In America, the conventional approach to medical care has been to pay a small ‘deductible’ fee up front, and then have the medical practitioner be reimbursed via a third party insurance company.

While this seems to be the ‘normal’ way things are done today, it wasn’t always this way.

Before 1973, and the introduction of the Health Maintenance Organization Act, many patients paid with their own hard-earned money for primary and specialist care. This was certainly more common in rural areas, where a single doctor might treat an entire town and make a comfortable income from cash payments.

During the late 1970s into the 1980s, the growth of HMOs and employer-paid medical plans meant a shift in consciousness towards insurance-funded medical care began.

Today, those payments that once came out of a person’s pocket are filtered through an insurance company, and eventually back to the doctors.

However, this addition of insurance companies hasn’t made the process easier. It’s made it more cumbersome.

For patients, seeing a doctor via the HMO/PPO ‘in-network’ method can require weeks of patience, and scores of medical forms to be completed before any human contact is given. According to Dr Eric Topol in his book The Patient Will See You Now, “the average wait time to see a doctor across the country is 2.5 weeks”.

For doctors, the volume of paperwork and protocols that must be adhered to recieve payments can be overwhelming.

As Dr Stephen Schimpff states in his article The Doctor’s Customer has become the Insurer: “Since the insurer will determine whether and how much the physician will be paid, [patients] are largely a bystander in the relationship. The doctor’s customer has become the insurer.”
In the year 2015, when most other services bring instant or overnight results, this drawn out process seems almost ridiculous. Yet, it is what the past 30 years of insurance-funded model has created.

But with new technology, comes new hope.

In 2015, according to a recent study by Polycom, most conventional businesses use video conferencing at least once a week. With this practice becoming common place in business, medicine may soon see a return to halcyon days of doctors seeing their own patients through remote video visits, also known as telemedicine.

The ability to save time and reduce inconvenience is driving more and more consumers towards the virtual doctor model, with patients realizing they can save significant money by choosing Telehealth.

In a study by Red Quill Consulting, the average Telehealth visit ranges from $40 – $50, while in-person care can cost as much as $176. For many patients, especially those with minimal insurance, this saving of money and time using telemedicine is a no brainer.

Of course, even insurance companies are now beginning to change their stance on telemedicine. More than half the states and the District of Columbia have passed Telehealth Parity Statutes which require health insurers to provide coverage for services provided via Telehealth if those services would be covered if provided in-person.

Medicare, which has to some extent set the standard, reimburses for Telehealth services when the originating site (where the patient is) is in a Health Professional Shortage Area (HPSA) or in a county that is outside of any Metropolitan Statistical Area (MSA).

The American Medical Association’s (AMA) newly formed CPT Telehealth Services Workgroup recently met in person for the first time last week to create new codes for Telehealth visits. According to AMA President Dr Steven Slack, “Input from the Telehealth services workgroup will help the CPT code set reflect new technological and Telehealth advancements available to mainstream clinical practices.”

The benefits of virtual visits may also soon prove to outweigh the costs, simply through the prevention factor.

In a 2014 cardiac study at Partners Healthcare, 3000 congestive health failure patients received in-home monitoring of weight, blood pressure, heart rate, and pulse oximetry. As a result, readmissions dropped by 44%, saving the health plan $10 million in 6 years.

One fact hasn’t changed in 50 years: paying for healthcare is a personal choice.

Each patient must choose between the expedience of paying out of pocket and the virtual care options now available, or continuing along the conventional path.

With the growth of Telehealth, we are seeing a ‘turning of the tide’, the emergence of a new era of choice for both doctors and the patients they care for.