All health care is local

The Wall Street Journal recently ran an editorial arguing that “state medical-licensing barriers protect local MDs and deny patients access to remote-care physicians.” What the piece doesn’t mention is the majority of telehealth encounters in the country take place on one of the Big Four’s platforms—those companies that represent the four largest in the national queue based telemedicine industry—all of which operate on a system staffed by doctors from around the country who make themselves available for limited consultations outside of usual care pathways. This form of telemedicine has been adopted widely as a means to reduce costs for insurance carriers, many of whom provide the service to members with a fee equivalent to a co-pay. One part of the low cost of the service is the opportunistic model for doctors who log into a grid the same way Uber drivers do, taking phone calls on a one-time-only basis to address members for a low payment, generally around $25 per call.

So, for example, as a patient living in Idaho, when you rise to the top of the queue, the next available doctor who is licensed to practice in your state is the physician with whom you’ll be connected. That doctor could be in Idaho, or living in a state nearby like Washington, or they could be on the other side of the country in Georgia.

Being connected with a doctor far from home shouldn’t come as a surprise, a study by the Federation of State Medical Boards found that 21.4 percent of doctors nationwide held two or more state licenses as of 2014.

While allowing patients to access doctors from around the country increases the number of entry points to care, particularly for those living in the most rural areas, it doesn’t always translate to the highest quality of care. The vast majority of telemedicine visits aren’t for high specialty consultation for which a niche expert across the country may add value. Rather they are for acute care of minor conditions. This triage, reassurance, and next-step planning are best handled locally, by doctors familiar with the health resources in the patient’s community.

At CirrusMD we only connect our users with doctors who are truly local—if you’re accessing the platform in Colorado, the doctor you’re connected with is right there with you in the Centennial State.

We’re able to use only local doctors by having a different workflow which requires fewer doctors than the companies that make up the Big Four. While they operate using synchronous communications requiring one-to-one interactions such as phone or video chat, and therefore more providers to staff the system, CirrusMD’s encounters begin with asynchronous communications via secure text message, so one doctor can treat as many as eight patients simultaneously without lowering the quality of the interaction.

By only using local providers, patients can rest assured knowing their physician is familiar with their local resources, so if a referral is needed it will be with an in-network provider. Additionally, being local ensures referrals are convenient for patients, so they aren’t sent on a 200-mile wild goose chase if that isn’t needed.

Are there circumstances in which the only doctor who can treat a condition is a thousand miles away? Of course there are; however, for the vast majority of telemedicine encounters focused on acute care, the best care will come from a local provider.