Virtual visits cost less
Like Dr. Basch, Dr. Aga said it’s possible that some insurance companies might begin to cover office visits only for certain conditions or services if they can be managed more cheaply via telehealth. He hopes that doesn’t happen; if it does, he predicts that patients and doctors will push back hard.
Why would a virtual primary care visit cost a health plan less than an in-person visit if it’s paying doctors the same for both? Dr. Aga said it’s because fewer prescriptions and lab tests are ordered in telehealth encounters. He bases this assertion on the quarter of a million virtual visits that Kelsey-Seybold has conducted and also alludes to published studies.
The characteristics of telehealth visits might explain this phenomenon, he said. “These visits are typically much shorter, and it’s easy to be problem-centric and problem based. Physicians use more of their intuitive skills, rather than just lab everybody up and get an x-ray, because that patient’s not there, and it’s easier to draw blood or get an x-ray if somebody is there.”
Cutting practice overhead
From the perspective of Kelsey-Seybold, which is now conducting about a fifth of its visits virtually, “infrastructure costs are less” for telehealth, Aga notes. Although Dr. Kubitschek and Dr. Sawyer say it doesn’t take less time to conduct a telehealth visit than an office visit, other practice costs may decrease in relationship to the percentage of a doctor’s visits that are virtual.
“If implemented appropriately, telehealth consults should cost less in terms of the ancillary costs surrounding care,” said Dr. Basch. He recalls that, some years ago, a five-doctor primary care group in Portland, Ore., began charging small monthly fees to patients for full-service care that included email access. After a while, 40% of their patients were coming in, and the rest received care by email or phone. As a result, the doctors were able to downsize to a smaller office space because they didn’t need a waiting room.
Although Dr. Basch doesn’t believe it would be appropriate for practices to do something like this in the midst of a pandemic, he sees the possibility of it happening in the future. “Eventually, a group might be able to say: ‘Yes, our practice expenses can be lower if we do this smartly. We could do as well as we’ve done on whatever insurance pays for office visits, knowing that we can deliver care to the same patient panel at, say, 10% lower overhead with telehealth.’ ”
A version of this article first appeared on Medscape.com.