When most of us imagine a doctor's office, we think of a windowless waiting room with few amenities except for a pile of out-of-date magazines. But in a decade from now, our experience of the doctor's office might also include a virtual consultation from the comfort of our living rooms.
Increasingly, patients are turning to phone or video to consult with a physician from a distance. To meet the growing demand, more than a dozen companies have emerged to provide secure technology for virtual visits between doctors and patients. Telehealth, as it's often called, is expected to be worth $34.27 billion by the end of 2020. It's a hot market, but its critics have rightly questioned whether it will ever become mainstream. (Has your grandma heard of it?)
Today, one of the most prestigious brands in health care has made an important step in that direction. The Cleveland Clinic is providing customers of a CVS MinuteClinic in Ohio with access to its experts for both online and mobile doctor visits. Patients can walk into a nearby MinuteClinic and get a vaccine or test, or consult a nurse practitioner about a minor skin abrasion or illness. Depending on the severity of the patient's symptoms, that nurse might suggest a follow-up consultation with a primary care practitioner from the Cleveland Clinic. During working hours, a practitioner is likely to be available within 5 to 10 minutes. But Cleveland Clinic is currently working to incorporate 24/7 access.
"Some of our best doctors see that this [telehealth] is where the world is going," says Peter Rasmussen, the medical director of distance health at the Cleveland Clinic. Rasmussen says many doctors are changing their practices to stay relevant in a world that is dominated by smartphones and tablets. "We want to meet the expectations of patients now and in the future," he adds.
American Well, one of the largest telehealth companies, is working with both CVS and the Cleveland Clinic to provide the back-end technology. CEO Ido Schoenberg says that this is the first time that a big-brand academic medical center has partnered with a convenient care clinic to provide telehealth services. "Many hospitals see telehealth as an opponent," says Schoenberg, adding that the technology is perceived as a threat because it might hinder the pipeline of visits. An exception to the rule is Kaiser Permanente, which is pushing more and more of its office visits to phone, email, and video.
Patients should expect to pay about $50 for a consultation with the Cleveland Clinic, in addition to the cost of seeing a practitioner at a MinuteClinic. The prices for those visits are in the ballpark of $30 to $140.
Telehealth offers a range of benefits for patients, including convenience and affordability. Rather than flying across the country to see a top specialist, it's increasingly possible to get a virtual consultation. For those who have a common ailment, like a cold or flu, an inexpensive virtual consultation might be sufficient to keep them out of the doctor's office.
But the limitations of telehealth are equally well documented. In some circumstances, it's important for a doctor to see a patient in person. And some of the top specialists already have long waiting lists for patients who are willing to pay astronomical prices to see them, so they have little incentive to bother with telemedicine. Making matters more complicated, many doctors face byzantine state-by-state legal requirements and/or discover that their medical malpractice insurance doesn't extend to telehealth.
American Well faces myriad obstacles of its own as it seeks to expand this service to other states. Some state laws require that doctors have a valid state license in the state where the patient is located. That would prove to be a stumbling block for a patient in another state who wished to consult with a Cleveland Clinic specialist based in Ohio. But company executives are hoping that the laws will slowly change in their favor. Various government reports have expressed concern about how a limited supply of primary care doctors can meet the demands of a growing aging population, and telehealth has been floated as a possible solution. The theory goes that if telehealth goes mainstream, doctors will be freed up to spend more time with patients.
"Five years from now, we hope that the term 'telehealth' won't be used anymore," says American Well's Schoenberg. "It will just be care."