Healthcare has become too expensive for most entities to afford (state and federal governments, private industry, and private citizens). So, how do you dramatically lower (50% or more) the cost of “producing” an encounter? We clearly need to think and act differently than we are now. There has to be an admission that the current workflow is broken and simply automating it will not help.
One mechanism might be more closely matching the healthcare issue with venue and resources spent on the encounter. Currently our default is seeing patients in the clinic or sending them to the hospital via the emergency room.
In many cases, if a simple communications tool, along with streaming medical data, were available in real time it might be more convenient and less costly to treat the patient in place. This concept, while not new, has never been widely deployed as currently the most likely way a provider or system is paid is by face-to-face encounters. Treating patients with remote, non-face-to-face technology is often not reimbursable. However, with the advent of payment reform and pay for outcomes (vs. volume), I believe it will be increasingly likely that treating patients in the lowest cost setting consistent with their illness needs to become standard practice. In many cases the best option will be home-based care and not facility-based care.
We need to begin a national discussion about when it is both safe and effective to treat patients (not just give advice, but diagnose and treat) in non-face-to-face settings. “Virtual” care is a technical reality and very disruptive to the current face-to-face, facility-based care delivery model. “Virtual” care holds out the promise of more convenient and timely care (immediate care when you need it, without having to travel).
Furthermore, because the overhead of producing a “virtual” visit is much less (maybe as much as 50%) than a face-to-face visit, we need to consider this alternative for care delivery as we run out of funds to deliver care to our citizens. The alternative might be drastic rationing/queuing and service delivery cutbacks due to lack of adequate funding.
The time has come for providers, government officials and citizens to consider this next “evolutionary” step in service delivery reform for routine ambulatory care services.