We get paid to see patients. So what happens when patients aren’t in the room? This is a big and growing issue in medicine.
I do hospital call on weekends, and occasionally have a long meeting with families. In some cases, this involves a large group in a conference room. These meetings can take quite a bit of time, but technically, since the patient isn’t present, it requires different charges than if he was. Even if the whole meeting is about the patient.
Office visits are often the same way. It’s not uncommon for the family of an Alzheimer’s disease patient to want to meet with me without the patient. They’re reluctant to bring up the problems with their loved one present, or to discuss the future.
Unfortunately, these aren’t usually covered by insurance (although this is slowly changing) so families have to pay cash for them, even if they have a direct impact on patient care and take a lot of time.
Telemedicine is the same way. Although it’s getting easier to get visits paid, it’s still not consistent. After all, the patient isn’t physically in the room with you, either. This one, though, at least is starting to take off. But it still has a long way to go.
To date, I haven’t done telemedicine. In a small practice, I can’t afford to lose money on visits, so I don’t plan on starting these until the reimbursement is higher and more consistent. I have to keep the lights on for the patients who depend on me. Not to mention that there are liability issues with it since you are unable to examine the patient more than just by sight.
I’m surprised that it’s taking so long for these visits to catch on. If I see someone in my office, I may get paid $80, but if I do it remotely, even for the same amount of time, I get $0. In an era where people are pushing “patient-centric” care, you’d think telemedicine would be about as patient centric as you can get. But apparently not, given the reluctance of many insurers to cover it. And if it’s not being adequately covered, many of us can’t afford to do it. This is, after all, a business.
There needs to be a better realization among payers that patient care doesn’t always involve the patient being physically present, even though we’re still trying to help them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
