It’s one thing to slam someone’s work from afar. It’s quite another when that person challenges you right back — in person.
That scenario played out Monday during a session on direct-to-consumer care at the American Telemedicine Association‘s 2016 annual meeting in Minneapolis. John Jesser, president of LiveHealth Online for health insurer Anthem, said that a study that appeared in JAMA Dermatology on Sunday was “devious” in using “actors” to play teledermatology patients. Jesser characterized a Wall Street Journal article about the study as “hostile toward this industry.”
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The study, led by University of California, San Francisco, dermatologist Dr. Jack Resneck Jr., found that doctors from some of the 16 telemedicine sites contacted misdiagnosed skin cancer, syphilis and herpes. Some doctors prescribed medication without asking about basic medical history, the researchers found.
Jesser backpedaled a little, calling the study “a good alarm,” but said telemedicine is held to a higher standard than in-person care.
Study co-author Dr. Carrie Kovarik, associate professor of dermatology at the Hospital of the University of Pennsylvania, rose from her seat to disagree.
“I’m not expecting people to hold telemedicine to a higher standard. I expect them to hold it to the same standard that they have in their offices,” Kovarik said. “We saw some sites doing wonderful work and we saw some sites using unlicensed international practitioners, and this has to stop.”
She has had to undo some of the damage that telemedicine dermatologists have done to her patients, Kovarik added.
The study involved 62 clinical encounters in February and March 2016. None of the sites asked patients for identification or raised concerns about pseudonyms or falsified photographs, the study said. Few collected the name of an existing primary care physician or offered to send records, the JAMA Dermatology article added.
DTC teledermatology is expanding rapidly but has not been studied much, the researchers said. Meanwhile, telemedicine companies have “raised substantial investor capital and marketed themselves heavily to consumers, employers, and health plans,” according to the study.
“Telemedicine has potential to expand access, but these findings raise doubts about the quality of skin disease diagnosis and treatment currently being provided by [direct-to-consumer] telemedicine sites and apps,” the study concluded.
When Kovarik demanded accountability for telehealth providers, Jesser countered that every state has a medical board.
“But medical boards don’t surveil in real time,” Jesser added. “We’re really, really aware and careful because these are real doctors who have real malpractice insurance and real careers.”
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