional Veterans Advisory Board meeting at the Dunedin Public Library on Monday. [MARTHA ASENCIO-RHINE   |   Times]
  8. Priscilla Shirer plays high school principal Olivia Brooks in “Overcomer,” a new film from the Kendrick Brothers. Photo courtesy of Sony/Affirm Films
  9. The men who create the toys received each Christmas season by many children in Polk County are far from being unblemished elves. [Polk County Toys For Tots/Facebook]
  10. Aug. 16• Archive
Advertisement
Advertisement
Advertisement