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Doc APProvED

Doc APProvED: Tailor-Made for Enterprising EPs Telemedicine

Mohseni, Alex MD

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doi: 10.1097/01.EEM.0000443922.84347.f7

    Emergency physicians are often the first to jump into new medical trends and to use new technologies. We saw an explosion of urgent care centers over the past decade, and now we are seeing a similar upsurge of telemedicine services. Doctors of all types are making their services available online in their free time, some even full-time. Physicians are drawn by the prospect of controlling their practices and hours and reducing overhead and stress. Patients are drawn to telemedicine services mostly for convenience: no waiting weeks for an appointment, no driving, no waiting in a waiting room, and no expensive co-pays for ED visits.

    Your options are growing daily if you want to dabble in this trend. The easiest option is to join an already established online service, and let them handle all the technology and billing issues. Existing services include,,, and Even Google is getting in on the game; it launched Helpouts in November, an online HIPAA-compliant site where customers can seek advice from any provider, including physicians. All you need, other than your medical credentials, is a computer with a video camera and microphone (both of which are standard on most laptops these days), and a broadband Internet connection.

    Where telemedicine is not fully matured is in reimbursement. Despite recent legislation across many states dictating that telemedicine visits have to be covered by private insurance companies, there are sufficient loopholes and nuances that mean most private payers are not yet covering telemedicine visits that originate from the patient's home (as opposed to a telemedicine consultation with a neurologist in the ED, for example). The explosive growth of flexible spending accounts and large deductibles means more patients are paying cash for a larger portion of their health care anyway.

    Most services typically charge patients about $50 a visit by credit card, and take their cut before giving the rest to the physician. Most set a flat rate, but Google allows the physician to set his own price and takes 20 percent of the total.

    If any group of physicians is good at making diagnoses at a glance, it would be emergency physicians. The next five years will see not only more growth in telemedicine services but also (hopefully) parity for reimbursement.

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