I often wonder, as I write these blog posts, if readers just think that I am talking in hypotheticals, irrelevant to our clinical practice in Montana. These scenarios that I describe, but that we don’t yet see in our communities, that supposedly don’t affect our practice, have no impact on us…so we think. You may even think that I am exaggerating when I urge us to act now on all the changes in healthcare. So let me tell you a story (no economics, so easy reading after the last few posts). You decide how this will or will not change the market.
One of my colleagues in Missoula has a 25 year old daughter working in Bozeman. She is healthy and has no PCP. On a Saturday, she develops pain in her shoulder area and upper chest that’s new. Her mother suggests a pulled muscle – treat yourself to a massage. On Sunday, she calls her mother back and says she developed a rash in the same area, and by the afternoon it had started to blister, and it was really painful. Now, it’s time to seek medical advice, but what’s open at 5:30pm on a Sunday? The ED at Deaconess? Not so fast.
The young woman remembers an email from a month ago about some telemedicine service that employees have access to if they need it. She pulled it up and promptly followed the link to download the app for the service. She registered and then requested an appointment. Within 10 minutes, she received a call and was speaking directly with a primary care physician. The physician took a history and then the patient showed the physician the rash since it was a video call, and the physician promptly diagnosed shingles. She instructed the young woman that she will call in a prescription to her pharmacy and it would be ready in 30-45 minutes. From the time the young woman looked at the old email to the time she had her prescription in hand, it was less than 2 hours, in her own home, and she only drove 10 minutes to the pharmacy. The total cost was $10 (co-pay at the pharmacy). Her employer pays for the telemedicine service.
And what if the video call determined that the patient needed facility services? The telemedicine company has their own clinics in cities where they are operational (and by the way, that handoff is smooth), and partner with certain urgent care facilities otherwise. And don’t lose sight of the fact that financially, these are our best patients that are leaving.
Access is changing everywhere, including Montana. And this can change referral patterns for specialists as well. I know that I said, you decide the impact, but I can’t resist… You either have to get on the bus, or get run over by the bus.
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