The Medical Trends of Telemedicine and Urgent Care Centers

Convenience and efficiency underscore the rise in both methods of healthcare delivery.

When the coronavirus pandemic closed down Summit CityMD’s offices in March, except for essential visits, within a week the network saw an increase in telehealth visits from 20 per day to perhaps 3,000 or 4,000 per day, according to its CEO, Jeffrey Le Benger, MD. 

The overall healthcare sector telemedicine adaptation was both widespread and rapid, ushering in what is now a trend of patients communicating with their physicians from the comfort of their own homes – although physicians generally report that in-person visits have recently increased in tandem with New Jersey’s improved coronavirus public health metrics. One doctor interviewed by New Jersey Business magazine estimates that telemedicine now represents about half of all visits. 

If telehealth has existed for years, why wasn’t it more widely used before the pandemic? One reason is that with many fee-for-service models, in-person visits are typically reimbursed at a higher rate than those in telemedicine, so having patients travel to doctors’ offices may be sensible. Healthcare payers have, in part, at times justified lower reimbursement rates for telemedicine by arguing they are less effortful for physicians. 

Besides allowing people to remain at home during the height of the pandemic and even help treat COVID-19 patients, telemedicine permits residents who spend their winters in Florida to maintain videoconferencing appointments with their New Jersey physicians, and in the same vein allows easier access for the elderly and nursing home patients, says Stephen Brunnquell, MD, president of the Englewood Health Physician Network. 

He adds that for psychotherapy patients, he has heard from his psychiatrists that their patients may be more revealing about their personal lives via telemedicine, and, separately, that diabetic educators are able to virtually tour their patients‘ kitchens to learn what foods they have been eating. 

However, Mary Pat Angelini, CEO of the mental healthcare entity Preferred Behavioral Health Group, An Oaks Integrated Care Affiliate, asserts, “The preference would be to have the person sitting in front of you, so you can pick up on their body language and their attitude, and just be able to see them – to [even] smell them – to see if there is anything going on.” 

She adds, “Telehealth has been difficult with some of our clients who have more severe psychiatric diagnoses; those individuals who participate in our day programs who really need a more structured atmosphere. … Those are our most vulnerable clients, and I do fear that if we don’t get back full-throttle [with in-person treatment], we are going to lose some of these people, one way or another.” 

There are also more obvious telemedicine considerations, with Summit CityMD’s Le Benger saying, “I think doctors are feeling somewhat skeptical, because if you have to do a physical exam, you have to see that patient to get the real nuance of what that patient is coming in for. And there are absolutely certain things that patients cannot be seen over a videoconference for.” 

Another issue is an inability for physicians to be reimbursed twice in the same day: Unless there is a compelling reason combined with extensive paperwork, telemedicine visits that require an additional, same-day trip to the doctor can only be reimbursed as one appointment. The same has held true for in-person visits (one per day), but it is more typical that a physician conducting telemedicine visits will need to actually see patients again immediately, for a physical exam. 

As for concerns with use among patients, Federico Cerrone, MD, FASSM, a pulmonologist with Pulmonology and Allergy Associates, Atlantic Medical Group, says, “I guess my oldest patient is probably 98 years old, who was on Zoom. And he had no problem with it. So, I think everybody is becoming a little bit more savvy with the technology.” 

Telemedicine Overview 

If there is a theme among healthcare professionals interviewed for this article, it is that telehealth will remain a force in the medical community into the future. Healthcare reimbursement rates, however, appear to be one of the greatest unknowns in the months and years ahead. 

Tarun Kapoor, MD, senior vice president for clinical integration at Virtua Health, says his system only had a handful of billable telemedicine visits in 2019, while it is now conducting several hundred each day. 

Kapoor explains, “I think it’s been an adoption by both commercial and federal payers, saying, ‘Yes, patients need to be able to see their doctors and nurse practitioners and so on; an alternative is that they don’t get care and they get sicker, and show up in an emergency department.’” 

He also adds, “People are realizing now: ‘I can actually be reasonably productive working from home, or working from ‘over there,’ or working from ‘over here.’ And if I can do that, well, then, why can’t I have a medical visit that is digital based?’ It now just becomes an expectation of having that as an option.” 

Urgent Care Centers 

The growth of urgent care centers is yet another healthcare trend: Patients often want to conveniently be seen immediately for a medical concern, and much of it centers around the ease of having no-appointment-necessary access to x-rays, laboratory testing and basic pharmacy services, for example. 

Virtua Health’s Kapoor imitates the consumer mindset: “Let me get this straight: [The urgent care center] is open 12 or 14 hours a day; I can go before or after work; I don’t have to clock out of work; I don’t have to go somewhere else to get an x-ray; and I can get laboratory testing done right here?” 

The caveat, of course, is that patients with crushing chest pains should be treated immediately at full-fledged emergency rooms, and not at an urgent care center. 

Englewood Health’s Brunnquell says, “An urgent care center might be just fine for a simple urinary tract infection at 10 o’clock at night, or a small laceration that could easily be sutured in a place other than the emergency room.” 

Additional Benefits

Summit CityMD’s Le Benger says that urgent care centers can control the total cost of care. He explains, “Everybody knows that the high-acuity centers, such as the emergency room in a hospital, are very expensive, and they get to bill at a much higher rate than these urgent cares.” 

Le Benger additionally explains that Summit Medical Group has an integrated care model, which includes some high acuity urgent care centers with complex imaging as well as lab studies, for example. He also speaks about hospitalists: “These are people who see our patients in the low acuity centers, who follow these patients directly. There is a continuity of care to a lower cost center … we take care of all transitions of care, and the gaps of care of that patient.” 

If there are unifying themes between the topics of urgent care centers and telemedicine, they might be described as “convenience” and “efficiency,” which – incidentally – are the recurring themes in both the ongoing digital evolution and most modern consumer marketing efforts. 

And both urgent care centers and telemedicine can arguably lower costs for medical care, while being part of the equation for improving quality outcomes.

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