For many urgent care providers, telemedicine is a competitor that’s siphoning off patients.
That’s not the view of Doctor’s Care, which is ramping up its use of telemedicine as a way to give patients more options for receiving care.
The chain of 55 centers in South Carolina and Tennessee is expanding its offerings with a minimal investment in technology, using information and communications systems that it already has in place.
While many urgent care center operators are wary that telemedicine might divert patients from its facilities, that’s not the view of David Boucher, president and chief operating officer of UCI Medical Affiliates, which provides non-medical support services for the chain and operates the centers.
“This is something that we need to do,” Boucher says. “This is just looking at this as a consumer, and when we did that, we just said that this is where [care] is going, and so we have to have some kind of service offering here.”
Doctors Care first began examining telemedicine in 2013, studying it as a way to balance loads between its facilities. Wait times at some of its urgent care sites could be three hours or more, while other locations had no wait times. By equipping facilities with telemedicine capabilities, it would be able to offer patients at busy facilities the opportunity to be seen immediately and remotely.
While some urgent care operators have had mixed results with using telemedicine for load balancing, Doctors Care found that patients opted to be examined remotely. In all those examinations, a nurse or medical assistant is with patients in the facility at which they present.
In its load balancing approach, there’s a high-definition connection for the sites, and an all-in-one camera supports otoscope and dermatology examinations of the eye, ear, nose, throat or skin. Bluetooth-enabled stethoscopes are used at both presentation and provider sites, and patients are able to have lab and X-ray procedures at the presentation site; physicians examining patients remotely can switch to another patient until these tests are run.
The IT investment for load balancing was small, Boucher says. Rather than installing completely new infrastructure to support telemedicine, Doctors Care was able to build off its existing telephone and network infrastructure from Cisco.
The capability helped Doctors Choice achieve two of its key goals of reducing patient wait times and increasing patient satisfaction, says Boucher, who is giving a presentation on the chain’s experiences at this week’s spring conference of the Urgent Care Association of America in Orlando, Fla.
“We now have patients that come in and don’t care if there’s no wait time in one of our sites—they want to be seen by telemedicine,” he says. “Because of the technology, a telemedicine exam allows them to see what the doctor is seeing on the screen.”
Certain types of simple conditions lend themselves to examinations by telemedicine consults, such as sinusitis, upper respiratory illnesses, fever, ear infection, sore throat, eye infection, lice infestations, mild skin conditions and chronic care management.
Doctors Care has since expanded the telemedicine to offer direct-to-consumer consultations, which Boucher believes will expand the chain’s opportunities for seeing patients. Other telemedicine providers are already reaching out to consumers, so it doesn’t make sense to avoid offering the service, he says.
“One of our centers might be getting $150 for a visit, and some people might say that we’re giving our services away if we offer it for $59 by telemedicine,” he says. “We don’t want to wake up some morning and find that our volume has dropped 50 percent because we’ve been disintermediated by other telemedicine providers.”
The investment to expand its existing telemedicine capabilities was small, on the order of $50,000, he says.
Some urgent care providers are wary of telemedicine because they view it as a threat to their businesses, says Alan Ayers, vice president of strategic initiatives for Practice Velocity, a Rockford, Ill.-based vendor that provides technology and billing capabilities for urgent care centers. Telemedicine is not currently taking business from urgent care now, but that could change in the future, he says.
“Longer term, we do see urgent care cases increasing in acuity, and if urgent care is going to be an alternative to the emergency room, providers should be treating conditions that are just short of those that need to go to the ER,” Ayers says. “It’s not necessarily a bad thing that telemedicine would take away some of the routine, low-touch care.”
In addition to load balancing, telemedicine could enable centers to provide more care offerings in more venues, such as occupational health, or help operators make better use of specialists’ time or offer specialist services at facilities without having to increase staffing.
But some in the industry view direct-to-consumer care as a business risk, he says. “If you’re running an urgent care center that’s not too busy, that can provide added revenue, but ultimately, many in the industry may feel that those services may cannibalize their business.”
However, telemedicine marketed directly to consumers is still relatively new, adoption is early and it has not affected patient volume at urgent care centers, says Bernie Kuhn, MD, a principal with Merchant Medicine, a consulting firm that offers services to urgent care operators.
“Telemedicine is looking to treat the same subset of episodes now seen in retail clinics, and there are only so many patients to go around,” Kuhn says. For the firm’s urgent care clients who have started offering direct-to-consumer telemedicine services, increased volume “really hasn’t materialized. Physicians do it for a few months, and then they lose interest.”
Because of the limited panel of conditions suited for direct-to-consumer telemedicine, Kuhn doesn’t believe that it poses a challenge for urgent care centers, which fill a gap in which patients may come only once or twice a year to a center for urgent, but not emergency care. “In those cases, the physician actually needs to touch the patient,” he says. “This is one of the areas we’ve been following, and we think it’s all hype.”
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