Online Physician Visits

An article in the journal Population Health Management explores the impact of online physician visits upon health spending.  A control group consisted of patients who continued to go in person to an acute visit clinic associated with the Mayo health system in Rochester, Minnesota.  The intervention group used a secure online system to send information regarding their problem to a physician, who at some point in the next 24 hours would review the information, ask for more data if needed, make a diagnosis and direct the patient for additional treatment or write a prescription or take other action him or herself.  The study looked at the effects on health spending over the next six months.  (Population Health Article)

The outcome measure was basically whether the patient became a cost outlier, that is, had significantly higher costs than the general population.  The results indicated that the patients with online visits were less likely to become cost outliers.  While this was not a fully randomized trial, the authors did attempt to control for a variety of potentially confounding factors.  Because of improved access and convenience for both patients and physicians, as well as possible beneficial cost effects, electronic interactions have begun to grow rapidly.  Some are real-time and some, as in this study, are delayed, or store and forward in telemedicine parlance.

The implications of the study’s results are many and fascinating and should lead to substantial follow-on research.  From an economic perspective, what are the actual cost savings to a physician practice which uses electronic visits–can capacity be managed more efficiently, are there net savings on equipment, software, space and staff, what is it worth to the patient to avoid travel time, missing work, etc. and what is the value to employers to lessen absenteeism.  From a total health spending perspective, does the convenience of an online visit mean that patients would seek interactions for issues that they might ignore if they had to go in person; which could raise overall utilization and costs, although it might mean significant problems were addressed sooner, which might have long-run benefits.

We all know that electronic interactions of all kinds are very different from in-person, face-to-face encounters or even live phone calls.  Are patients less likely to demand additional care in an online visit?  Do doctors find it easier to say no to requests for additional services that a patient may want?  Are doctors more or less likely to order referrals and diagnostic test in an electronic interaction?  Does a physician miss important diagnostic clues which might be picked up in an in-person observation of a person’s non-verbal behavior and physical state?  All of these questions will be important to answer as the volume of electronic visits continues to accelerate.