The health system is expanding its virtual care services from the acute care setting to urgent care.
Dartmouth-Hitchcock Health (D-HH) has partnered with MDLIVE to offer virtual urgent care visits.
The virtual urgent care market is well established, with MDLIVE and several competitors in the space such as Teledoc, Doctor On Demand, and Amwell. Urgent care and behavioral health are two of the most common telemedicine services.
Launching D-HH Virtual Urgent Care is a logical and strategic step for the Lebanon, New Hampshire-based health system, says Mary Lowry, MBA, administrative director of Dartmouth-Hitchcock Connected Care. "At Dartmouth-Hitchcock, we started growing our telemedicine portfolio of services in the acute care space. We have launched virtual urgent care to round out our telemedicine portfolio."
D-HH Virtual Urgent Care, which launched on March 15, utilizes the MDLIVE telemedicine platform and offers visits via video or telephone. The service provides treatment for dozens of common conditions, including upper respiratory illnesses, allergies, rashes, bug bites, gastrointestinal maladies, and urinary tract infections. The service, which is offered 24/7 year-round including weekends and holidays, is available to anyone in any state or U.S. territory.
D-HH and MDLIVE physicians are staffing the service, says James B. Ebert Jr., MD, medical director of D-HH Virtual Urgent Care. "We have a core team of 14 Dartmouth-Hitchcock emergency medicine physicians who are all board certified and have a long history of telehealth experience. That core team provides the bulk of the service, but we also have our MDLIVE partnership that provides additional physician coverage when it is needed."
The physicians can prescribe medications and send prescriptions to a pharmacy of a patient's choice.
D-HH Virtual Urgent Care is designed to be convenient for patients, Lowry says. "There are a couple of different options. The patient can say that they want to see the next available provider, or they can schedule their visit for later in the day. Patients can also choose a provider from a list of who is available. It is all handled by the software, so we can ensure there is a smooth opportunity for patients to be seen without a long wait. The average wait for a virtual urgent care visit is about 10 minutes."
The fee for a D-HH Virtual Urgent Care visit is $49 for D-HH employees and dependents who are on the health system's insurance plan and $59 for other patients. "We based our fee on the lower end of the market price. We have a slightly lower rate for our employees who are on our health plan, and we didn't want there to be too much of a difference between the fee for our employees and the fee for other patients," she says.
At this point, the fees are self-pay, Lowry says. "We are working toward being able to accept and process insurance payments; but for now, we are leaving it up to patients to identify with their own health insurance plans whether the virtual urgent care visit is covered. Patients can use a debit card, credit card, and healthcare spending account card."
For patients with D-HH primary care providers, virtual urgent care visit notes are shared electronically with the PCPs. For other patients, visit notes can be shared with PCPs via e-fax.
Virtual urgent care best practices
There are several best practices for providing virtual urgent care visits, Ebert says.
Technology plays a significant role, he says. "If it is a video visit, having high-quality visualization of the patient is very important. Audio is also a factor—being able to clearly hear the patient is very important."
Clinicians should conduct virtual urgent care visits in a space that is quiet, free of distractions, and capable of maintaining patient confidentiality, Ebert says.
Physician engagement with the patient is essential, he says. "Even though you are not able to physically reach out and touch the patient, the engagement process and establishing rapport with the patient in an environment of trust and empathy is very important. That comes mainly through eye contact and tone of voice, which allows the clinician to gain a better capability to get a comprehensive history from the patient and ultimately leads to a diagnosis."
Open and honest communication builds trust, Ebert says.
"The clinician needs to be direct with the patient and to be honest about impressions of the case. With a health complaint, the clinician should create a differential of what the possibilities are. You need to be open. You need to clearly voice what you believe to be going on or what you do not know to be going on. Then you need to guide the patient to the appropriate resources if the case is beyond the scope of what you can do through telehealth."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
When Dartmouth-Hitchcock's virtual urgent care physicians are unavailable, MDLIVE doctors provide coverage.
When setting the fee for virtual urgent care visits, Dartmouth-Hitchcock looked at market prices and made the prices for employees and other patients comparable.
When clinicians conduct virtual urgent care visits, best practices include open and honest communication with patients to foster trust.