Telemedicine is Risky Business for Physicians

September 4, 2014

Companies are pushing physician-based telemedicine as a solution. But, while promoters may have not thought things through, physicians must.

Telemedicine is a "cornerstone solution" to achieve the Triple Aim for healthcare improvement, Yulun Wang, Ph.D., president of the American Telemedicine Association Board of Directors and Chairman & CEO of InTouch Health, a telemedicine company, told EHR Intelligence.

While the American Telemedicine Association and other telemedicine stakeholders are pushing telephone and Internet patient visits as viable solutions, particularly for chronic disease, to be adopted immediately, there are steep barriers from payers and legitimate concerns for physicians. Promoters may have not thought things through, but primary-care physicians, whose pay is increasingly tied to quality measures and cost of care, and who are ultimately liable when things go wrong, must.

For the sake of clarity, this does not include remote monitoring technologies. I am a big fan if for no other reason than it is human nature not to cheat when someone is watching.

The basis of Wang's argument is a good reason to be skeptical of his motivation and awareness of how healthcare works. In Wang's opinion, there are not many options for improving care while also decreasing costs. "There aren't many ways to do that, to be frank," said Wang.

Really? Bet you could name the top five without thinking too hard, and telemedicine would not be among them.

Wang also feels that hospital systems, hospitals, and physicians should move aggressively to adopt telemedicine.

This is a curious position since these services are already provided by interim (between physician visit) patient behavioral support providers and systems that specialize in different chronic diseases with physician oversight. These providers have efficient, effective, well-established and proven patient engagement programs, and their services are already covered by healthcare and malpractice insurers.

The EHR Intelligence article poses this question, "Why aren't health systems, hospitals, and physician practices working more aggressively to allow telemedicine to support their move to outcomes-based care?" Because they are the ones on the front line facing three very real issues:

1. Most insurers are not paying for telemedicine visits for a number of reasons including the risk of missing an emerging condition that can be inexpensive to treat if caught and expensive if missed.

2. Malpractice liability is unsettled because precedents have not been established. Without specific tort reform and legislative indemnities at least at the state level and backing from insurers in the form of established payment protocols, it would be unadvisable if not reckless to change anything.

3. There are no best practices established for physician- and hospital-based telemedicine, which in the absence of legislative protection and insurer recognition, presents a high-risk proposition for them.

With the nationwide availability of established providers who have positive empirical experiential data on the quality and efficacy of their outcomes, physician-based telemedicine for chronic disease is neither more intelligent or in touch, and unnecessarily risky and redundant.