By Ashley M. Casey
Staff Writer
Coming down with a bug is tough enough. But it’s even tougher when you have to pack your sniffling (or worse, puking) kids into the car for a trip to the doctor’s office or urgent care. After spending what seems like an eternity in the waiting room, surrounded by other people’s germs, you finally see the doctor.
The hassle of treating minor acute illnesses could be eased by telemedicine: a video visit with a board-certified physician. While the technology of telemedicine is relatively new, it shows promise. A survey of Upstate New Yorkers by Excellus, which rolled out telemedicine for certain insurance plans this year, showed that 80 percent of respondents who had used telemedicine rated their experience as “very good” or “excellent.”
“We’re seeing very high satisfaction rates,” said Dr. Martin Lustick, corporate medical director and senior vice president for Excellus BlueCross BlueShield.
According to Lustick, 82 percent of those who had used telemedicine said they would use it again.
“Once people try it, I think they find that it’s convenient,” Lustick said.
In fact, 48 percent of telemedicine users ranked convenience as the No. 1 reason they used the service. The ability to be seen immediately was ranked the most important feature of telemedicine. During the week, more than half of telemedicine users accessed the service between 6 a.m. and 6 p.m., but on the weekends, usage peaked between 6 p.m. and 6 a.m.
Lustick stressed that telemedicine is best used for minor acute conditions such as rashes and insect bites, cold and flu, nausea, constipation and diarrhea. Such minor illnesses are considered potentially preventable, according to Excellus, and “could have been treated outside of the emergency room or their conditions could have been avoided altogether through better care coordination and quicker access to primary and preventive care.” Potentially preventable illnesses account for 9 out of 10 emergency room visits.
“What’s being implemented now with minor acute illnesses can help with availability so people don’t have to go to the ER, but it doesn’t really replace a primary care doctor,” Lustick said.
Indeed, the majority of those who have used telemedicine prefer an in-person visit with their primary care doctor, but a virtual visit with a doctor could be convenient after hours and may reduce the risk of spreading — or catching — germs in the waiting room.
“I’m a pediatrician, so when I was in practice and people called in and we thought they had the flu, we tried to keep them out of the office,” Lustick said. “Kids can avoid coming in and avoid exposing people in office.”
The downsides of Dr. Skype
Telemedicine does have its limitations. While the service is less costly than an in-office visit or a trip to the ER, very few people are actually using telemedicine. Only 3 percent of Central New Yorkers surveyed have actually used the service, although 23 percent said they plan to use it in the future.
Also, few primary care providers have signed up for telemedicine. If your practice offers the service, likely you will not see your own primary care provider, but one of the physicians on call through the telemedicine provider. Excellus contracts with MDLIVE for its telemedicine services.
“It would be nice if people were seeing their own physician,” Lustick said.
Because the visit is conducted by video, telemedicine physicians cannot measure a patient’s vital signs or perform a physical examination.
“Obviously, they can’t lay their hands on you. The physical exam is limited to visual inspection, looking and listening,” Lustick said. “If they don’t feel they can adequately evaluate you, they’ll tell you you need to be seen [in person].”
Connecting rural areas with specialist care
Despite the limitations of telemedicine, it is useful in rural areas that may have a shortage of specialists.
“The specialists there will be able to provide services to distant rural areas whether it’s in conjunction with primary care providers … or directly,” Lustick said.
Lustick said he knows of a neurologist in Upstate New York who follows up virtually with patients who have movement disorders such as Parkinson’s, which can make traveling to a faraway doctor’s office difficult.
Dr. Robert Gregory, professor of psychiatry and behavioral sciences at SUNY Upstate Medical University, said telemedicine has been a boon to patients in underserved areas. In fact, last month’s report from the Youth Mental Health Task Force, headed by 129th District Assemblyman William Magnarelli (D-Syracuse) and 24th District Congressman John Katko (R-Camillus) recommended the use of telepsychiatry to reach young people in rural areas that lack adequate mental health services.
“Many of the outlying communities have a dire shortage of psychiatrists, especially child and adolescent psychiatrists,” Gregory said.
Through Project TEACH, the New York State Office of Mental Health oversees programs that virtually connect psychiatric providers with primary care providers. Gregory said SUNY Upstate Medical University collaborates with the University at Buffalo, University of Rochester, Columbia University Medical Center/NY State Psychiatric Center, and Hofstra Northwell School of Medicine in the Child and Adolescent Psychiatry for Primary Care (CAP PC) program.
“There are many primary care physician groups who don’t have access to psychiatrists but are struggling with very ill children,” Gregory said. “[Psychiatrists will] meet with the primary care team through televideo. They’ll also meet face-to-face with clients and provide recommendations.”
Lustick said the overhead costs of telemedicine are much lower than the costs of operating a traditional medical office. According to Gregory, the equipment need not be expensive. The telepsychiatry specialist and the primary care provider each needs a device capable of video chatting, such as a computer or smartphone.
Many video chatting programs are free or low-cost, but encryption of the video calls is important to protect patient data and privacy. Zoom videoconferencing software and Apple’s FaceTime devices come with encryption, and while Gregory said Skype is less well encrypted, the technology is improving.
Accessibility for all
While not all Excellus plans grant subscribers access to telemedicine services, the technology is becoming more widely available across New York state. Albany-area medical group Community Care Physicians recently unveiled its virtual care app, VICA – Virtual Care. The app went live Feb. 14 and is available to any New Yorker with an iPhone.
“VICA – Virtual Care allows people easier access to the medical care they need from a physician group in New York that they may know of and can trust,” said Dr. Rommel Tolentino, physician lead on the project and practicing physician at Schodack Internal Medicine and Pediatrics of Community Care Physicians. “It’s efficient and cost effective and patients can save on wait and travel time.”
Users do not need to be a patient of Community Care Physicians, but VICA providers can access a patient’s records electronically if they are part of the CCP group. If you’re not a CCP patient, a VICA provider can still send prescriptions to your preferred pharmacy, provide your primary care provider with a summary of your visit and coordinate follow-up care.
Currently, most insurance companies do not cover VICA consultations, which cost $45. VICA’s hours of availability are limited to 8:30 a.m. to 4:30 p.m. Monday through Friday, but the company may extend the hours based on patient demand. VICA should be available for Android users within the next six months. To learn more about VICA, visit vicaccp.com.
As for other telemedicine services in the state, Gregory said CAP PC has been so successful in treating children and adolescents with psychiatric issues that the state Office of Mental Health is expanding funding for the program. Lustick said telemedicine is poised for an explosion in use.
“There are experts predicting orders of magnitude in increases in adoption,” he said.
Lustick said Excellus’ MDLIVE program is proving popular, especially with younger people.
“My own son in college got a sinus infection treated through the program at MDLIVE,” Lustick said. “He said, ‘I don’t think I’m going to go to the clinic at school anymore.’”
Nevertheless, Lustick said telemedicine is best used in conjunction with regular visits to a primary care provider, and telemedicine providers should treat simple conditions.
“For people who have complex chronic conditions, they will certainly get better care if they see their regular doctor,” he said.
To see the results of Excellus’ telemedicine survey, visit bit.ly/telemedicinesurvey.
