Hospitals, Patient Engagement

Telemedicine doc: Value-based payment will restore physicians’ role as part of care teams

“Doctors need to be the stewards of the relationship,” according to Dr. Michael Fratkin. “Wise guidance is what’s missing.” It’s been replaced with excessive paperwork and a hint of paternalism.

A couple of weeks ago, the image of a coffee mug that said, “Please do not confuse your Google search with my medical degree” went viral on Facebook. The post, on a page called The Emergency Medicine Doctor, has been shared 132,000 times, has garnered more than 93,000 “likes” and drawn upwards of 5,000 comments.

Various versions of the mug — including one with Google’s new logo — are available on eBay, Etsy and other online shops. I won’t be buying one, nor will a lot of physicians I know. While a funny sentiment, it, as many have said in the last two weeks, comes off as paternalistic.

This topic has come up for me a couple of times recently. You may have caught my video interview just before Thanksgiving with Frost & Sullivan connected health analyst Nancy Fabozzi, in which she boldly predicted that technology would replace physicians for a lot of routine care in the next 10-20 years.

Friday, I heard related sentiments from Dr. Michael Fratkin, founder of a remote palliative care startup called Resolution Care in isolated Eureka, California. Fratkin, a MedCitizens contributor to MedCity News and strong proponent of telemedicine, didn’t go as far as Fabozzi, but he said that the physician’s role must change.

“Doctors need to be the stewards of the relationship,” Fratkin said in a video chat that was not recorded. “Wise guidance is what’s missing.”

Yes, guidance, not authoritarian decision-making. “We will restore the role of the physician,” Fratkin added. “But it will be team-based and what the patient deems appropriate.”

To Fratkin, physicians and their office staff have gotten too bogged down in administrative work, thanks to the prevailing fee-for-service paradigm. “It is my intention to restore the central role of the provider,” he said, without a hint of paternalism. “Doctors provide wise guidance.”

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Fratkin has embraced value-based reimbursement. He is involved in a value-based pilot underway with MediCal, California’s Medicaid program, to offer remote palliative care to recovering or dying patients in rural Northern California.

For now, the pilot offers enough revenue to make his vision for care possible on a small scale. Fratkin still is looking for more funding from his community or grants to keep Resolution Health afloat for a year or so until value-based purchasing becomes a sustainable revenue stream, hopefully by the end of 2016 or early 2017.

Then he wants to scale up what currently is a solo practice, first by refining the prototype in his own community, then throughout California and eventually nationally — assuming the nation figures out the sticky problem of cross-state licensure for physicians practicing telemedicine.

“If we get this right in palliative care, there can be implications for all of healthcare.”

Photos: MedCity News screen grab, Facebook user The Emergency Medicine Doctor