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Telemedicine Pocked with Low-quality Dermatological Care

   May 31, 2016

The growth of teledermatology services is causing concerns about quality of service and clinician qualifications among some researchers. One says direct-to-patient models are "proliferating with international and unlicensed doctors."

The growing industry for direct-to-consumer telemedicine services came under fire earlier this month with the release of a JAMA Dermatology study documenting concerns with the quality of service and qualifications of clinicians.

One of the study's senior authors, Carrie Kovarik MD, spoke with HealthLeaders Media about the study. She is an associate professor of dermatology, dermatopathology, and infectious diseases at the University of Pennsylvania. The transcript below has been lightly edited.

HLM: What was the genesis of this study?

Kovarik: Karen Edison [MD] and I have been doing teledermatology for years. We really hold it very dear to our hearts, and have always really tried to make sure that it's held to a high ethical standard, and is done right.

As we've been trying to scale up teledermatology in our own practices, other players have come into the mix.

As reimbursements started to come into play, and direct-to-patient models started to increase, there have been a lot of corporate-based groups and people that have tried to expand quickly, sort of faster than quality assurance practices can be done.

It expanded quicker than it should have in some places, and the quality suffered. We started seeing some of these patients reaching out to some of these companies in between visits, and just coming back with poor outcomes.

As we dug deeper—I did the first review a year or two ago—just kind of looking at the landscape, and realized that not only were they proliferating, but they were proliferating with international and unlicensed doctors.

[The study assessed services to California residents. Only "(26%) of providers disclosed information about clinician licensure, and some used internationally based physicians without California licenses," according to the study abstract.]

[These were] doctors and nurses that weren't trained in the specialties they were practicing in, on sites where they didn't really take a history from the patient, and they were kind of just getting the payment just to give the patient satisfaction and giving them meds.

People were just turning a blind eye. No one was doing anything, I think because some of this is people's livelihoods, but nothing was going to stop unless someone did some investigation and put it out there.

HLM: There are some who feel that this is best handled not in the pages of JAMA but that the industry needs to do a better job of policing itself. Was the telemedicine industry doing that?

Kovarik: No. They're telling you what they want you to hear. The ones that want to be good and do quality work have already come to me and asked, how did we do? We didn't publish individual results.

The ones that are going to continue doing what they do have been defensive and have come out with excuses. They're going to continue to proliferate until someone takes them to court, [and] many of them are already in litigation for bad practices.

HLM: This problem must be bigger than teledermatology.

Kovarik: It is, and there are several other papers that already go into it. One was looking at sinus infections.

HLM: Is the ultimate solution for consumers to vote with their feet?

Kovarik: A big issue is that employers are starting to sign on to these services.

Some of these are huge direct-to-consumer corporate practices, and patients aren't having a choice in some circumstances. So they've got to complain in a bigger way.

I guess if there's enough press, then patients may not go to those sites, or employers may not choose to pick them up.

Oversight and regulations lag behind so much, and we're trying to get some bills through that help us to implement quality services, but that takes years.

Payers can help us. We're trying to get the Connect for Health Act, which will help, because if that gets through, Medicare will cover some telemedicine, and it also requires quality reporting, which would really be nice.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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