A virtual visit can be just as real as one in a physician’s office, believes Thanh Nguyen, a family nurse practitioner with Providence Health eXpress in Oregon. But unlike a clinic visit whose economics is fairly well understood, the jury is still out on the return on investment of telemedicine.
While speaking at the recently-concluded American Association of Nurse Practitioners’ Specialty & Leadership conference last week in Rosemont, Illinios, Nguyen recalled how — during a session with an emotional patient — she found herself leaning over to hand the person a box of tissues before realizing they were not physically in the same room.
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In addition to sharing her personal stories and giving tips on the importance of maintaining eye contact across cyberspace, Nguyen offered her assessment of the state of healthcare’s use of telemedicine tools and the role NPs can play in advancing their adoption.
Telehealth technology offers solutions to healthcare’s staffing and access challenges along with providing growth opportunities for nurse practitioners, according to Nguyen. But the economics behind it remain unclear and licensing requirements and other political controversies continue to cloud the picture.
Nguyen said she’s always asked about the return on investment with telehealth technology. But, as healthcare moves from fee for service to value-based payments under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the answer is “We don’t know.”
What is known, however, is that it has improved access with virtual visits and remote managing and monitoring of patients, Nguyen said while presenting evidence that telemedicine is helping healthcare achieve the triple aim of improved patient experience and population health at a lower cost.
“It will be interesting to see where the bottom line will be and if this is paying off,” she said. “I know we have saved lives by having these services available to our patient population.”
Echoing recent comments about a “quadruple aim,” Nguyen added that she’d like to add a fourth aim for healthcare providers.
“I don’t want to work for free,” she said. “I don’t want to work for 14 hours and be paid for eight or less.”
But current insurance reimbursement policies don’t pay her for the time taken to respond to patients’ e-mails and state licensing requirements have resulted in wasted time spent dealing with patients who she caught fibbing about their location.
Nguyen is licensed to practice in Oregon and Washington, and current rules dictate that providers must be licensed in the state where the patient is located in order to treat them.
“In the state where their feet are touching, I have to have a license,” she explained.
One time a patient with a Nevada drivers’ license insisted he was visiting Oregon, but then gave himself away when he gave a Nevada number to telephone for his prescription. Nguyen said she stopped the visit at that point and waived her fee even though she had already spent 20 minutes on the phone with the patient.
More than 500 people are attending the AANP conference which runs Sept. 22-25 at the Hyatt Regency O’Hare hotel.
Photo: Meriel Jane Waissman, Getty Images
