It’s late. You don’t feel well; in fact, you feel so ill that you think you need to call your doctor. You call your primary care physician because you know they can remotely access your electronic health record and that your physician knows you and your health history. Your physician provides continuity of care that is coordinated and comprehensive. They diagnose the problem.
Some, in similar situations, are opting to seek care provided by someone other than their primary care physician and, in fact, are being encouraged to do so by their insurance company. Care through telemedicine is being promoted by two large insurance companies in Ohio. You chat by video with a physician you have never met, who has no historical knowledge of you and your health history, who has no access to your medical records, and who lacks the appropriate diagnostic equipment to examine you. According to State Medical Board of Ohio regulations, such care fails to meet their established minimal standard of care.
Yet, this is the care these insurance companies are encouraging you to seek. And, they incentivize telemedicine care by paying a telemedicine physician for chatting with you via video, but refuse to pay your own personal physician for providing you after hours care via phone or email.
Our current health system undervalues primary care and, as a result, health care spending in the United States is more than double that of other industrialized countries, yet America ranks 24th out of 30th in life expectancy. These insurance companies are contributing to the problem by further fragmenting care through promoting the use of telemedicine services over contacting your own primary care physician for care. We know that a strong primary care-based health system leads to better health and better care at lower cost but this is, yet again, another example of insurers incentivizing the opposite – fragmented, episodic care that is not comprehensive and that lacks continuity.
Telemedicine can vastly improve access to care and convenience but we must not lose sight of the fact that quality and safety must be ensured. Technology that supports and fosters the connection between patients and their physicians is vital and should be supported by everyone. But, insurance companies’ incentivizing use of technology that drives patients to seek fragmented care outside the medical home is counterproductive. Instead of paying physicians to care for patients they don’t know and can’t examine, pay the patient’s physician-led primary care team to provide comprehensive, continuous, and comprehensive care.
Reimbursing for care provided by the patient’s primary care physician via telemedicine certainly makes more sense than what is happening now.
Stewart is a family physician in Johnstown and the President of Ohio Academy of Family Physicians