Introducing The “Uber Approach” To Medicine: On-Demand Doctor Apps
[guest post by Dana]
As most readers know, that innovative private taxi company upstart, Uber, has been taking a lot of hits lately from the left which tends to frown upon competition, no matter how much it benefits Americans. Now another innovative idea has arrived, on-demand doctor apps that bring the “Uber approach” to medicine:
House calls were once commonplace in the U.S. Today, 9 out of 10 general practitioners say they do not typically make house calls, according to the American Academy of Family Physicians.
But new phone apps may signal a comeback for house calls.
Pager is currently only available in New York City but it will expand to San Francisco in coming weeks. A rival company on the West Coast, Heal, already operates in San Francisco, Orange County and L.A
Gaspard de Dreuzy, one of Pager’s three co-founders, says the services’ typical customers are working mothers ages 30 to 45.
“It’s really an urban population that is busy and values its time,” he adds.
So much so that they are willing to pay a premium. Like other services, Pager is not currently covered by insurance. Customers pay a $50 fee for their first visit and $200 for subsequent visits from one of the company’s 40 health practitioners, including doctors, nurses and physician assistants.
That fee is about 10 times more than the typical $15 to $25 doctor co-pay for patients with insurance. But there are situations where a Pager visit might be cheaper than conventional care. For instance, $200 is significantly cheaper than the median cost of an emergency room visit: $505, according to federal figures. The ER is often the only medical option for people without insurance.
“We’re trying to move forward to a model where the Pager service will be as affordable as any other care option for people who are insured or not,” de Dreuzy says.
Some medical professionals are wary of the idea and cite potential drawbacks:
Dr. Robert Wergin of Milford, Nebraska says on-call services could be useful for one-time medical needs. But treating chronic conditions like diabetes, arthritis or Alzheimer’s requires careful, consistent attention over many years. A doctor responding to a phone app may not be familiar with a patient’s family history, medications, allergies and other critical details.
“If these apps develop and they further fragment care it’s not going to help the health care delivery system. We’ll get more of what we already have: higher costs and lower quality,” says Wergin, president of the American Academy of Family Physicians.
Other experts worry about doctors making appropriate prescribing decisions when patients are paying $100 or more for their services.
“The visit becomes much more transactional,” says Dr. Jonah Feldman, a specialist in health care delivery at Winthrop University Hospital. “And it will be much harder for that doctor to come out of that visit without giving some kind of treatment, and that exposes patients to the risks of overtreatment.”
But there is also good news in that traditional medicine and on-demand doctor business can co-habitate:
The sector’s oldest company, Medicast, founded in 2013, recently abandoned its direct-to-consumer model in favor of collaborating with large hospital networks. The company recently helped Providence Health & Services — a medical system in the Pacific Northwest — launch its own house call app for the Seattle area.
Medicast CEO and co-Founder, Sam Zebarjadi says the company is working with a dozen other hospital systems on similar offerings. Previously the company operated its own doctor networks in Miami, Los Angeles, Orange County and San Diego. But Zebarjadi says he found that consumers have “a really big issue around trust, which is one of the reasons we decided to start partnering with hospitals and health systems.”
These collaborations may also further another key goal: getting insurance coverage. Like Pager, Medicast is currently a cash service. The company offers to file the bill for a house call with a patient’s insurance provider, to see if they are willing to cover it. But in coming months Zebarjadi expects some insurance providers to begin covering Medicast visits.
–Dana
Hello.
Dana (86e864) — 7/25/2015 @ 10:54 amGreetings:
Can’t help but wonder if Attorney General Lynch has started her Department of Somekind of Justice minions on the “disparate impact” and “redlining” lawsuits.
11B40 (0f96be) — 7/25/2015 @ 11:19 amLooks more like concierge doctors for the average guy. BTW, the arguments against it seem ludicrous. “Dr. Robert Wergin of Milford, Nebraska says on-call services could be useful for one-time medical needs.” Correct and that’s what it’s for. Not for chronic illness.
If we currently have higher costs and lower quality I would suggest we dump Obamacare as it’s obviously not working. And when he says “further fragment care” he needs to explain exactly what is currently fragmenting care.
Is Dr. Feldman suggesting doctors will overcharge or over treat patients just because they are on a house call? That’s ridiculous and I’d need to see proof of that. Plus, the patient is paying for time+service no further “treatment” or “transaction” in implied nor necessary. If anything is beyond the capability or expertise of the doctor a referral will no doubt be applied. If an emergency situation exists the doctor would be the best person to see that and respond appropriately. I wouldn’t doubt seeing many cases of saved lives by these doctors arriving at a patients home and finding an emergency which the patient did not realize.
Hoagie (f4eb27) — 7/25/2015 @ 11:35 amYou’ve got a point there, 11B40. I can’t see a little Jewish doctor parking his Mercedes 550 at 11th and Martin Luther King Blvd. at two AM for a house call with the “guys in the hood” hanging around. Unless of course he is retired Israeli Military.
Hoagie (f4eb27) — 7/25/2015 @ 11:43 amA doctor responding to a phone app may not be familiar with a patient’s family history, medications, allergies and other critical details.
There are a number of health centers that include a card the size of a credit card that will hold the person’s entire medical history. It should be simple, and probably another benefit of such a service, to provide a way to scan the medical history onto the card. Then each user would have their own medical history at hand all the time.
The way hospitals are shredding medical records now, I tell everyone I know to get their own medical records and keep them if they have any disease history or prior surgery. I sure have my own.
Mike K (90dfdc) — 7/25/2015 @ 4:35 pm1) As though doctors always care about their patients as patients… I had a doctor once for about 3 years, when I lost my job, and didn’t have insurance, he suddenly lost all interest in helping me in any way whatsoever. Not even the minimal write it off as pro-bono type stuff. I was a money suck for him.
2) ““If these apps develop”… if the apps develop further, then they likely can DEfragment health care, since you’ll pretty much be defacto carrying your healthcare portfolio around with you, as you ought to be anyway.
IGotBupkis, "Si tacuisses, philosophus mansisses." (225d0d) — 7/25/2015 @ 5:04 pmThere’s also the factor of the doctor visiting the patient’s home, and realizing a contributing factor to an issue which the patient was unaware of, too. Granted, it’s only a TV show, but House often found some problem due to environmental effects… While it’s TV medical drama, I’d bet there are indicative problems which a doctor’s trained eye might see which anyone else without medical training might miss, and which a patient might not see fit to mention during an office visit…
IGotBupkis, "Si tacuisses, philosophus mansisses." (225d0d) — 7/25/2015 @ 5:08 pmHoagie (f4eb27) — 7/25/2015 @ 11:35 am
Right on, Hoagie. You nailed it. The statements you quoted bothered me, too.
felipe (56556d) — 7/25/2015 @ 5:12 pmI use such a service frequently for minor stuff and I get good quality care for a minimal price. Obviously, I can’t use it for everything but minor stuff saves me two hours in a doctor’s office and a co-pay on my insurance. Hard to beat! It is a great market response to nonsensical problems created by the government interference in health care.
WarEagle82 (d7d337) — 7/25/2015 @ 7:16 pmThis does look like concierge care on a budget, Hoagie. My family has paid a doctor for concierge care for over a year and it’s great. It’s good to have affordable alternatives so people can pick what works for them.
DRJ (1dff03) — 7/25/2015 @ 8:22 pmHonestly, who did not see this coming? “Concierge” care is exactly what medical care was in America before the Medicare Act back in the ’60s. Goodness gracious, doctors are highly educated, but they still have to make a living. Some would prefer to do it according to their oath. Others prefer the government teat. I am always astonished that people think stupid government mandates will stop enterprise and capital regardless of the profession.
Ag80 (eb6ffa) — 7/25/2015 @ 10:23 pmThe ER is often the only medical option for people without insurance.
Someone is not paying attention. Anyone who has an issue that requires the attention of a doctor within a week or so, insured or not, will end up in the emergency room. Doctors are so tightly scheduled that you cannot be seen on short notice.
Also, medical care is already fractured. Your GP finds (or is told of) something and, in many cases, you are directed to specialist who may even end up sending you to yet another one. So having all your history in one place does not happen today.
Finally, will dealing with you medical needs in this manner (the app) insulate you from the penalties involved with PPACA, or is it an overlay of whatever coverage you currently get?
Gramps, the original (bc022b) — 7/26/2015 @ 6:57 amSome would prefer to do it according to their oath. Others prefer the government teat.
Those are not mutually exclusive.
Kevin M (25bbee) — 7/26/2015 @ 1:37 pmMy real problem with this kind of service is with the quality of the doctors. Especially if insurance gets into the act.
It costs money to provide medical services. Staff, equipment, consumables, back-office, etc. A doctor spending half his time traveling from one house to the next is already going to have to charge double. Once insurances starts squeezing costs the only way to meet them is to hire cheaper doctors.
Unlike drivers, doctors are not fungible. I don’t think this will catch on.
Kevin M (25bbee) — 7/26/2015 @ 1:44 pmModern medicine has evolved into a group effort, led by one or more physicians. Blood drawing, history workup, record-keeping, specialists, technicians, etc. You really can’t go back to the day when Dad went to fetch the doctor because Sally had a fever.
The telephone killed the house call (it was too painless to get the doctor out), and smartphones won’t bring it back. The only place the house call survives is the treatment of the infirm elderly, and even that is limited to routine checkups. If something serious develops, they still get carted off to a facility.
Kevin M (25bbee) — 7/26/2015 @ 1:51 pmKevin M, I don’t think your concerns recognize what modern medicine has become for most adults. Either they fall into the category of patients with serious health problems so they are treated at specialty providers or hospitals — places that, in my experience, redo every test, xray and CT scan and essentially recreate their own history for each patient. Or they are patients who seldom need medical care so they don’t have a relationship with any doctor who closely follows their health. Instead, they typically go to same-day or urgent-care clinics that provide routine care based on what the patient reports is his history. If they need blood work or x-rays, the clinic may or may not be able to provide it. If not, the patient will have to go elsewhere. That’s very similar to this Uber-style concierge scenario, but without the waiting in a busy clinic with lots of sick people.
How many Americans are still cared for by a family doctor who knows our history, can do a battery of tests in his office, and provides full-spectrum care? Medicine has become so specialized that we see new doctors for almost every illness, and this story strikes me as simply adding a layer of patient convenience to the mix.
DRJ (1dff03) — 7/26/2015 @ 4:15 pmMy family’s concierge doctor said something interesting to me the other day. He said he had become so burdened by his office practice that when a patient needed hospitalization, he turned their care over to a hospitalist because he didn’t have time to see them and also handle his office patients. He felt his hospitalized patients were suffering as a result, because the hospitalist didn’t know their history. He also felt he was losing his own skills by only treating office patients.
DRJ (1dff03) — 7/26/2015 @ 4:19 pmWow, so many good comments to respond to!
Mike K, what did you mean, “The way hospitals are shredding medical records now”? What is shredding? And I would love to have a card with my history on it.
Also, what infrastructure would one of these app doctors need? If they are affiliated with a hospital, which seems necessary, he can simply call the paramedics if the gastrointestinal problem he is called to is really a heart attack, no? Seems like overhead reduction would be a plus, also, and so beats the Minute Clinic model.
And DRJ, I go to a huge group, with one doctor who I rarely see. But they have my records, so when I call in for a sinus infection, all the PA has to do is look at my electronic records (pre-Obamacare version) and call in the prescription. I have created a record, and they respond to it.
Now, can we please have this for pets? For something other than the terminal visit? 🙁
Patricia (5fc097) — 7/26/2015 @ 5:10 pmIt sounds like you’re the doctor, Patricia. All they are doing is writing prescriptions. My insurance would do that over the phone in an hour.
DRJ (1dff03) — 7/26/2015 @ 5:41 pmYou are entitled to your records, Patricia. Also, ask for copies of all test results and keep a chart/log of every time you go to the doctor with the diagnosis and prescription.
DRJ (1dff03) — 7/26/2015 @ 6:01 pmDRJ, yes, they know me and my history well, so now I really don’t need to go in, and I do get the prescription the same day. I think they are trying to fast track some things so they don’t lose patients to clinics or concierge doctors.
All these local doctors use hospitalists. I think their group requires it. It’s rare that they go in and make rounds. The offices are just too busy.
Patricia (5fc097) — 7/27/2015 @ 8:28 amPatricia,
I think we are both open to healthcare alternatives, which we need to be these days.
DRJ (1dff03) — 7/27/2015 @ 9:11 amDefinitely DRJ.
Patricia (5fc097) — 7/27/2015 @ 11:04 am