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The doctor is always ‘in’ — 24/7 online

Dr. Pavel Conovalciuc, a Washington state physician, works under contract with MeMD, a firm hired by Presbyterian Healthcare Services to provide video visits for its health plan members. (Marla Brose/Albuquerque Journal)

Dr. Pavel Conovalciuc, a Washington state physician, works under contract with MeMD, a firm hired by Presbyterian Healthcare Services to provide video visits for its health plan members. (Marla Brose/Albuquerque Journal)

Copyright © 2015 Albuquerque Journal

The doctor will see you now, on your smartphone.

Have a cough, sore throat, rash or sinus infection and don’t want to drive to an urgent care clinic? Now, many New Mexicans can set up a “video visit” by computer or cellphone with a health care provider, such as a physician or a nurse practitioner.

Presbyterian Healthcare Services launched the new video visit service last month that allows its 440,000 health plan members to schedule the online visits, which are free for most plan members.

Presbyterian contracted with an Arizona-based firm, MeMD, to provide the service, which puts patients in voice and video contact with a nationwide network of physicians.

A video visit could put you in contact with Dr. Pavel Conovalciuc, a physician in Spokane, Wash., who works under contract with MeMD.

“Just to make sure you’re not in any distress, do you have any episodes where you feel winded or wheezy?” Conovalciuc asked a Journal reporter who played the role of a patient in a recent simulated video visit.

“Do you have any chronic medical conditions I need to know about?” he asked. “You mentioned a cough. Do you bring up any phlegm with that, or is it just kind of a dry cough?”

After a discussion of symptoms, Conovalciuc recommended a treatment that included hydration, vaporizer use, a nasal rinse and over-the-counter medications.

He did not prescribe any medications. But because Conovalciuc is licensed to practice medicine in New Mexico, he has prescriptive authority here. Prescriptions are sent electronically to the patient’s preferred pharmacy.

MeMD providers are barred from prescribing controlled substances or narcotic painkillers.

Conovalciuc said he treats about 50 patients a day by video for MeMD and a second company, MDLive. He is paid $25 per visit, which typically takes 5 to 10 minutes, he said.

Glenn Rosenbaum used Presbyterian's online video visit to speak with a nurse practitioner when his daughter, Ellie, 7, had an ear infection. Rosenbaum said he began the process about 4 p.m. Jan. 30 and had prescription medicines in hand by 6 p.m. (Marla Brose/Albuquerque Journal)

Glenn Rosenbaum used Presbyterian’s online video visit to speak with a nurse practitioner when his daughter, Ellie, 7, had an ear infection. Rosenbaum said he began the process about 4 p.m. Jan. 30 and had prescription medicines in hand by 6 p.m. (Marla Brose/Albuquerque Journal)

Telemedicine is a growing and lucrative part of his practice, said Conovalciuc, 39, who holds medical licenses in 10 states and practices from his home in Spokane.

“Telemedicine has been going viral,” he said.

Patients with colds, respiratory infections, pink eye, even back strain find it convenient to visit a doctor via computer, tablet or cellphone, he said.

“They don’t have to spend hours at urgent care centers being exposed to people with flu, colds and everything else,” he said. “It’s at their fingertips. It’s at any time that they want.”

The service is intended to free up capacity at urgent care clinics and to provide a fast, convenient way for patients to get professional advice for simple medical problems, Presbyterian officials said.

Presbyterian is the first New Mexico medical system to offer video visits to its health plan members.

Some limitations

Telemedicine does have its limitations. A doctor can’t make a physical examination, peer into the patient’s ears and throat, or listen to your chest with a stethoscope.

And telemedicine always has raised questions about whether patients are sacrificing quality care for lower cost and convenience.

Dr. Robert White, medical director of informatics and quality for ABQ Health Partners, said doctors always run a risk of misdiagnosing a patient, even in traditional clinic examinations.

“The doctor in a video visit would have to make a quick decision” about whether to treat the patient or refer them for advanced care, said White, who practices urgent care medicine. “In that respect, the risk is no different than things you decide face-to-face with patients.”

The main obstacle to telemedicine always has been the business model of medical care, White said. Telemedicine raises difficult questions about how doctors are reimbursed.

“For many years, doctors have provided care over the phone,” he said. “Many times, both the patient and doctor would be far happier doing their business over the phone, but they can’t, because most doctors can’t get paid that way.”

Conovalciuc said he recognizes the limitations of telemedicine and routinely quizzes patients about serious symptoms that would prompt him to refer a patient to an urgent care clinic or an emergency department.

“We play it safe,” he said. “If the presentation isn’t clear, you have the option of going to urgent care or your primary care doctor.”

With video visits, you still have to wait to visit with a health care provider.

Presbyterian officials say video visits average 37 minutes each, beginning from the time a patient requests an online visit. Patients are told to expect to wait 15 to 30 minutes for a health care provider to become available.

About 140 patients have used the online service since its Jan. 1 launch, Presbyterian officials said. Most accessed the service by cellphone.

Glenn Rosenbaum said he learned at 4 p.m. Jan. 30, a Friday, that his 7-year-old daughter, Ellie, was complaining of an earache.

He registered his daughter with myPres on his laptop computer at home and received notification in about 10 minutes that a nurse practitioner was available to speak with him. At about 6 p.m., Rosenbaum drove to his pharmacy and picked up a prescription for an antibiotic and ear drops to relieve pain.

“It was quick,” he said. “We have sat in urgent care for several hours. To be able, that quickly, to visit with somebody and get a prescription in our hands in under two hours was remarkable.”

Presbyterian Health Plan members can request a video visit by visiting phs.org and registering for a myPres account.

The health professional creates a record of each video visit and emails it to the patient, but the record is not automatically sent to your primary care physician and does not become a part of your permanent records, Presbyterian officials said.

Video visits are intended to give patients a convenient way to access health care and cut down traffic in urgent care clinics, said Dr. Jason Mitchell, chief medical and clinical transformation officer for Presbyterian Healthcare Services.

“This is huge if you live 40 or 50 miles from the nearest health care facility,” he said.

Video visits are inappropriate for people who are short of breath, seriously injured or suffering severe abdominal pain, nausea or vomiting, he said.

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