New AMA Guidelines for Telemedicine
When I co-founded CirrusMD it was with the goal of giving everyone access to convenient, timely medical care with local physicians for a wide range of conditions, in the same way that I and other doctors address concerns for our friends and family—through text messaging, phone and video chat.
Since we were founded, CirrusMD has prided itself on the fact that our workflow allows doctors to effectively guide their patients to the right care, at the right time, from the right provider. At the end of the day, a patient should have the exact same communications experience talking to the doctor on our platform as they would if they had gone to see the doctor in the office. The only difference should be that they didn’t have to wait for an appointment and the conversation can be ongoing, rather than limited to the timeframe of the in-person visit. Even though the visit is taking place virtually, the doctor’s ethical responsibilities and the value of the relationship still stand.
For CirrusMD and the doctors that use our platform, that ethical responsibility means we ask the questions and take the time to ensure we make sound judgments on behalf of our patients. That meant moving away from the legacy fee-for-service economic model, which incentivizes physicians to churn and burn through patients as quickly as possible. Instead we operate under the value-based care economic model, placing responsibility for the life on the physicians’ shoulders to instead incentivize them for spending whatever time it takes to get the patient the care they need. In addition to changing our business model, it also meant we needed to approach our virtual care platform differently, with a text-first workflow, so doctors would have the ability to finish each interaction with “let’s keep in touch.” We also built specifically to enable doctors to practice in teams and share responsibility for staffing the group’s remote service.
Most telemedicine companies in the market are built to support encounter-based, fee-for-service visits rather than ongoing communications between groups of doctors and patients. Neither the economic model nor the platforms of mainstream telemedicine companies allow for convenient, high-quality follow-up care. By focusing on one-off video interactions, these companies fall short when a patient presents with nondescript symptoms like abdominal pain. It could mean appendicitis, something as benign as gas, or a variety of conditions in between—in many cases time is the best diagnostic test but if limited to an encounter, the doctor has to make a decision right away: to reassure the patient, call something in, order a test or send the patient to the ER. Unfortunately, the workflows and economic models of most virtual care companies incentivize the doctor to make decisions as quickly as possible—with the appendicitis example above, the physician doesn’t have time to touch base and see how the patient is doing in an hour, instead they are going to practice defensively so they can quickly move on to the next patient.
Last week, the American Medical Association approved guidelines for the ethical practice of telemedicine—ensuring that physicians don’t let the virtual aspects of the visit be an excuse to cut corners and not gather vital information they need to make the best diagnosis and recommend the best treatment for their patients’ symptoms. I believe that ethically, the best plan of care includes a plan to keep in touch. The fee-for-service economic model on which our reimbursement system is built keeps a high wall between doctors and patients. But the world is changing. For many doctors, the office visit that doesn’t happen is now profitable for at least some of their patients. In the era of value-based care, new communications tools are available that enable doctors to safely care for patients remotely. To be effective, doctors won’t want to use antiquated telemedicine technology designed to maximize billable events. Newer platforms, optimized for relational communications between patients and care teams will enable creation of new clinical workflows for the best practice of modern medicine.