Insurance Coverage Questions
Asif Ansari, MD, regional medical director at Montefiore Medical Group in New York, told this news organization that his experience as a PCP “has led to the conclusion that care delivered by a patient’s own provider is superior, whether in person or via telemedicine. Nothing can replace that relationship, level of familiarity, and access to personal health information.” Dr. Ansari was not involved in the study.
The study did not include virtual visits with another physician in the same clinical group, he noted. A physician in the same group “likely operates on the same electronic health record, which contains valuable information including medical problem lists, lab results, medication lists, and allergies. Theoretically, access to such information would lower ED utilization. This is a significant missing piece when we look at the overall impact of virtual care.”
More patients are now looking for the convenience and access that virtual medicine provides, noted Dr. Ansari. “If we do not appropriately leverage this tool in primary care, we will see more and more external entities enter the field, leading to further care fragmentation.”
“The rate-limiting step may be what the insurers cover as they review future trends in utilization and quality metrics,” he added. “It is important [for us] as clinicians to thoughtfully engage and help determine where the future leads us in the interest of our patients.”
Steven Shook, MD, lead for virtual health at Cleveland Clinic in Ohio, also commented on the study for this news organization. He noted that without additional information, “it’s hard to say that the two groups they’re comparing are identical. For example, patients who are self-selecting to do virtual visits with an outside physician or direct-to-consumer telemedicine may have good reasons — maybe they can’t see their own doctor in the hours available, or maybe their own doctor doesn’t do virtual visits. We don’t know the urgency of the need to see a doctor. So, lots of factors aren’t included or measured in this study.”
Future studies need to assess how virtual visits affect the total cost of care, Dr. Shook added. “It’s not just whether the patients end up in the ED, but whether we may be more likely to order an MRI because we can’t lay hands on the patient. And we need to know how the need for any additional tests affects the patient’s diagnosis and outcome.”
Overall, Dr. Shook said, “virtual visits need to be integrated into patient care. They need to be part of a comprehensive program that primary care practices provide to a patient, to balance the access, convenience, and continuity that comes with that.”
The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care. The study also received funding from the MOH through a grant awarded to Dr. Lapointe-Shaw and a project grant from the Canadian Institutes of Health Research awarded to Dr. Lapointe-Shaw and another coauthor. Dr. Lapointe-Shaw, Dr. Ansari, and Dr. Shook reported no conflicts of interest.
A version of this article appeared on Medscape.com.