imbursed at the same full level as an office visit. Telemedicine is now very practical. Physicians should be wary of many of the telemedicine sites that are out there. Most of the ones you read about in the headlines do not meet CMA’s Principles of Telemedicine. These are the anonymous doctor banks, prescription mills, and sites that use physicians in foreign countries. Fortunately, there are telemedicine sites that closely adhere to the CMA’s telemedicine standards. Store-and-forward platforms like HealthLens (I am a founder), Azova, and SkyMD enable physicians to practice online in a medically sound and ethical manner. The primary standard is allowing patients to receive online care from their established physician. This enables followup with that particular physician and a physical location if an office visit is necessary. CMA-adherent platforms also provide secure messaging between patient and physician so the visits can be interactive. Some sites even facilitate the use of the patient’s medical insurance to cover the visit.
Most commercial insurance companies, including Blue Cross, Blue Shield, Cigna, UnitedHealthcare, and Aetna, cover storeand-forward telemedicine. Medicare only covers it in Alaska and Hawaii, but there is legislation in progress to expand to all 50 states. To get reimbursed for store-and-forward telemedicine visits, just attach the GQ modifier to your CPT code, e.g., 99203 GQ. In my practice, I see about 60 patients online per month. Acne, eczema, and seborrheic keratoses make up the majority of the conditions I diagnose online. Time-sensitive conditions, like shingles, are not uncommon online diagnoses, and it is much easier to get patients on antivirals within that 72-hour window of opportunity when they don’t have to wait for an office visit. I even see new patients on the internet. According to the Medical Board of California, you can evaluate a new patient online and establish a physician-patient relationship as long as the photo(s) submitted by the patient allow(s) the physician to perform an adequate physical examination to
reasonably make a diagnosis. Established patients, who make up the majority of my online visits, can be evaluated and treated without a photograph. This works out well for prescription renewals. Medical research will also benefit from the shift to online care because of the data that telemedicine provides. In the short time HealthLens has been in operation, we have amassed a large library of clinical images, corresponding diagnoses, treatments, and, most importantly, outcomes. The granularity of the data will allow for unprecedented levels of analysis. Veering from long practiced-norms is a troubling process for the medical community. However, the opportunity to eliminate so much of the expense involved in patient care cannot be ignored. Physicians should be leading the charge in shifting patient care online. We will be the primary beneficiaries. Dr. Schmidt is a dermatologist and member of the Santa Clara County Medical Association.
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