High tech options let you visit your doctor without going to the office

Patients know the drill: You notice something wrong, big or small, and you call to make an appointment with your doctor.

You take off work, check in at the doctor's office and go to the waiting room. Then you are escorted to the examination room where you wait some more.

For patients who live far away from their doctor's office — and there are plenty of those in central, southeastern and eastern Kentucky — there are some high-tech options that may save travel and wait time.

But some are easier — and more important, more likely to be reimbursed by medical insurance — than others.

Chuck Thornbury, a Glasgow physician, said he's on the cusp of the new e-medicine and his innovation, Me-Visit, looks a lot like the online shopping and social interaction you're already doing every day.

If more patients could be treated by an e-medicine system Thornbury believes that doctors' practices could serve more patients, which he said will be a benefit once federal health care reform takes effect next year. He noted that Kentucky is thousands of doctors short of the number needed to care for the state's population. E-medicine could narrow that gap, he said.

Thornbury doesn't think that e-visits should be used frivolously, or that many patients would be tempted to get more serious conditions diagnosed via e-medicine rather than making a needed office visit.

"Doctors know their patients, and they know where that line is," Thornbury said. "You have to respect the tool. This is not a panacea. ... But the culture that banks online, shops online, they're going to do some health care online."

Such visits are not now reimbursed by insurance companies. But Thornbury thinks that medical insurers will eventually have no choice but to expand reimbursement practices to cover e-visits. A charge of $40-50, split between the patient co-pay and the insurer, makes sense, he said.

Dr. Jeffrey Foxx, who has offered virtual office visits for a year as part of his practice at Lexington's Family Practice Associates, said that while such visits "are not as popular as you would think," the virtual office visit is here to stay.

The problem with the virtual visit, Foxx noted, is that the patient loses the personal interaction they get with an in-person exam.

But such visits can be useful within certain well-defined parameters, he said, adding that those parameters would include an established patient seeking help with a minor health condition, such as a rash for which a picture can be submitted.

"It's more of a convenience thing," Foxx said. "It's not for chronic, long-term care, ... If it (the condition) doesn't go away, you need to look at the patient to see what's going on."

Other health care providers deal with more established, insurer-supported technology.

The University of Kentucky has long operated a telemedicine program, in which a medical professional in another town acts as a Lexington-based doctor's hands and ears.

While UK began telecare in 1995, it wasn't until 1999 that Medicaid began reimbursing providers for such visits. Such reimbursement required the approval of the state legislature, according to Rob Sprang, director of Kentucky TeleCare.

When UK started offering televisits, said Sprang, "We did everything we could to duplicate a traditional doctor-patient encounter."

Kentucky One Health, which includes the Saint Joseph health network, opened its Saint Joseph Telehealth Primary Care Clinic-Clay City in Powell County in 2011. Its second, Saint Joseph Telehealth Primary Care Clinic in Campton, opened in August, 2012 in Wolfe County.

They are staffed by nurse practitioners, nurses and health officers who use telemedicine technology to collaborate with the organization's physicians and specialists.

Kentucky One Health spokesman Barbara Mackovic said the group is working toward establishing two more clinics in rural central/southeastern Kentucky. In the two clinics that are currently operational, 44 percent of patients served did not have health insurance.

Baptist Health, the other major player in health care in central, southeastern and eastern Kentucky, offers a high-risk obstetrics telemedicine service to women in Corbin and is working to extend that service to Madisonville, according to spokesman Ruth Ann Childers.

Marketing a product that is reimbursed by insurance companies is described by providers as being a holy grail in the medical community.

Sprang explained, "If the provider can't see me, and it's not back and forth, it's not reimbursable. And if it's not reimbursable, I just can't do it right now. ... My doctors can't come in this room and see patients for half a day and not get paid for it. We still have to do what providers can be reimbursed for."

Here's how UK's televisits differ from e-visits and Me-Visits, which are conducted primarily by email contact and smart phones, Sprang said: "For most of the clinical services we do, there is a nurse or some kind of clinical professional in the room with the patient."

"Those are the things you get with a traditional telehealth method," Sprang said.

Nonetheless, Sprang said, "There are companies out there that will tell you where to feel for the lymph nodes on your throat, and depending on what you say they will write you a script for antibiotics. I feel very uncomfortable with that. These people have no relationship with the patient."

Even something as a simple sore throat can be viral or bacterial, Sprang said. He also worries that with some medical applications, doctors may not have any connection with the patients.

"It scares me, because the technology can do whatever we want it do. Just because we can do it doesn't mean we should," he said.

But Thornsbury, the head of Me-Visit, said that using such technology is inevitable, with or without insurance buy-in.

"Even if you do cash and carry, it still makes pretty good sense. I see that insurance carriers will have to support this for it to take off. But I just don't see why they wouldn't," he said.