Telemedicine: a demonstration of epic dysfunction


The current attempts at telemedicine reveal the dysfunctional relationship between American healthcare and modern, consumer-facing technology and seem to expose the true nature of all parties. As explained in several articles here, Medicare has now proposed paying doctors $14 for a five-minute “check-in” telemedicine “calls” with their patients. The service is to help patients determine if they need to come in for a visit. The dysfunction and intellectual conflicts abound:

  • Medicare called the new service a “check in” because federal law prohibits Medicare paying for telemedicine services that replace in-person office visits (but that’s its main opportunity!)

  • Some individual physicians are against payment for the new service because they say they already provide the service for free, and the service will reduce interactions because patients will be forced to pay a copay for the service.

  • But the physician head of the American Academy of Family Physicians applauded the new service:“Anytime you can tie payment to what many of us are already doing is good,” he said.

  • The Medicare Payment Advisory Commission, which advises to Congress, was very critical of the plan, sounding like complete luddites coming out against convenience, stating that direct-to-consumer services will increase spending: “Due to their greater convenience, these services are at risk of misuse by patients or provider.”

  • Medicare states the services will reduce expenses by reducing unnecessary care; but their own proposal says expenditures will increase expenditures in the long run.

  • Medicare while opening up payment for telecare, puts strange restrictions on the service: “Only patients who have established relationships with a doctor would be eligible for the service. Doctors also would not be allowed to bill for the check-in service if it stems directly from an in-person visit or is followed by an appointment with the doctor.”

To me, these conflicting views represent a fundamental misunderstanding of the power of new technologies and expose how healthcare fails to take advantage of breakthrough opportunities. New technologies that make life for consumers more convenient should be unleashed on the market in an open way that allows legacy systems and new entrants to uptake and deal with advances in a transparent, competitive way. There is no guarantee that such technologies will lower costs or improve quality. But I would bet that digital virtual care will in the long run would achieve just that. Experience in other markets suggest there is a high likelihood that would happen. And our Zoom+Care experience in digital care supports this view. Certainly trying to prevent the spread of such technologies or implementing laws that lock in the old way are doomed to unleash unintended consequences.


Read: KHN Doctors Give Medicare’s Proposal To Pay For Telemedicine Poor Prognosis

Read: CMS Proposes Historic Changes to Modernize Medicare and Restore the Doctor-Patient Relationship

Read: Letter from Francis J. Crosson, M.D to MedPac

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