COPC comprises 45 separate physician practices and an urgent care facility that's centrally located. Stone was one of the first five physicians trained to use the Care4 Station, which is essentially a booth in which a patient can utilize up to six digital peripheries (in some instances requiring the help of a midlevel) while conversing with a physician via secure video conferencing. In instances where using the periphery tool is challenging for the patient, such as the otoscope, or if the physician needs more information that requires a physical presence, a medical assist is just a button-push away.
During the pilot phase, the kiosk is situated in Central Ohio Primary Care's urgent care facility, and an on-site provider accesses it from an office within the building. Stone explains that as the state hasn't passed a telehealth reimbursement mandate a physician still meets with each telehealth patient in-person following the electronic consult. Thus, the practice bills payers for an office visit.
The in-person follow-up is needed for another reason, Wulf explains, because Ohio prohibits prescribing to a patient the physician hasn't personally, physically examined. "Right now we're waiting for the Ohio state medical board to define what personally, physically examined means in the context of telehealth," he says.
Wulf and Stone agree that while the kiosk has been useful, it isn't going to help physicians see patients faster.
"I don't think a physician is going to get six-to-seven visits an hour by using it. We see the value in this tool as helping divert people from the ED," says Stone."And as we move from fee-for-service work into quality-based work, it's inevitable that one of the biggest metrics that will decide how much we get reimbursed will be the overall care of patients and cost of care."
Another use that Wulf and Stone see for these kiosks is putting booths in employer sites or areas with convenient public access that are connected to local primary care physicians' offices.
That's a future that may not be far off if the reimbursement climate continues to warm, agree Guy, Wechsler, Stone, and Wulf.
"Eventually all payers will reimburse for telemedicine. It only makes perfect sense for them to do so. Right now they have concerns that reimbursing for this opens up a Pandora's box, and it will lead to all kinds of new payment structures, but I believe that concern is overblown and it will happen," says Wechsler.
This article appears in the July 2012 issue of HealthLeaders magazine.