Should telehealth appointments cost the same as in-person visits?
Practicing pediatricians have been using telehealth technology to communicate with patients who are not able to physically visit offices because of social distancing measures during the COVID-19 pandemic. Infectious Diseases in Children asked Editorial Board Member Eugene Shapiro, MD, professor of pediatrics and epidemiology at Yale School of Medicine, if patients should pay the same amount for a telehealth visit as they would for an in-person visit.
I have mixed feelings on how patients should be charged for virtual visits. On the one hand, the main thing that one is missing in a virtual visit is the physical examination, although you still do have the visual physical examination, which is probably as important as anything. Of course, there are some exceptions. In general, the physical examination is not very important; at least in terms of making a diagnosis, the history usually is the most important thing.
The appropriateness of charges may vary depending on what the purpose of the visit is. If it is a routine visit for follow-up of a chronic condition — for instance, high blood pressure — there is not much that needs to be done, generally, in person, as long as a reliable value for the blood pressure is available. If it is somebody with a new problem — for instance, fever and sore throat — you may need to get a swab to test for something like strep throat, which you cannot do remotely, but you can tell them to come in to get the necessary laboratory tests, whatever they may be.
I believe that the way patients are charged — actually, the way the whole system is charging for medical services — is not very fair or rational. To start with, it does not make a lot of sense that the time a physician spends with a patient, in most instances, is not taken into account as much as procedures, even minor procedures, which often result in a substantial charge.
In general, I would say that to the extent that the patient gets the same value from the telehealth visit, I think that it is very fair for the charge to be the same as an in-person visit, as long as the patient gets what is needed. I think that is probably the bottom line.
Click here to read the Cover Story, "Pediatric telehealth gets ‘trial by fire’ during COVID-19 pandemic."