The Doctor Will Click on You Now, but Can She Feel Your Pain in an E-Visit?

http://www.bloomberg.com/

Health insurers want you to see the doctor, just not in an office or hospital.To cut medical costs and diagnose minor ailments,WellPoint Inc. (WLP) andAetna Inc. (AET), among other health insurers, are letting millions of patients get seen online first. In a major expansion of telemedicine, WellPoint this month started offering 4 million patients the ability to have e-visits with doctors, while Aetna says it will boost online access to 8 million people next year from 3 million now.

The insurers are joining with companies such as Teladoc Inc., MDLive Inc. and American Well Corp. that offer virtual visits with doctors who, in some states, can prescribe drugs for anything from sinus infections to back pain. While patients with time constraints like the idea, some doctors say they worry that online visits may offer a higher potential for wrong diagnosis. A stomach ache may be nothing, or it could be appendicitis, said R. Adams Dudley, at the University of California, San Francisco.

“Just one little touch can make a big difference” to feel where the pain is at, said Dudley, a professor of medicine and health policy at the school. For symptoms doctors need to see, “some computer screens just don’t have the best resolution, and you can’t really adjust the lighting.”

Peter Antall, a pediatrician, heads the Online Care Group, which provides doctors for American Well. He says that while “there are some things we can’t do,” he remains confident that doctors from his group have the skills to know when more intense care is needed. At the same time, online care can serve a host of needs, he said, from cutting consumer and insurer costs to giving busy or isolated patients easier access.

It’s a debate that has included the American Medical Association, which last month offered new guidelines to shape telemedicine’s development; state licensing boards that agreed on their own draft policy in April; five of the nation’s top publicly-traded health insurers; and a small group of closely held telemedicine companies convinced their time has come as concerns about medical cost and access rise.

The discussion promises to escalate as patients become increasingly sophisticated in their online pursuits, delays in making doctor appointments grow longer, and the cost of services provided by medical centers increases.

The median cost for an ER visit has risen to $1,223, according to a study published in 2013 in the journal PLoS ONE. Meanwhile, it costs less than $50 to visit Teladoc, American Well or MDLive, according to the company websites.