While our main focus is the old school house call, Pre-R also offers some tele-medical consultation, because we believe the globe (not just the US) is at the very beginning of a telemedicine revolution.

However, the points made in this Wall Street Journal article: “How Telemedicine Is Transforming Health Care” make it clear that governments, insurance companies and doctors themselves are probably going to gum up a potentially beautiful thing.

From my vantage point, I don’t view medical conversations on the phone or Facetime as a great revenue stream. To me, they’re an interview, in two directions. Patients get to size me up, and I can choose what seems like the best next step toward answering their problem. I can also kindly point them elsewhere if they demand apples rather than my oranges. Maybe I can solve the problem by phone or in their homes, or maybe I’ll point them to student health, another doctor, or the ER. Maybe I’ll just suggest some over the counter meds.

I don’t care if the call is from out of town, state or country, and only if a prescription or house call is needed do I get the correct spellings of names. Folks call with some kind of medical question or need, and I try to steer them straight with the least amount of hassle on both ends. Sometimes they throw us a bone on Paypal to say thanks. If patients need me to call in a prescription or come for a visit, there is a higher chance we’ll be paid.

However, attempts to monetize telemedical advice for the common cold, or to process such advice through insurance, or to regulate thousands of medical texts and conversations that cross between states, all just seems nutty. Low hassle, low harassment medicine is our mantra.

Here are some quotes from the article mentioned above that wound me right up:

• “In a poll of 1,500 family physicians, only 15% had used it in their practices—but 90% said they would it if were appropriately reimbursed.”
• “Rules defining and regulating telemedicine differ widely from state to state and are constantly evolving.”
• “And there’s the question of what services physicians should be paid for: Insurance coverage varies from health plan to health plan, and the big federal plans cover only a narrow range of services.”
• “Consulting a random doctor patients will never meet… further fragments the health-care system, and even minor issues such as upper respiratory infections can’t be thoroughly evaluated by a doctor who can’t listen to your heart, culture your throat or feel your swollen glands.” A random doctor is better than one you can’t get an appointment with for three months. Plus, how truly valuable is all that listening, feeling and culturing? From my vantage point it’s largely upsell and button clicking. Thoughtful conversation, availability and follow up offer the highest value.
• “While employers and health plans have been eager to cover virtual urgent-care visits, insurers have been far less willing to pay for telemedicine when doctors use phone, email or video to consult with existing patients about continuing issues. ‘It’s very hard to get paid unless you physically see the patient…'”
• “Doctor-to-doctor consultations are also seldom covered by insurers.” Give me a break doctors… and insurers.
• “Currently, doctors must have a valid license in the state where the patient is located to provide medical care, which means virtual-visit companies can match users only with locally licensed clinicians.” I’ll vote for any candidate who wants to consolidate all the state medical boards into one.
• “At the Mayo Clinic, doctors who treat out-of-state patients can follow up with them via phone, email or web chats when they return home, but they can only discuss the conditions they treated in person. “If the patient wants to talk about a new problem, the doctor has to be licensed in that state to discuss it…'” Lunacy!

Simple and elegant, US healthcare is not.

Call Pre-R. We’ll chat, try to help, then get on with our days.