Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please can you give a brief introduction to traditional in-person physician office visits for patients with Parkinson’s disease? What clinical benefits do these visits provide?
Access to neurological care for Parkinson disease is currently limited by distance, disability, and the distribution of doctors.
Currently, 40% of Medicare beneficiaries with Parkinson disease do not see a neurologist, and those that do not are ~20% more likely to fracture a hip, be placed in a skilled nursing facility, and to die. So as with other chronic conditions, specialty care can improve outcomes.
How did the idea of using web-based video conferencing to provide “virtual house calls” for Parkinson’s patients originate?
Over five years ago, a remote nursing home in upstate New York contacted Dr. Kevin Biglan (University of Rochester) and me to say that ~50 of their residents had Parkinson disease and asked if we would care for them remotely. We said yes.
From that experience providing care to individuals in nursing homes, we then said why not provide care to patients directly in their homes. If Dr. Marcus Welby could do so two generations ago, why can’t we use technology to do the same virtually today?
What did your recent study into virtual house calls for Parkinson’s patients find?
Dr. Kevin Biglan, colleagues, and I randomized 20 of our existing patients with Parkinson disease to continue to receive care with us in person or care with us in their home via telemedicine.
We found that over 90% of patients completed either type of visit as scheduled and that the clinical outcomes as measured by quality of life and motor (movement) scores were comparable in both groups.
What benefits are there of virtual house calls?
Each virtual housecall saved patients and their caregivers three hours of time and 100 miles of travel.
85% of the participants expressed interest in enrolling in a telemedicine program rather than conducting visits at their physician’s clinic.
Are there limitations of virtual house calls for Parkinson’s patients? For example, can a physician do all the tests that would be performed in a regular office visit?
Telemedicine is not meant to supplant but rather to supplement in-person care. The quality of the physical exam is better in person, but once a diagnosis is made, much of the care can be centered on the needs of the patient.
Laboratory and even imaging testing can generally be done remotely in a patient’s community.
What hurdles must be overcome before the wider use of virtual house calls becomes a reality?
Licensure – State medical licensing boards general require that a physician be licensed in the state where the patient is physically located at the time services are rendered. For example, a patient from West Virginia can come see me in clinic in Baltimore, but I cannot see that same patient in her home in West Virginia.
Reimbursement – Medicare, for example, will pay a physician for an office visit and will even pay an additional fee to a hospital if that office visit is within a hospital setting. However, Medicare will not pay a physician for a virtual housecall and will not pay any technology fee. In essence, Medicare is subsidizing inconvenient, often unsafe hospital-centered care instead of incenting convenient, safe, patient-centered care. In Canada, where telemedicine is reimbursed, use is common and not even newsworthy.
Change in these barriers will not come from physicians (who will be viewed as self-serving) but rather from patients.
Do you think virtual house calls will be useful for patients with conditions other than Parkinson’s?
Absolutely. This same model can be applied in conditions ranging from autism to Alzheimer disease, diabetes to lupus.
Our vision is that anyone anywhere with Parkinson disease should be able to receive the care she needs. The same should hold true for any condition.
What impact do you think your recent study will have and what further research needs to be carried out on the use of virtual house calls?
We hope that this study will foster adoption among patients, caregivers, and patients and highlight a low-cost patient-centered way to deliver care.
Further, we hope patients will increasingly demand services that meet their needs rather than accepting the status quo which is not focused on them.
How important do you think virtual house calls will be in the future of medicine?
One colleague said that today we can do almost anything by pressing a button on a smartphone from reading a book to purchasing an airline ticket. Why should health care be different?
Do we need to read old National Geographic magazines in order to receive the care that we need? Do we need to drive miles and wait hours to see a physician? Do we have to live in an urban area to access specialty care? Can we do better? We think so.
Where can readers find more information?
NPR recently wrote a kind piece on our work: http://www.npr.org/blogs/health/2013/03/12/174110032/can-free-video-consults-make-parkinsons-care-better.
Thanks to the Verizon Foundation and other donors, we currently are offering anyone with Parkinson disease in five states (CA, DE, FL, MD, NY) a one-time evaluation via telemedicine with a Hopkins specialist for free.
Interested patients or families can call us toll free at 855.237.7446. We look forward to hearing from you.
About Dr. Ray Dorsey
Dr. Ray Dorsey is an Associate Professor of Neurology at Johns Hopkins Medicine where he directs neurology telemedicine and the movement disorders division.
Dr. Dorsey is helping investigate new treatments for movement disorders and improve the way care is delivered for individuals with Parkinson disease and other neurological disorders. Using simple web-based video conferencing, he and his colleagues are seeking to provide care to individuals with Parkinson and neurological diseases anywhere that they live.
Dr. Dorsey’s research has been published in the leading medical and neurology journals and has been featured on National Public Radio, The New York Times, and The Wall Street Journal. He previously worked as a consultant for McKinsey & Company.
He completed his undergraduate studies at Stanford University, business school at the Wharton School, and medical school at the University of Pennsylvania.