The Congressional Budget Office estimates that an additional 11 million people will be newly insured under Obamacare next year, and up to 24 million more people will have insurance by 2016.
Health care organizations are gearing up to absorb the greatest number of newly insured patients since Medicare enrollees began signing up in 1966. And consumers have granted convenience medicine a place in the changing health care market. One study compared traditional office visits to e-visits at four primary care practices for two conditions: sinusitis and urinary tract infections. The patients in the study used their own physicians for both types of visits. Researchers found equivalent rates of follow-up care, indicating equal rates of misdiagnosis or failed treatment. They found similar rates of patient satisfaction. But they also found a trend toward higher rates of prescriptions for antibiotics as a result of e-visits, leading them to speculate that without a hands-on exam, doctors may use a more conservative approach and be quicker to prescribe an antibiotic.
Other studies largely suggest that electronic visits with primary care doctors provide lower-cost care with similar quality outcomes to traditional trips to the doctor's office. They're useful for common, short-term ailments and health advice, not more serious or chronic diseases, and patients who need hands-on exams, lab work or imaging tests are referred to doctors' offices, clinics or emergency rooms for care.
But the health care system in general is moving toward less-fragmented care, and any new players need to work with established systems and physicians if they are to provide consistent, efficient care for patients. "I live in Nevada. Some of my patients live 300 miles from anywhere," says Dr. Daniel Spogen, board member with the American Academy of Family Physicians. If one of his patients had a consultation with a telehealth provider, he'd want to see the medical record. "The ability to increase accessibility for patients can really be a benefit of using telehealth technology," he says. "What's very important is that it doesn't operate independently, but serves as another arm for getting overall information on that patient."
Research shows that when patients get their care from multiple physicians who don't communicate with one another, services are duplicated and the quality of care goes down, adding to the overall cost of health care. Ideally, a record of each outside medical encounter should be shared with a patient's primary care provider. But only patients themselves can approve the transfer of their medical records. Schoenberg says American Well physicians strongly encourage patients to approve sharing the records with their own doctors. "We go a long way to make sure that full documentation of the encounter is passed on to the primary care provider," he says. "But if a patient says no, we can't force it."
Medicine will always need expert hands-on care to listen to a heartbeat, collect a urine sample, or feel for a lump. But sometimes people don't need to drag their achy bodies into a car, drive for 45 minutes, and sit in a waiting room with other sick people for a half an hour only to be told their cold symptoms are normal and will run their course. For many such patients, Schoenberg says, "…click, click, click, and you see a physician."
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