Dr. Lester Hartman as seen via Skype
No one could blame 3-year-old Anish for getting hysterical when he saw a doctor. He’d been through open-heart surgery and a skull operation. He knew that white coats often meant pain.
The first time his mother brought him to see Dr. Lester Hartman of Westwood-Mansfield Pediatric Associates, he had such a meltdown in the office that the visit had to take place in the parking lot, with the engine running, Anish in his carseat, and the pediatrician leaning his laptop on the driver’s side window as he took notes.
Clearly, this was not going to work. So these days, unless Anish needs to be physically seen, his parents schedule their appointments for evening hours. They sit at their home computer and they consult with Dr. Hartman, face to face, but not in person — by Skype.
Those Skype visits put Dr. Hartman way far out on the cutting edge of using technology to communicate with patients, even though Skype is now very old news in the general population. But he has high hopes that if health reform plays out as expected in Massachusetts, he’ll be able to ramp up Skype and use other electronic tools more creatively in his practice. (See his guest post below.)
‘Why hasn’t it gone further faster?’
Health care lags dramatically — perhaps “pathetically” is the correct adverb — behind other sectors in the use of the technological tools that now tend to dominate our personal lives — email, Skype, Facebook, smartphones. As Dr. Ronald Dixon of Massachusetts General Hospital put it: “Our patients are all Skyping with their grandchildren, so why can’t they Skype with us?”
But multiplying signals suggest that early adopters like Dr. Hartman may soon get a major boost from a political source: The looming state health reform. It aims to save money by shifting care away from “fee-for-service” payments for each procedure and toward giving doctors a “global” budget for a patient’s annual care.
Health insurers do not generally reimburse doctors for time spent emailing or Skyping or texting. When a doctor is paid for each bit of in-person care, but not for such “virtual” care, that’s a major disincentive to go virtual. On the other hand, if a doctor is paid an overarching annual sum for your care and will get bonuses for keeping you healthier and within your budget, checking in with you by email or Skype may suddenly become much more attractive.
Dr. Joseph Kvedar, director of the Center for Connected Health at Partners Healthcare and a practicing dermatologist, says that under the current health-care payment system, he emails constantly with his patients for free just because he sees it as part of caring for them. But “If the cash register never rang, I wouldn’t have a job. Right now, if you stop coming in to the office, I have a real problem. That won’t be the case anymore two years from now. The time is upon us that it will be as quaint as bank tellers.” Continue reading