We have produced this report to provide forward looking insight into the emerging online medical services industry.

Just like many industries before it, wherever more efficient, many of the services in the medical industry are moving online. Each year we will provide insight into this trend, at this page.

Introduction

We’ve all done it. It’s 10:30 at night. You have a fever and developed a rash. You begin to worry. What is it? Do you need to go to the emergency room? Can it wait until morning? So, you do what millions of Americans do each day. You head to your computer and begin searching your symptoms on one or more of the thousand of medical websites on the Internet; but, now, you can go one step further and consult, 24/7 in real time, with a physician or nurse practitioner.

In 2002, The Pew Research Center produced a report on those accessing medical help online. The report estimated that more than 6 million Americans sought health and medical advice online per day. In a newer report released in July, 2018, The Pew Research Center adjusted that number to 93 million people researching health related issues per day. The report went on to state that 93% of those seeking medical information looked for specific illnesses or conditions and 55% sought information prior to visiting a doctor.

America is experiencing a perfect storm in healthcare in 2018 and it’s expected to exponentially grow. According to the Association of Medical Colleges, the U.S. will experience a shortage of over 100,000 physicians by 2030, an increase of 55% in patients over the age of 65 and an increasingly healthcare insured population. Other concerns include access to medical care for millions living outside of urban centers. For instance, in 2018, The National Rural Health Association estimates nearly 700 rural hospitals are at threat for closing; and, those closures are projected to continue.

Now’s the time for online medical care to expand.

There’s little argument that the Internet has changed the way we live and interact. Beyond the world of social media, Americans have found the Internet to be a wonderland of benefits, ranging from education to employment, recreation to entertainment; and, not least, a relatively new service, health and wellness.

What Is Telehealth or Telemedicine?

Telehealth and telemedicine are long used catch-all phrases (and can be used interchangeably) which cover a variety of medical services offered through various media such as email, telephone and/or the internet. While a form of telehealth has existed for several decades, the new frontier is in physician-to-patient communication and healthcare through websites and apps which offer more services than ever before. As we see more online services develop, we see the terms telehealth and telemedicine be replaced with more specific search terms such as “online doctor”, “online medical services”, “online healthcare”, etc. As technology evolves, so will online medical services.

Most of us are familiar with websites such as WebMD, the government’s Center for Disease Control or MedLine Plus, on which we can find information on conditions and diseases; but, those are information sites only with little interactivity. We’re using the term telehealth to describe actual medical care as a result of direct, electronic communication with a physician and patient. Descriptive titles such as “Concierge Doctor”, “MD Live”, “Virtual Doctor”, “Online Doctor”, etc. better defines what online medical care is about. Today, we can access a physician, live, 24/7 for consultation and treatment; and, it will only continue to grow as more patients seek new ways to receive healthcare. The Kiplinger Report offers advice on choosing an online physician.

What’s Possible?

Let’s take a look at a comparable Internet boom. In the 1990s, the Internet created a platform which allowed colleges and universities to reach more students through interactivity with content, professors and other learners. Online degrees and diplomas were once considered lesser degrees than traditional brick and mortar schools; but, no more. Where once online education was suspect in terms of credibility and accreditation, today it’s considered an attractive method for adult, working learners to obtain degrees and certifications. In 2015, there were 5,954,121 students enrolled (National Center for Educational Statistics) in online degree programs provided by accredited colleges and universities.

As with education, it’s not much of a leap, nor too early, to consider the effects of what online medical services may look like in the future. In the 1960s, NASA, Lockheed Martin and the U.S. Indian Health Service, joined forces to develop the Space Technology Applied to Rural Papago Advanced Health Care project to offer telemedicine services to an American Indian Reservation, utilizing the same technologies used for astronauts in space. The most successful use of medical technology during this period was in radiology; but, as technology advanced in the 1990s, more services were provided. Physicians could offer long-distance patient consultations in real time.

Fast forward to the 21st century and physicians, pharmacies, clinics, and even insurance companies, are beginning to offer online, medical services unimaginable just 15 years ago. Broadband, digital cameras, smartphones and high speed internet connections have opened new platforms from which physicians, nurse practitioners, physician assistants, pharmacists, etc. may reach even more patients.

A specialized organization for online, physician services has already been established with the American Telemedicine Association which provides online physicians with resources, libraries, case studies, etc. to help with developing their practice and joins the American Medical Association, American Academy of Family Physicians, American College of Physicians and other professional associations in support of online medical care.

What Services Are Provided?

Technology is quickly moving to provide platforms which may open more avenues for providing quality, expedient healthcare. In 2016, The Medical Futurist described the future of smart homes, which are built with sensors and devices that can detect certain health issues and send information directly to a physician of possible concerns. The Japanese are estimated to earn over $5 billion in the U.S. with its smart home technology capable of identifying medical conditions. Apple, Inc. announced in September, 2018, a Smart Watch capable of providing accurate heart readings, along with its fitness and physical activity logs. These advances move seamlessly into the new field of telemedicine. Smartphone apps are being developed for individuals to measure blood pressure and heart rate.

Forbes Magazine reports that over 80% of physicians utilize smartphones and medical apps in their practice and have the ability to enhance patient self-monitoring which sends information directly to the physician. As mobile devices and apps become more personalized and secure, more health information can be relayed directly to the online physician.

Easy Fixes?

Traditional physician services often involve delays in getting appointments, long wait times in physician office waiting rooms, exposure to other people’s germs, seemingly brief physician-patient times (most physicians are able to spend only 15 minutes per patient due to workload) and often, billing and insurance issues.

Now, imagine being able to see and talk with a physician, via an Internet connection and digital camera, almost immediately. New online services can provide 24/7 access to physicians, physician assistants or nurse practitioners. The amount of time a healthcare professional spends consulting with patients online is less of an issue than an in-office appointment. That’s because of a decrease in patient load (office centered physicians often have patient loads in excess of 2,000 people as opposed to fewer than 500 for online physicians) and services are often billed at set rates ($50-$99 per session as opposed to the “superbill” model which charges for itemized services).

There will always be certain medical conditions which will require a physician office visit such as x-rays, scans, certain laboratory tests, etc. Online physicians, however, are able to diagnose and treat infections, colds, flu, respiratory infections, etc. Prescriptions may be transmitted to pharmacies and patients never need to go to an overcrowded, germ riddled doctor’s office for evaluation and a prescription.

Some specialty physicians are already available through telemedicine, such as psychiatrists, psychologists, clinical social workers and dermatologists. Many behavioral health issues may be treated online, ranging from depression, stress/anxiety, grief counseling, addiction, etc. Dermatologists can evaluate conditions such as rashes, moles, acne or skin infections over an electronic platform. Radiologists are able to review scans and other images from a distance and provide physicians with accurate results. As technology advances, so will the number of physician specialists.

Let’s Talk About Benefits For Healthcare Providers

In the year 2030, for the first time in U.S. history, the U.S. Census Bureau estimates that people over age 65 will outnumber those under the age of 18 years of age. What does that mean in regards to healthcare?

As America ages, more healthcare services will be required to meet the care requirements for aging patients. Couple that with the retirement of older physicians and nurses and the shortage of 100,000 physicians and over 600,000 nurses by 2030. The shortages are a result of healthcare professionals retiring or leaving the profession due to burnout. It’s critical that healthcare develop ways to attract and retain physicians and nurse practitioners, as well as ancillary staff.

According to the Agency for Healthcare Research and Quality, a division of the Department of Health and Human Services, studies indicate that nearly 50% of physicians express some form of burnout in their practice. Reasons cited for this dissatisfaction are stress, chaotic environments, time pressures and lack of control. The results are physicians leaving practices in record numbers; but, it also brings into consideration, quality patient care and safety. Telehealth medicine can address several of those issues by providing more flexible schedules, more free time and an improved work-home balance for physicians and nurses. For this reason, some doctors are opting to offer online primary care physician services through a variety of technologies and hubs.

When discussing the financial costs vs rewards of practicing traditional and internet medicine, there are several factors to consider.

The American Association of Medical CollegesThe American Association of Medical Colleges estimates the cost of a medical degree to range from an average of $214,816 for in-state, public medical schools and $264,564 for an in-state, private medical school. Add to that, the cost of setting up a medical practice, which is estimated to be to around $120,000. That’s a lot of debt. Compare traditional, in-office costs to the estimated $20,000-$25,000 costs in establishing an online practice (AMD Global Telemedicine).

This new field of practice provides soft benefits healthcare professionals want as well.

We’re seeing the development of online physician group practices, which provide online physicians the benefits of a traditional group practice; but, with fewer patients (physicians establish internet services see approximately 25% fewer patients than traditional physicians), more attractive hours, increased free time and the ability to set his/her own cost of service. Many newer services allow the physician to travel while offering services.

How About Patient Benefits?

Where to begin? Online medicine offer nearly instantaneous access to a physician, anytime, is every patient’s dream scenario. Online medicine offers no wait times. No travel times. No sitting in physician offices with people who may be infectious. As we see many rural hospitals closing, and subsequently, physician offices moving to larger communities, telehealth can be particularly useful in providing patient care for those with limited resources.

Online physicians hold the same credentials as in-office physicians and are board certified and licensed to practice. The major differences between the two types of practice are accessibility, number of patients, length of time spent in direct patient care, cost and no patient travel involved. Recognizing that there are some conditions and illnesses that require additional testing and laboratory results, online physicians are able to make referrals to other physicians, outpatient diagnostic centers or clinics. Patient information, captured through Electronic Health Records, is often stored on a cloud and allows online doctors to immediately access and update patient records necessary for quality care.

Patient satisfaction surveys of those receiving online care are showing very positive results. The Annals of Family Medicine conducted a limited, patient survey gauging patient satisfaction with results indicating those surveyed citing ease and convenience of a telehealth appointment and cost. Additional survey results indicate that patients were interested in continuing to see a primary physician through video conferencing.

Insurance vs Membership

As more states pass parity laws (allowing telehealth physicians to bill private at a reimbursement rate similar to more traditional physicians) more patients will be able to access online physicians.

Online health companies are developing and patients are able to obtain memberships which allows them, depending on the company, unlimited text, same-day video physician appointments; as well as, memberships ranging from $50-100 per month (usually reimbursable through Health Savings Accounts, Flexible Spending Accounts, Medical Savings Account, etc.) and direct pharmacy submissions.

Most physicians accept Medicare and the ability to be reimbursed is key. In February, 2018, federal legislation was approved which allowed private Medicare Advantage plans and accountable care organizations (ACOs) to offer telehealth services (Forbes Magazine), opening the opportunities for reimbursement for online medical services.

In July, 2018, additional good news came when The Centers for Medicare and Medicaid Services proposed increased Medicare coverage for patients using online physician services. CMS Administrator Seema Verma, during a telephone press conference said of the CMS plan, “Under this proposal, Medicare will start paying for virtual check-ins, meaning patients can connect with their doctor by phone or video chat…Many times this type of check-in will resolve patient concerns in a convenient manner that gets them the care that they need and avoids unnecessary cost to the system.”

What Does The Future of Online Healthcare Look Like?

If we had a crystal ball to look into the future, we’d probably see the future of online healthcare considered as traditional medicine is today. Naturally, there will always be a need for patients to receive specialized care, such as surgery, in a traditional setting. However, the advancement of treatments of conditions or diseases, indicate that it’s not unreasonable to imagine more treatments will be able to accessed online.

For example, look at gastroenterology. The traditional testing for colon conditions and issues has long been through an invasive procedure, the colonoscopy. Today, an alternative to the traditional colonoscopy exists in the form of a wireless capsule enteroscopy; or, a pill which is equipped with two miniature cameras, which patients swallow. This capsule is able to take multiple images of the small intestine, requires less rigorous prep time than traditional colonoscopy and provides physicians with equally clear diagnostic tools.

Another example in the advance of medical technology which exemplifies the increasing trend toward online and/or virtual medical care, is in the treatment of diabetes. Where once patients were required to painstakingly monitor blood samples, administer insulin injections and make frequent physician visits, internet medicine changes that. Today, diabetics are able to maintain a quality of life with a simple insulation pump the size of an electronic pager which automatically administers insulin as needed. These pumps have the ability to “talk to” a smartphone application which registers administration of insulin, dosage and time; and, information may then be transmitted to the patient’s physician, without the necessity for an office visit.

What does this have to do with internet medicine? It speaks to the shift in medical care in accepting more computerized technology and immediate physician ability to provide patient care. Virtual medical care allows patients to become more actively involved with their care and allows physicians to have instantaneous access to health information to monitor, adjust and reevaluate treatment options.

Endless Possibilities

It’s hoped this overview of The State of Online Medical Care 2018, has provided broad brushstrokes of the history, what services are currently available, the increase in state and federal legislation to support continued online medical care growth and the health benefits to patients and professional benefits for physicians.

Individual physicians and physician groups are seeking better ways to reach patients in a more efficient and efficacious ways. Federal and state governments are approving and enacting legislation which will open the doors for concierge doctors to establish more personalized and concentrated patient care. Private insurers are embracing the concept of online healthcare with changes in reimbursement fees; and, indeed, developing their own cadre of online physicians to care for the insured.

It’s estimated that by 2020, the CMS proposal will be enacted which will probably lead to an increase in online physicians and medical service options for patients. Add to the reimbursement benefits, the improvements in phone apps, computer and webcam abilities and an increase in physicians remaining in the medical field as a result of more control over their practice; and, the “perfect storm” threatening healthcare, will be reduced by virtual medicine, online doctors and patient involvement.

The future in healthcare appears to be remarkable. And a lot of it will be online.