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Facing a PCP Shortage?

A Telemedicine Urgent Care Delivery Model Can Extend Provider Reach



NE TREND in health care: A shortage of primary care physicians is driving more

patients to seek primary care in emergency rooms—and insurers don’t like it. In fact, earlier this year Washington State Medicaid toyed with the idea of denying reimbursements for some ER visits—retroactively, after the visits took place—when the payer deemed them “unnecessary.” The state relented, but not until

after docs sought a court injunction to stop the law. The situation, said the CEO of Tacoma-based Franciscan Health Systems Cliff Robertson, M.D., illustrates the problems the PCP shortage is causing. His system— including 5 hospitals, 70 clinics, and more than 400 physicians—employs telemedicine services from Carena, Inc., which does video “house calls” with patients. Carena provides the physician network and the back-end support for the calls. Presently only self-insured customers can use it, but the health system is negotiating with Medicaid and other commercial payers to create reimbursement schemes so all patients will be covered. Robertson and several Carena executives discussed the program during a panel at the

American Telemedicine Association’s annual meeting. The system has some shortcomings:

Carena docs can’t treat everything via video, and there are interoperability issues between Carena’s and Franciscan’s EHR that they expect will soon be solved when both parties finish an Epic EHR implementation currently in process. Issues aside, Robertson believes wholeheartedly that physician-patient video care encounters will be a service every physician will offer within 5 years.

Giving Patients More Care Right now, while nurse call lines

help insurers and providers stave off some unnecessary doctor visits by reassuring patients who don't need to come in and that they should stay home and tough out whatever their present health problem is, Robertson said that patients tell Franciscan that they want more. They want some actual care advice—not to be told either to come in or not. Telemedicine urgent care is the bridge. “Virtual care delivery models

are going to extend the reach of the primary care provider,” Robertson told SearchHealthIT after the panel, adding

that when he was a practicing PCP, probably 60% of the care could have been handled online. “I believe that within the next 5 years you're going to see more and more primary care docs offering these types of services as part of their practice.”

Telemedicine Can’t Treat Everything Carena launched with the idea

of preventing ER readmissions by dispatching physicians to make house calls to check in on patients. It was costly but less costly than ER visits, which made it appealing to payers, said Carena’s Medical Director Benjamin Green, M.D. The company’s been gaining popularity among patients for several reasons, he added: The rise and ease of use of video technology, improving bandwidth to support it, and a general willingness for patients to learn how to use a new system in exchange for getting live care—where they are—instead of going through the rigmarole of making a doctor’s appointment and getting in to the office. But the technology has its

limitations, Green said. While otitis media (middle ear infections) cannot



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