Joel Diamond MD, FAAFP, is an adjunct associate professor of biomedical informatics at the University of Pittsburgh. He is a diplomat of the American Board of Family Practice and a fellow in the American Academy of Family Physicians. He cares for patients at Handelsman Family Practice in Pittsburgh –an independent practice the offers telegenetics – and serves as Chief Medical Officer for 2bPrecise.
Embrace new tech and clinical services to remain independent while continuing to achieve clinical excellence and business stability.
Independent physicians, particularly those in primary care, have traditionally succeeded in attracting and retaining patients because they are local, conveniently situated to the patients they serve (perhaps even neighbors), and often highly recognizable in their communities. The coronavirus-fueled tsunami that has driven rapid adoption of telemedicine threatens this paradigm.
Location and convenience are no longer key considerations when patients can access any provider, anywhere. Weighed against these advantages, the comfort of personal familiarity likewise becomes less important.
To remain independent while continuing to achieve clinical excellence and business stability, practice leaders must embrace telehealth themselves, and find ways to leverage new technologies and clinical practices.
Telegenetics is one such opportunity. Of the four primary determinants of health–genetic predisposition, behaviors, medical services received, and social and physical environment–genetics may account for up to 30 percent of a patient’s wellbeing1. With genetic and genomic test results in hand, independent physicians are better equipped to identify patients who are at risk for heritable conditions, arrive at precise diagnoses that may enable faster treatment, and consider targeted therapies and clinical trials with the potential to be highly effective based on the patient’s molecular profile.
And telegenetics is ideally suited for the virtual-visit environment of 2020. Providers can schedule billable telehealth consultations with candidates for genetic/genomic testing to discuss options and potential value, as well as follow-up virtual visits to discuss results and what the test might mean for current and future clinical decisions.
Consider pharmacogenomics (PGx). Increasingly, PGx is viewed as an essential component of medication safety. PGx testing reveals how well patients metabolize specific medications, based on drug-gene interactions and, more and more frequently, on drug-drug-gene interactions. Innovative independent primary care physicians are engaging their staff to identify polypharmacy patients (often the elderly who prefer to avoid face-to-face visits right now) and patients who have failed a first- or second-line therapy (e.g., for depression, hyperlipidemia, or hypertension). These patients can be scheduled for a consultation to discuss PGx testing, which can be conducted at home with a simple cheek swab. Test results are reviewed virtually, and the provider can make medication adjustments if indicated.
Rarely are independent providers presented with a win/win/win situation like this:
Additionally, telegenetics can help level an increasingly competitive playing field. Independent practices can demonstrate that they offer highly innovative and personalized care. Those leading the way with precision medicine in their communities report that their ability to offer genetic/genomic counseling has allowed them to differentiate from competitors–and increasingly accessible remote specialists–to attract patients.
Barriers that previously discouraged independent physicians from adopting precision medicine are quickly being removed. Payer requirements that a genetics counselor review test results and meet with the patient are diminishing. This is being accelerated by the rise of direct-to-consumer genetic testing where counseling is being offered only when “necessary” and increased provider confidence in their ability to access decision support tools as they factor genetics/genomics into care plans.
It is clear that the delivery of healthcare will forever be changed by the current pandemic. This shift need not be a death knell for independent practices, particularly those who are agile and visionary enough to embrace new approaches such as telegenetics.
1 American Action Forum, September 4, 1918: https://www.americanactionforum.org/research/understanding-the-social-determinants-of-health/#ixzz6Q6U5WSOj
JOEL DIAMOND, MD, FAAFP, is an adjunct associate professor of biomedical informatics at the University of Pittsburgh. He is a diplomat of the American Board of Family Practice and a fellow in the American Academy of Family Physicians. He cares for patients at Handelsman Family Practice in Pittsburgh –an independent practice the offers telegenetics – and serves as Chief Medical Officer for 2bPrecise.