The physician shortage we’ve been warned about is expected to arrive in only 10 years. According to the Association of American Medical Colleges, by 2025, the United States will be dealing with a deficit of more than 130,000 practitioners, including primary care doctors and specialists.
This coming shortage has implications for healthcare delivery, as well as healthcare costs. If there are too few physicians, workers’ compensation insurers will have difficulty connecting doctors and patients, leading to lost time. It goes without saying that longer claim durations go hand–in-hand with reduced patient satisfaction and higher claim costs.
It is a point of pride for AMR that the majority of our medical reviewers are also physicians who maintain an active practice. The physician shortage, therefore, could also impact the availability and speed of quality medical reviews. Finding new ways to make healthcare delivery more efficient, including electronic record keeping and telemedicine, will preserve crucial services, such as medical reviews.
Providing care from a distance
Telemedicine, a system where doctors and patients interact through phone or video conferencing, has traditionally been utilized to deliver healthcare in rural areas where the nearest physician could be many miles away, hindering prompt face-to-face care.
In emergency or disaster scenarios, new wearable technology such as Google Glass might become useful in delivering telemedicine, but more research needs to be done. More common video tools, such as iPads equipped with the FaceTime app, are already in use, and can help avoid unnecessary expenses, according to Peter Greaney, MD, medical director, president and CEO of WorkCare, Inc., a physician-owned and managed occupational health services company. At the site of an injury, an iPad can quickly connect first responders with physicians. In a Risk & Insurance article, Greaney said, “The goal is to maintain self-care and avoid unnecessary transport.”
In addition to containing costs, telemedicine also provides a way for patients to see providers without putting other patients at risk for communicable illness. Doctors in Tennessee, where flu levels reached epidemic levels in January of 2015, used phone consultations to diagnose cases of flu and prescribe antiviral medication. This approach cut costs by avoiding office visits and bypassing testing, and protected other patients from infection.
In an ABC News story, Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville was asked about the safety of skipping flu testing. “If you’re really feeling crummy and you have the symptoms of influenza, your chances of having influenza are very, very high – over 90 percent. Doctors are saying I don’t need to do a test because sometimes the test is negative even if you have influenza.”
As of right now, not all telemedicine costs are reimbursable, according to the U.S. Department of Health and Human Services. For example, Medicare will pay only when the patient’s location or “originating site” is in a Health Professional Shortage Area (as defined by the Health Resources and Services Administration) or in a county that is outside of any Metropolitan Statistical Area (as defined by the Census Bureau). Additionally, the originating site must be a medical facility and not the patient’s home.
Regarding private payors, there is no accepted standard for coverage of telemedicine, resulting in patchwork payment. In some cases, telemedicine may require prior approval; other insurers will reimburse for a variety of such services. A 2015 report by the American Telemedicine Association showed that only 6 US areas have a supportive policy landscape that encourages telemedicine use: Virginia; Tennessee; New Hampshire; New Mexico; Maine and Washington, DC.
Increasing our use of telemedicine may be inevitable and can ultimately benefit payors and patients, alike; however, there are some challenges to address before telemedicine becomes more common.
Most patients haven’t experienced telemedicine yet, and could feel unsure about video interfacing for potentially sensitive or private medical problems. Patients may also be uncomfortable receiving care from a doctor they have never met in person.
Physician licensing is another issue that can limit the broad use of telemedicine. Normally, licensing determines where doctors may practice – if a telemedicine network requires licensing in multiple states, doctors may opt to skip the hassle and expense. In addition, from the physicians’ perspective, lack of physical contact with the patient may potentiate a request for more diagnostic tests to make up for a traditional physical examination.
There is no doubt that a shortage of caregivers will be countered by a continuing increase in the number of individuals requiring quality healthcare. Telemedicine offers a promising tool for bridging that gap.