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Reforming Delivery
Walgreens to the Rescue!

The LA Times reports that Walgreens is now offering digital visits to doctors in five states. The visits are priced at $49, lower than the typical cost of an in-person doctor’s visit. The chain plans to expand into twenty more states before the year is out. But there are big obstacles keeping a lid on telemedicine:

Payments are also an issue. Right now, [president of the American Academy of Family Physicians Robert] Wergin said, insurance companies won’t reimburse him for virtual appointments.

“The only way for me to have a business model is for you to come in and have a visit,” he said […]

To expand, however, Walgreens and MDLIVE will need changes in state regulations in the 25 states were such visits are not permitted.

Loosening up regulations restricting telemedicine is one of the easy fixes waiting to be made in our health care system. Allowing doctors to claim reimbursement on digital visits is another. Yet opposition to telemedicine persists: the AMA, for example, has endorsed digital visits only on the condition that doctors get licensed in every state in which they see patients.

The Walgreens decision shows that this opposition hasn’t discouraged interest in telemedicine, however, and the big chain has the market power to raise the profile and popularity of digital doc visits further. Increasing the availability of telemedicine won’t solve our health care cost problem on its own, but it could help, especially for cash-strapped Americans in need of primary care. Indeed, methods that deliver care to Americans more cheaply, rather than just new kinds of drugs and treatments, should be a higher priority of U.S. health care policy.

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  • Andrew Allison

    Is there any data on the percentage of “virtual visits” which result in the patient being referred to a live primary care physician? In other words, how effective are virtual visits in resolving issues? On the subject of payments, the patient pays at the time of service so the question of insurance payment to the doctor doesn’t arise. FWIW, Anthem Blue Cross is pushing virtual visits through a third party provider, presumably in the hope that it will reduce their outlays, The whole thing is complicated by the huge deductibles for ACA.

    • fastrackn1

      Not as effective as a live visit for some things, but an easier, faster, and cheaper starting point from which a doctor can decide if that live visit is the next step.

      • Andrew Allison

        How, if I pay $50 for a virtual visit to get told I need to see a live family practitioner, is this reducing costs? Hence my question.

        • fastrackn1

          Yes true, in an instance like that you would be out of pocket more.
          But maybe if it is all averaged out across all patients and all visits there would be a savings, because in many instances only the virtual visit would be necessary.
          Only time will tell of course how those numbers play out, but it seems worth a try.

          • Andrew Allison

            That’s why I wrote, “Is there any data on the percentage of “virtual visits” which result in the patient being referred to a live primary care physician?” ;>)}

          • fastrackn1

            Sorry, been busier than a one armed paper hanger with a case of the hives today, and not thinking too clearly…

            I couldn’t find an answer to your question by using Google, but I did FWIW, in a Google search, find a few other points to think about regarding an actual savings or a loss.
            First, will people spend more because of the convenience of using the service by using it more often than if they have to make an in-office visit, or spend more because they would have never done anything if they had to make an in-office visit?
            And second, will the inability of some virtual visits to make a proper diagnosis cause people to have to use the virtual visits several times to get a correct diagnosis?

          • Andrew Allison

            Hope you’re feeling better! Benadryl (diphenhydramine) helps.
            As you might have deduced, I suspect that virtual visits for primary care are likely to increase, rather than decrease costs (to the patient, thanks to ACA). I assume that the second question must be a result of your hives [grin]. How many virtual visits do you think the average patient will make before seeking one-on-one help? I suggest one: if the virtual visit doesn’t fix the problem, not only would I not try again, but I’d never utilize one again.

          • fastrackn1

            “How many virtual visits do you think the average patient will make before seeking one-on-one help? I suggest one: if the virtual visit doesn’t fix the problem, not only would I not try again, but I’d never utilize one again.”

            Yes, one virtual visit for rational, thinking people, like you and me, but there might be many who would do it multiple times. Also there might be physicians who use multiple virtual visits to milk the system?

            Actually, the 2 points in my previous comment above were not from me, they were some concerns the medical industry has about allowing virtual visits. The hives hasn’t affected me that much! [wry smile]

            One thing a did come up with myself is regarding the cost savings of virtual visits that has to also be applied to potential savings to people, is the cost of gas, wear and tear on their vehicle, and their time. Time would have a greater value if it means an hourly wage person could virtual visit from work and not have to lose a half days work going to a doctors office.

          • Andrew Allison

            Yes, the cost of gas, wear and tear on vehicles, time (not to mention the time to wait for an appointment) is the major selling point for today’s VV (virtual visits). But the question remains, if I have to expend all that resource anyway, what’s the point of a VV? Seems to me that (in general) we are not thinking clearly about the application of technology to primary health care. What I think we’re talking about is triage, which could be done just as well by an NP as an MD, at much lower cost

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