A Home Care Perspective
Friday, May 5, 2006
| Kathy Duckett
Are physicians going to see telemedicine as an extension of their ability to serve their patients, or an incursion into their locus of control (including reimbursement)?
Over the last 50 years we have increasingly required the patient “go somewhere” to get the medical care needed. Except in home care. We started 150 years ago by bringing health care to the patient. Very little has changed in that basic concept; we still provide all of our care in the patient’s home. Telemedicine’s increasing emphasis is on bringing health care to the patient instead bringing the patient to health care. As a home care provider I find myself concerned that some of the challenges we’ve met in the medical community will be translated to the implementation of this new technology.
Over the years I’ve found many physicians who embrace the benefits that home care can provide. I’ve felt honored and privileged to work with physicians who have seen me as providing patient insight in a way that is unavailable to them due to my unique perspective: caring for the patient in the “real world” of that patient’s home.
However, I have also met a number of physicians who complained about the uncompensated time spent in coordinating care when a patient has had home care, and the lack of control over the care provided. They found burdensome the demands I put on them to return my phone calls and make decisions on the patient’s care based on my assessments. They were quite verbal about the amount of paperwork they had to complete for me and the time consumed completing the paperwork for Medicare in order to get paid for that time.
As we’ve rolled out telemedicine to our patients every physician I have spoken with has understood how this will help us better manage the patient’s condition. But we have found physicians slow to respond with parameters to guide our decisions on when to call them. Physicians are also concerned about the potential paperwork increase and their time commitment in the implementation of this new technology.
So this is my concern: as telemedicine moves care farther and farther away from the physician’s “hands” will the people who really have the ability to decide yes or no be willing to say “yes” for their patients?