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Future shock of teledermatology

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By Warren R. Heymann, MD
April 16, 2016

The authors surveyed 62 patients older than 18 years, and 43 caregivers of patients younger than 18 who had been taking isotretinoin for at least 3 months. “Most respondents reported no concern about the safety of an e-visit compared with that of an office visit. When given a choice of cost of an e-visit [from $25 to $200] 40 (38.1%) respondents were unwilling to pay any amount out pocket for an e-visit, and 64 (61%) were willing to pay a median amount of $25.”

The authors state “The median price of $25 per e-visit that respondents selected may not make e-visits financially feasible for the dermatologist.” You can say that again! I shouldn’t be so surprised that almost 40% don’t want to pay a damned cent. How many times have you gotten an image on your iPhone or email from a patient wanting to know what they have and what you can do about it? I’ll bet you dollars to doughnuts that nobody every offered to pay you for your opinion. With the risk of sounding “Cruzian” I’ll make a prediction. By 2020, if not sooner, insurance companies will not allow live visits to occur unless there is a cheap e-visit first.

It will be marketed as allowing quick, convenient, mobile access to your dermatologist 24/7/365. You will be required to answer within 30 minutes. If more than 10% of these encounters result in real office visits, you will then be a second tier provider, receiving only $15 per e-encounter rather than the generous $25 that first-tier dermatologists receive. Obviously, this is all subject to change depending on the Presidential election: Ted (open market competition — working down to $1 per visit), Bernie (Medicare for all — $1 per visit), Hillary ($1 per encounter after using your own server for the e-visit), and the Donald ($1 per lesion evaluation, $1.50 for questions related to hair).

Mori WS, et al;  JAMA Dermatology 2016; 152(3): 338-40. Personal burden of isotretinoin therapy and willingness to pay for electronic follow-ups.

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