Broadly speaking, yes I think a telemedicine practice could function (successfully) in lots of different ways.
Knowing that you can't offer the same things that an office based practice can – you can make up for it in other ways that are valuable to patients.
Telemedicine is great for:
Preventative health might be harder, b/c people don't always value that – so I wouldn't build the value proposition entirely around this, but make it one of many options. Paint a very broad brush of value to attract the most consumers at the best price.
i. https://imlcc.org/ telemedicine
i. Or better yet, discuss Cologuard options with patients – and then send a fax
i. A transparent fee for service might be desirable to them
ii. A transparent monthly membership fee might save more time/travel/hassle/copay
We can agree to disagree on some issues. We can have fair and civil discussions. But we shouldn't shame a doc for looking for solutions. Which is probably why they felt the need to ask the question anonymously.
The idea isn't too be able to replace all of the physical things about medicine – the idea is to offer an alternative for when all of those things are necessarily required.
Dermatologists do their board exams on pictures alone (not real patients). A doc that is available to help a patient determine what is low / middle / high risk is still helpful. Telemedicine may not be able to do the biopsy, but then again, a number of clinics would refer to derm for the biopsy.
PVCs are rarely caught on physical exam alone, but technology like https://ekohealth.com/ or https://alivecor.com/ open up interesting options for patients that don't have insurance or who have needs not being met by busy clinics.
So then the doctor could design the model to take advantage of technology's strengths while identifying the weaknesses.
Thanks for the additional information – all very interesting.
I've always been curious how docs could do telemedicine to other countries – with the long wait lines in Canada, the UK, and the poor access in other countries, it seems like there are opportunities to help patients in new ways.
Providing telemedicine to the US from another country seems very doable – the beauty of tech is that its not location dependent.
If you did the telemedicine compact, you could be licensed in dozens of states so that you could serve a much wider audience which would help with growth and with finding market fit.
Yes, I think there's lots of patients that don't enough time with their docs and could be interested in some dedicated time/answers/guidance (maybe one time, fee for service) but if they like that, they may also like a membership. People have busy lives and the hassle of getting to the doctors office can actually make their conditions worse.
Home blood pressure monitoring is supported by EBM - https://www.uptodate.com/contents/ambulatory-and-home-blood-pressure-monitoring-and-white-coat-hypertension-in-adults#H16 but you could always ask the patient to go to a fire station for a free blood pressure check to confirm their machines accuracy.
I think most non-abuseable medicines are reasonable to prescribe as long as you have good access to them (email, call, text, video chat) and continuity. I wouldn't start an SSRI on a pt I'm never going to see again, but if they have a membership for monthly access to me, then that's more access than most patients get from their doctors office.
Easy to set boundaries before or at before enrollment about no controlled medicines and an evidence based antibiotic protocol. I actually find most patients are pretty reasonable about antibiotics for colds if you give them time and help with their symptoms.
Wholesale meds: https://www.dpcfrontier.com/dispensing-medications most states allow docs to purchase medications direct from the wholesalers just like pharmacies, and dispense them to their patients. Some docs have seen this before as "3rd party packers" where the cost is grossly inflated. But we can get 100 lisinopril 20mg for $1.99 or 1000 pills for $15.23.
Here's a video: https://recordit.co/kY4WbAR7tX
Wholesale labs: aka "client bill" pricing, you set up a contract with the lab company (quest, labcorp etc) for direct payment w/o no paperwork/approval/denial etc – in exchange for great pricing. Locally a cbc is $1.50
Here's a link to our wholesale med/labs/imaging prices - http://bit.ly/2JoVyJi Yep, getting licensed in other states would make it much easier.
Sherpaa actually was acquired by an employer clinic company, crossover health. But the point still stands.
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