Healthcare Musings December 2016

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Telemedicine Does Greatly Benefit Doctors and Their Practices
by Mark P. Seraly, MD

December 2016 - When it comes to telemedicine and the ability to conduct an online medical visit, much has been said about the direct benefits to the patient – particularly as it relates to convenience and time savings. But does offering this new, convenient option for the patient mean more work and burden for the doctor and staff?

It's a valid concern. The good news is that there is ample new evidence to help providers understand that a small investment in telemedicine can lead to a variety of benefits on their side, including patient acquisition, patient retention, office efficiency, favorable economics and expedited and improved delivery of care.

I’ll review each of those benefit areas in this article, but let me first start by introducing my journey with telemedicine as a board-certified dermatologist who sees over 10,000 patients annually in my southwestern Pennsylvania private practice.

Most, if not all, medical providers can relate to this story: one weekend while attending a soccer game for one of my children, it struck me how many emails and texts I was receiving from patients, family, and friends asking for dermatologic advice. It occurred to me that today’s smartphones married with web-enabled technology could free me – and countless other providers – from this complicated reality of people needing care at all hours, my office’s finite resources and schedule, and care compliance.

That was the origin of our company and our teledermatology solution offering. Dermatology is an example of a specialty well suited for telemedicine, being such a highly visual practice area and one where we are trained extensively using photographs. Several teledermatology solutions now exist in this space, offering providers like me the opportunity to alleviate access and care delivery challenges.

After three years of closely studying and optimizing the impact of teledermatology on adopting providers and their practices, I can confidently report these benefits (which may vary based on the area of medicine practiced):

Patient Acquisition

Telemedicine can be an excellent channel for acquiring patients who need care but are having difficulties with access. Access issues can be due to a variety of reasons, including geographical proximity to a specialist; mobility; aversion; lack of insurance; or even simply scheduling constraints. Within my specialty, for example, a 2013 study by Harris Williams & Co. Ltd, reported that fewer than 30% of visits for medical dermatology complaints are seen by dermatologists, largely due to access and limited availability of dermatologists.

That’s where telemedicine steps in as a solution. Once new patients connect with a provider in an online setting, it sets the stage for a longer-term relationship that may eventually involve additional online or in-person follow up care and/or procedures. A Harvard Medical School study published earlier in 2016 found that practices in California offering teledermatology saw a nearly 64% increase in patients seeing a dermatologist.

So for providers who worry that offering online visits will “cannibalize” their practice, they should instead view telemedicine as a new way to acquire patients, satisfy them with quality care, and treat them for years to come, both in and out of the office.

Patient Retention

Your patients today have more options than ever in getting healthcare, thanks to the surge in urgent care centers, retail offerings, and telemedicine apps. As the demand for medical services increases beyond the slots available for in-office visits, patients are going to seek medical care that works with their schedule.

So why test their loyalty? Offering a telemedicine option for your existing patients allows them to continue their care relationship with you rather than go elsewhere. Millennials in particular will be a key demographic to attract and retain, as 60% of them in Salesforce’s “State of the Connected Patient Report” in February 2015 said they support telehealth to eliminate in-person visits.

Office Operational Efficiency

The office is a place of finite resources. There are only so many doctors, PAs, nurses and staff to service patients. There are limited appointment slots and exam rooms. Without adding staff, space, equipment, and materials, all of which come with costs, it’s simply not possible to see 10 or 20 additional patients in person each day.

Yet in some specialties, a certain number of office visits are straightforward cases that can be handled as an online encounter in far less time and with far fewer resources than in the office. Compare an online case requiring 5-7 minutes with an in-person case that averages 20 minutes. If you can move 5 or 10 cases per day online, it can add up to big time savings, which frees up your office for more procedures, complex cases, and detailed annual exams.

To do this successfully will require some investment in staff training, but we’ve done this at my private practice – and last year, I saw over 1,000 online cases. That may sound like a daunting number, but it boils down to about 19 cases per week.

Favorable Economics

The cost outlay is usually minimal, but some staff training time will be needed to get everyone up to speed with the new offering and how to introduce the service to relevant patients.

With those minor investments, the return can be significant – patient acquisition, patient retention, and operational efficiency.

Telemedicine allows you to easily scale. Imagine having multiple providers in the same practice seeing patients online; now you have essentially doubled the productivity and the economic benefits for the practice. Conservatively, we find that, in dermatology, practices can see a minimum 10-fold return on investment annually on a telemedicine offering.

But What About the Quality of Care?

By providing patients in need with better access to specialists, we reduce the chance that they will defer treatment or get misdiagnosed elsewhere. And for cases not well suited for online visits or that require further diagnostics, the provider can simply refer them for an in-office appointment.

I recommend that any provider who is reviewing telemedicine platforms evaluate the options against a standard clinical workflow, to ensure adherence to quality care standards.

While dermatologists are a natural fit for delivering online care, the potential for telemedicine is much broader. Among providers, there is a need to better understand telemedicine’s impact and benefit potential. I hope I’ve illustrated examples within my field of dermatology practices of how the benefit opportunity can far outweigh concerns and investment.

About the Author

Mark P. Seraly, MD is a board-certified practicing dermatologist in Pennsylvania and founder of Iagnosis and its teledermatology platform DermatologistOnCall®. Dr. Seraly also serves as the vice chair of the American Telemedicine Association’s teledermatology special interest group. He is also a member of the American Academy of Dermatology Telemedicine Task Force and a sustaining member of the Dermatology Foundation’s Annenberg Circle.

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