The doctor will see you now — online

Special to the Observer

You’ve had the sniffles for a few days.

You are feeling bad, but you don’t want to take the time off work to drive to your doctor’s office and wait for an hour to see him for just 10 minutes.

Wouldn’t it be nice to just e-mail him?

Now you can, with a virtual doctor visit offered by physicians like Dr. Lee Thomas at Indian Land Primary Care.

This “house call of the future” is just one of the new ways of practicing medicine at the Lancaster County family practice, one of 36 medical offices across the country participating in a two-year experiment to revive the family doctor with a 21st-century update.

In addition to virtual office visits, patients will get old-fashioned customer service such as same-day scheduling even for checkups and new medical know-how like group support sessions for people with chronic diseases.

“The purpose is to make practices more patient-centered and physician-friendly,” said Thomas, who was selected from more than 350 applicants and who is the only participant from the Carolinas.

New model of health care

Skyrocketing medical costs and a lack of new family physicians are problems that the $8 million American Academy of Family Physicians’ TransforMED project hopes to cure.Dr. James Martin, TransforMED board chair and a family physician in San Antonio, says he expects that within five years patients will demand this type of care.

“I think it will be that powerful,” he says.

While not the only attempt by the health care system to improve technology and care, it is a first of its kind attempt to do so in all aspects of the way a doctor practices medicine.

A primary concern for many patients is the rising costs.

Martin says the decline of the family physician as the first point of contact is one reason.

Thomas pointed out that patients are going to specialists like cardiologists for minor chest pain or orthopedic surgeons for lower back pain rather than to primary care physicians who may be able to solve the problem for less.

Better chronic disease management, fewer inappropriate referrals and more preventive care could also cut costs.

Another issue is the lack of medical students going into primary care. Physicians can make a lot more money in other fields.

The TransforMED model hopes to draw more physicians into the primary care field by helping them make more money through more efficient technology that reduces overhead costs, giving them more flexible schedules and helping them have better experiences with patients.

Virtual office visits and more

“What we’re trying to do is really different from the way I have practiced for the past 30 years,” said Thomas, who founded Barnett Family Practice in Lancaster in 1976 after graduating from the Medical University of South Carolina.

He began the virtual office visits in late December, allowing established patients to submit medical information via his Web site and potentially avoid having to take time off work for a simple cold or cough.

Patients answer a series of “drop-down” menu questions about their symptoms and submit them to the doctor online. The doctor then either prescribes a medicine or asks the patient to come in for an office visit.

It’s not free — the patients are still charged an insurance co-pay.

Martin says that one patient of his even offered to pay double for such a service because of the time it saves.

Open access scheduling allows same-day appointments, even for checkups.

Traditional physician offices may leave 20 percent of appointment slots free for same-day appointments; Indian Land Primary Care leaves 60 percent open.

“The idea is to do today’s work today,” said Thomas.

Another approach is group visits for chronic disease management. For example, a group of eight to 10 people with diabetes may attend a session on a disease topic, like eye or foot care, and then have labs taken and meet briefly with the physician.

Martin says research has shown that group visits can dramatically improve patient health in part because they like to talk to and learn from one another about what works in living with the disease.

Another component of the program is software that enables the doctor to have access to the latest information about treating an illness rather than having to rely on memory or outdated training.

Other software enables doctors to track patient care through insurance claims data, including whether prescriptions being filled and visits to other physicians, for more complete continuity of care.

“It adds a level of patient accountability,” says Martin.

Like starting all over again

Thomas, who is affiliated with Presbyterian Healthcare System, says he signed his contract with Presbyterian on a Monday and two days later received the call about his selection for TransforMED.”It’s really like starting all over again,” he said.

Indian Land Primary Care is one of 18 participants being helped by an expert. Eighteen other practices in the country are doing it on their own.

The practices have been divided to determine the best way to roll out the program to a large number of offices in the future. A report on what worked and what didn’t is expected in early 2009.

David Garrett, a medical practice manager from Kansas City, Mo., is Indian Land Primary Care’s expert. He visits the practice regularly and stays in contact via telephone and e-mail more often.

These practices also meet every six months for learning labs.

The practices were selected to reflect diversity in practice size, location, age, ownership, arrangement, revenue and degree to which each has already implemented the TransforMED Model ideas.

Martin says motivation to change was also a factor.

Indian Land Primary Care is one of four new practices participating.

“It’s a tremendous opportunity for us,” said Thomas. “It’s a big deal for family medicine.”

More Information and www.indianland

Changing Family Medicine

Dr. James Martin was lead author on the Future of Family Medicine report commissioned by seven leading family medicine organizations in 2002. In the 1990s, health care costs and the number of uninsured were rising and satisfaction was dropping. The report was compiled by asking patients, doctors and others in health care for recommendations to make health care better. Launched in June 2006, the TransforMED demonstration project was developed to test the report’s recommendations.
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