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The Doctor Will (Virtually) See You Now: Cardiac Electrophysiologists at Valley Health System Now Offering Online Consults
The emergence of new technological capabilities is enabling physicians to provide care outside of the traditional face-to-face in-office setting. Patients increasingly want to be able to access care with ease, on their own terms, and preferably without the need to travel to a medical office, hospital, or clinic.
A recent Becker’s Hospital Review detailed that the global telemedicine market is expected to grow 14.3 percent annually between 2014 and 2020.1
Most states in the U.S. now have legislation that addresses telemedicine. Importantly, 64 percent of respondents indicated that they would attend an appointment with a physician via video telehealth. Thus, it’s not surprising that an expected 7 million patients will use telemedicine services in 2018, up from just 350,000 patients in 2013.
To meet this demand, Valley Medical Group’s Snyder Center for Comprehensive Atrial Fibrillation, located in Paramus/Ridgewood, New Jersey, launched a telehealth service earlier this year designed to help patients diagnosed with atrial fibrillation (AFib) access a consultation with a Valley cardiac electrophysiologist. These virtual office visits are video chats through a smartphone, tablet, or computer. Patients can see and speak with a member of our team using real-time audio and video technology from the comfort of their home, office, or anywhere they may be.
The online consultation service was developed to make it easier for people newly diagnosed with AFib or whose AFib has not adequately responded to treatment to access the expertise of Valley’s electrophysiology practice. With an online consultation, there is no need to travel or take time off from work or other daily obligations. Online consultations are up to 30 minutes in length and can be scheduled online at www.ValleyMedicalGroup.com/Online. The fee is $49.99.
The consultation includes a review of the patient’s medical history and ongoing management (if not newly diagnosed), a discussion about the interdisciplinary nature of AFib, an overview of the comprehensive approach to the management of atrial fibrillation offered by our team at the Snyder Center, and a discussion of whether the patient might benefit from pursuing a multidisciplinary evaluation.
Online consultation is currently open only to new patients. The goal of the consult is to review with the patient their current treatment strategy. For many patients, no further follow-up will be necessary. However, for others, there may be an opportunity to enhance their care by using the resources available within the Snyder Center. For these patients, further care will be delivered through a direct in-office consultation with an electrophysiologist at the Snyder Center. We believe that this model offers the possibility of greatly enhancing the efficiency of care delivered to patients with atrial fibrillation.
Our online consultations are presented in collaboration with SnapMD, one of the largest telemedicine companies in the nation. We chose to partner with SnapMD after evaluating several telemedicine vendors, all with a wide range of capabilities and service models. We ultimately chose SnapMD because the service is highly scalable, allowing us to take small steps to get started and giving us the option to grow in the future. Since our online consultation program is very targeted and precise, it did not require the large and costly infrastructure that many vendors require. Our system simply connects a Valley electrophysiologist with a patient via a secure and HIPAA-compliant platform that ensures high-quality image and audio quality, and is fully integrated with AthenaHealth (our outpatient electronic medical records [EMR] vendor). In a recent survey assessing “must-haves” of direct-to-consumer telemedicine applications for non-emergency consultations, integration to EMR was cited as the most important requirement.2 Additional important features included the ability of patients to directly schedule appointments as well as store and forward messages to providers.
We launched the new online consultation service to make it easier for more people diagnosed with atrial fibrillation to learn about The Snyder Center’s total patient management approach. We are dedicated to the effective treatment and management of atrial fibrillation through comprehensive, team-based clinical care and research. The Snyder Center moves away from a crisis management approach in favor of a value-based approach that emphasizes the overall health of patients with atrial fibrillation.
What does this mean for patients? The Snyder Center takes a total patient management approach to AFib instead of a “silo” approach focused only on ablation techniques. As a result, patients at the Snyder Center are evaluated by a multidisciplinary team that may include electrophysiologists, plus specialists in cardiology, diagnostic imaging, sleep medicine, nutrition and weight-loss management, diabetes, and stress management. We work together with patients to ensure they are getting the best available treatment for their atrial fibrillation, while also addressing other contributing health issues, such as stress, hypertension, sleep apnea, and obesity, which can cause or worsen AFib. Navigators and coordinators guide patients through the entire care continuum. The emphasis is on overall health, not simply treating atrial fibrillation.
A key benefit of receiving care at the Snyder Center is ongoing patient monitoring. Following the initial course of treatment, patients will continue to be monitored to ensure his or her condition has stabilized or is improving. The Snyder Center’s commitment to AFib goes well beyond the dedicated care we provide to patients. We are also researchers in the field. Our experiences with patients contribute to valuable research in the field of AFib diagnosis and treatment. Perhaps most importantly, we understand that managing AFib is a daily responsibility for many patients and we are dedicated to serving as partners in their care. By making telemedicine services available to our patients, we believe that we will improve quality by increasing access to this level of specialized care as well as increase our catchment area.
In the process of establishing this telemedicine program, we have also come to recognize several important barriers. First, telemedicine challenges the traditional and established model of direct face-to-face contact between a patient and provider. Thus, most patients searching for a specialist need to be made aware of the availability of this new resource. This is not easy, especially if the service is not being offered across the entire outpatient enterprise. Thus, the optimal means to market the availability of this new service to appropriate patients remains undefined. Second, most current models (including ours) are built on a video-conferencing platform. However, it remains undefined whether this is the optimal platform for communication or even the one patients most prefer. Third, the price points for these services have not yet been defined. Whether price should differ based on urgency of consult (e.g., same day vs electively scheduled) or type of provider (nurse practitioner, primary care provider, specialist, super-specialist) remains undefined. Finally, not all providers are ready to embark on this endeavor because the provider financial incentive structure remains a barrier. There are no work RVUs associated with these visits, which serves as a financial disincentive to provider care in this setting. Also, it is possible that no patient actually schedules an online consult in the time allotted for these encounters. This would again be a financial disincentive, especially for busy clinicians whose calendar otherwise typically remains full of scheduled in-office patients. Certainly, the early promoters and adopters of this technology in any healthcare system pave the way to learn lessons for other providers as well as their institution. A financial structure will need to be developed to support these providers for their effort, which is not amenable to reimbursement or accounting by traditional measures of physician productivity.
Paraphrasing the famous quote from the 1989 movie Field of Dreams — “if you build it, they will come” — it is hard to believe that this will not apply to telemedicine. The rapid proliferation of consumer facing applications, the need to later access to specialized care, and patient demand to be seen within the confines of their availability and not that of the provider, all speak to the needs to develop effective telemedicine systems across institutions. In the end, the “Uberification” of healthcare appears to have arrived, and we at Valley are ready to embrace the challenge of meeting the needs of our patients.
Disclosure: Dr. Mittal has no conflicts of interest to report regarding the content herein.
For more information, visit www.SnyderAFCenter.com
References
- Telemedicine to attract 7M patient users by 2018 — 12 statistics on the thriving market. Becker’s Health IT & CIO Report. Published Oct 5, 2016. Available online at https://bit.ly/2q7KO6W. Accessed April 5, 2018.
- Defining Telemedicine’s Role: The View from the C-Suite. Sage Growth Partners. Available online at https://go.sage-growth.com/defining-telemedicine. Accessed April 5, 2018.
