jmj11 Posted January 27, 2013 Share Posted January 27, 2013 I heard an ad about Care Simple (total telemedicine for simple problems) and went to their website and checked them out. I am quite curious about this concept because I've been contemplating offering virtual visits for follow up (only not new patients) because I have patients that drive for hundreds of miles. So, what's your thoughts? Do you think that this virtual visit ideas will have a big place in the future of medicine? The concerns of course or 1) this, at this point, must be cash only, 2) malpractice insurers must cringe at the concept. Also, I noticed that, regarding this company, they do NOT use PAs but only MDs and ARNPs. Another line draw to separate PAs out from the herd. Maybe it is due to supervisory arrangements, but it implies that ARNPs and MDs are the only ones that deliver medical care at this level. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted January 28, 2013 Share Posted January 28, 2013 I heard an ad about Care Simple (total telemedicine for simple problems) and went to their website and checked them out. I am quite curious about this concept because I've been contemplating offering virtual visits for follow up (only not new patients) because I have patients that drive for hundreds of miles. So, what's your thoughts? Do you think that this virtual visit ideas will have a big place in the future of medicine? The concerns of course or 1) this, at this point, must be cash only, 2) malpractice insurers must cringe at the concept. Also, I noticed that, regarding this company, they do NOT use PAs but only MDs and ARNPs. Another line draw to separate PAs out from the herd. Maybe it is due to supervisory arrangements, but it implies that ARNPs and MDs are the only ones that deliver medical care at this level. In most states it is illegal to practice medicine from outside that state unless you have a license. So I dont think this will go very far. Maybe a couple fo the big states like cali or new york where there's enough of a population to drum up business within state lines, but thats about it. Link to comment Share on other sites More sharing options...
physasst Posted January 28, 2013 Share Posted January 28, 2013 Yes, it will be a much bigger thing Mike. We are already doing a ton of this. Gordon is correct that you need multiple state licenses, but that is already being done. We are using telemedicine to a big degree and are already providing services in multiple places. One of our breast cancer specialists actually does a ton of consults in Alaska secondary to a contract with one of the tribes. She carries an Alaska license in addition to her one here. I know that one company in central Africa that employed mostly ex-pats was at one point attempting to secure telemedicine services with one of the big major US health care players. This will be done more and more. We are doing it for stroke, etc. It's nice, because patients that may have been transferred don't necessarily need to be, as our neurologists can review the imaging, chart, and do a virtual exam. Cards is doing it as well.... It's becoming a part of any major US healthcare providers business model, and it will be much, much bigger in 10-20 years. Medical tourism is also on the rise, although incoming tourists (to the US are on the decline). However, outbound tourists (US citizens going outside of the US for care) is dramatically rising, and in 2008, IIRC, one hospital alone in Thailand took care of 60,000 US patients. The landscape is changin' my friend. Link to comment Share on other sites More sharing options...
jmj11 Posted January 28, 2013 Author Share Posted January 28, 2013 Here is the fine line. When I worked at Mayo Clinic, many of my patients were out of state (or out of county). I took their phone messages. I made medication changes and called in new Rx to their pharmacies. Even now, I call in Rx to many neighboring states and the pharmacists say it is legal as their care is actually being delivered from my state, where I have a license. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 28, 2013 Administrator Share Posted January 28, 2013 Here is the fine line. When I worked at Mayo Clinic, many of my patients were out of state (or out of county). I took their phone messages. I made medication changes and called in new Rx to their pharmacies. Even now, I call in Rx to many neighboring states and the pharmacists say it is legal as their care is actually being delivered from my state, where I have a license. Right, so in the case of a medical visit where the practitioner is in one state, and the patient is in another... where does the care happen? I would argue that the location of service is the provider, since patients from many places, including local to the provider, are "seen". You pay your B&O taxes to the State of Washington... so why would, say, Alaska be able to regulate care you delivered over the Internet? Link to comment Share on other sites More sharing options...
physasst Posted January 28, 2013 Share Posted January 28, 2013 Here is the fine line. When I worked at Mayo Clinic, many of my patients were out of state (or out of county). I took their phone messages. I made medication changes and called in new Rx to their pharmacies. Even now, I call in Rx to many neighboring states and the pharmacists say it is legal as their care is actually being delivered from my state, where I have a license. Yeah, I'm not sure if it's required, but we simply have our providers engaging in telemedicine get licenses in the states that are needed.....It's all paid for as part of the contracts..... Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted January 28, 2013 Share Posted January 28, 2013 Here is the fine line. When I worked at Mayo Clinic, many of my patients were out of state (or out of county). I took their phone messages. I made medication changes and called in new Rx to their pharmacies. Even now, I call in Rx to many neighboring states and the pharmacists say it is legal as their care is actually being delivered from my state, where I have a license. With all due respect, pharmacists dont have a clue about the regulations governing PAs and MDs. Now what he says may be true in certain states, but I damn sure wouldnt just take the pharmacist's word for it. Most states have specific provisions in their law about telemedicine -- shouldnt be hard to get it straight from the horse's mouth. Link to comment Share on other sites More sharing options...
jmj11 Posted January 28, 2013 Author Share Posted January 28, 2013 Here is an interesting perspective of the American Telemedicine Association. Link to comment Share on other sites More sharing options...
bengreen Posted January 28, 2013 Share Posted January 28, 2013 jmj11: Thank you for checking us out. I'm the Medical Director at CareSimple.com and Carenamd.com (and a family physician). You raise some great points, and I love the discussion. First off, we love our ARNPs, but we are welcoming to PAs as well. It just so happens our practice thus far has been MDs and ARNPs only, due to various older supervision and contracting issues. We started as an MD only group, so we are moving in the right direction, I feel. PAs are absolutely qualified to deliver such virtual care. Clearly, telemedicine is gaining momentum in many areas of medicine, and when used properly and safely, can be very valuable to patients and providers alike. It seems like many of you have been using it quite effectively. From a legal perspective, you are absolutely right that state licensure laws restrict its use and it is critical that providers are appropriately licensed in respective states. The good news is there is a lot of momentum for improving barriers to licensure restriction spearheaded by the American Telemedicine Association. From a malpractice standpoint, our liability carrier is very supportive of our practice as we have clear protocols for treatment in place, and a dedicated/locally trained medical group. I think this is essential to practicing highest quality medicine. Bottom line, technology is changing the practice of medicine. CareSimple is an one example of how we at Carena are changing how providers deliver care and patients access care. I'd be happy to speak to anyone further about what we enjoy doing here. Thank you, Ben Green, MD Medical Director www.caresimple.com Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted January 28, 2013 Moderator Share Posted January 28, 2013 Thank you for responding and answering questions. Also thank you for bringing up the use of PAs and their effectiveness. jmj11: Thank you for checking us out. I'm the Medical Director at CareSimple.com and Carenamd.com (and a family physician). You raise some great points, and I love the discussion. First off, we love our ARNPs, but we are welcoming to PAs as well. It just so happens our practice thus far has been MDs and ARNPs only, due to various older supervision and contracting issues. We started as an MD only group, so we are moving in the right direction, I feel. PAs are absolutely qualified to deliver such virtual care. Clearly, telemedicine is gaining momentum in many areas of medicine, and when used properly and safely, can be very valuable to patients and providers alike. It seems like many of you have been using it quite effectively. From a legal perspective, you are absolutely right that state licensure laws restrict its use and it is critical that providers are appropriately licensed in respective states. The good news is there is a lot of momentum for improving barriers to licensure restriction spearheaded by the American Telemedicine Association. From a malpractice standpoint, our liability carrier is very supportive of our practice as we have clear protocols for treatment in place, and a dedicated/locally trained medical group. I think this is essential to practicing highest quality medicine. Bottom line, technology is changing the practice of medicine. CareSimple is an one example of how we at Carena are changing how providers deliver care and patients access care. I'd be happy to speak to anyone further about what we enjoy doing here. Thank you, Ben Green, MD Medical Director www.caresimple.com Link to comment Share on other sites More sharing options...
Contrarian Posted January 28, 2013 Share Posted January 28, 2013 At my "day job"... One of the MDs on our staff has never set foot in our clinic... she sees ~ 16 children a week in our practice, lives and works from Southern California and is a Child Psychiatrist. Our nurses "room" her little patients, get their vital signs, then quickly orient them and (parents) to the two-way Video screens. She does all documentation directly into the EMR remotely. As I know, our only issue has been that recently, one of the insurance companies just all of a sudden started to refuse to pay for her services "since she isn't in this state." Otherwise... its been working great for the last yr. My ONLY concern about small niche practices like yours and mine implementing Telemed is that as you spoke about in a previous thread... Its already difficult to convince lots of folks that what we charge in our private practices is a value service and expertise worth every penny ... and this is for FACE-to-FACE time. Once you go tele on them... they are likely to expect MUCH more discounted services. So in my practice... the first visit takes about 3 hrs (CH&PE, U/A, Addiction Education and Medication Titration at 30min intervals) and is $300. EVERY follow up visit after that is about 15mins long (U/A, Brief "Relapse Prevention" and Recovery Counseling) and is $150. No one gets a refill without being seen first and the refill is only until the next appointment date. Some of my long term patients, I see for 5mins, because they have the routine down, walk in the door with their payment in hand ready to Pee. The office visit (my addiction medicine experience and most importantly my ability to prescribe them a specific controlled substance and repeatedly refill it) is what they are paying the $150/month for... Link to comment Share on other sites More sharing options...
Guest Paula Posted January 29, 2013 Share Posted January 29, 2013 How do the virtual radiologists handle the licensure issue? I have talked to radiologists who are in Arizona and Hawaii reading our radiology exams in Wisconsin. Are they considered telemedicine? Link to comment Share on other sites More sharing options...
bengreen Posted January 29, 2013 Share Posted January 29, 2013 How do the virtual radiologists handle the licensure issue? I have talked to radiologists who are in Arizona and Hawaii reading our radiology exams in Wisconsin. Are they considered telemedicine? Yes this considered telemedicine, though this is an asynchronous model (store-and-forward in telemedicine lingo). From a licensure perspective, they should abide by same rules though. See this: From the journal, Radiology (http://radiology.rsna.org/content/243/3/613.full): In current practice, radiologists typically obtain a medical license for every state from which they receive images and provide interpretations by using teleradiology methods, in keeping with the standards posited by the ACR (10) that also call for them to be licensed in the state in which the interpretations physically take place. Link to comment Share on other sites More sharing options...
jmj11 Posted January 29, 2013 Author Share Posted January 29, 2013 jmj11: Thank you for checking us out. I'm the Medical Director at CareSimple.com and Carenamd.com (and a family physician). You raise some great points, and I love the discussion. First off, we love our ARNPs, but we are welcoming to PAs as well. It just so happens our practice thus far has been MDs and ARNPs only, due to various older supervision and contracting issues. We started as an MD only group, so we are moving in the right direction, I feel. PAs are absolutely qualified to deliver such virtual care. Clearly, telemedicine is gaining momentum in many areas of medicine, and when used properly and safely, can be very valuable to patients and providers alike. It seems like many of you have been using it quite effectively. From a legal perspective, you are absolutely right that state licensure laws restrict its use and it is critical that providers are appropriately licensed in respective states. The good news is there is a lot of momentum for improving barriers to licensure restriction spearheaded by the American Telemedicine Association. From a malpractice standpoint, our liability carrier is very supportive of our practice as we have clear protocols for treatment in place, and a dedicated/locally trained medical group. I think this is essential to practicing highest quality medicine. Bottom line, technology is changing the practice of medicine. CareSimple is an one example of how we at Carena are changing how providers deliver care and patients access care. I'd be happy to speak to anyone further about what we enjoy doing here. Thank you, Ben Green, MD Medical Director www.caresimple.com Yes, Thanks Dr. Green for commenting. I heard your intriguing ad on NPR. Link to comment Share on other sites More sharing options...
Elmers Posted February 4, 2013 Share Posted February 4, 2013 What are your thoughts on the insurance coverage for telemedicine? Will the insurance companies be willing to cover this? Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted February 5, 2013 Share Posted February 5, 2013 What are your thoughts on the insurance coverage for telemedicine? Will the insurance companies be willing to cover this? Probably but I would expect it to be a very low fraction of an office visit. That might be OK though, because you dont have as much overhead to pay in telemedicine. Link to comment Share on other sites More sharing options...
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