By BETSY TAYLOR
> Go to YouTube to view a video demonstration of Franciscan Virtual Urgent Care.
When Patti Maguire came down with a pounding headache after already feeling "just exhausted" and tapped out during a household move, she signed up online for a virtual urgent care visit, got diagnosed with a respiratory infection during a detailed conversation over the phone and started on an antibiotic she picked up at an area pharmacy that same night.
"It was just a godsend," Maguire, 58, of Louisville, Ky., said of her experience using KentuckyOne Health's new virtual urgent care service.
Two Catholic Health Initiatives systems, Tacoma, Wash.-based Franciscan Health System and Louisville-based KentuckyOne Health, have started providing virtual urgent care services to the public. For a flat fee of $35 per visit, patients communicate with a physician or a nurse practitioner by phone or video chat within 30 minutes of requesting a visit. Both systems used the virtual urgent care services with their own employees and said they received positive feedback about the service and quality of care, before offering it to the public.
Both systems are partnering with Seattle-based Carena, a business that has its roots in traditional house calls and has evolved to use the technology-enabled care delivery models. Carena physicians and nurse practitioners staff the virtual visits.
To use virtual urgent care, patients can dial in by phone or log onto a site through the Internet (Franciscancarenow.org or KentuckyOneAnywhereCare.org). Patients provide their dates of birth and indicate on a checklist whether they have certain symptoms associated with severe or life-threatening conditions — in which case they're directed to dial 911 or seek immediate care in person. If their condition doesn't require emergency or immediate face-to-face treatment — such as if they think they have symptoms consistent with a cold, flu, a rash or a urinary tract infection — they continue on to consult with a doctor or nurse practitioner. The clinicians are physically located in Washington state. Carena has providers who are licensed to practice in Washington and Kentucky, the states where the CHI systems offer virtual urgent care.
Meta Dooley, Franciscan's senior vice president of strategic planning and business development, said patients want and appreciate the convenient access to quality urgent care. Franciscan also wants patients who use the virtual urgent care service to develop relationships with care providers they see in person. "Part of this is an objective around new patient acquisition," she said. For instance, Franciscan, using information provided by patients, conducts outreach calls to them following their virtual visits. Some patients also initially begin the visit, but indicate they want a referral to a physician for a face-to-face appointment instead. Those patients receive a callback with provider contact information.
Franciscan began offering the service to the public in September; and, through October, 422 patients either took part in a virtual visit or asked for a referral for a primary care physician, said Franciscan spokesman Scott Thompson. For KentuckyOne Health, which started its service in November, 183 patients logged in or called the service and 50 received virtual consultations in that month, said Travis Burgett, that system's director of strategy.
Dr. Ben Green, Carena's medical director of clinical innovation, said when care providers can't diagnose through a virtual visit, they refer the patient for a face-to-face visit. Those who are not diagnosed through the telehealth service do not have to pay the fee.
During the virtual visit, the providers may recommend an over-the-counter medicine, outline other care options or prescribe medications, though they do not prescribe or refill controlled substances, such as narcotic pain relievers. They only prescribe antibiotics when appropriate. "We don't think of ourselves as an antibiotic mill," Green noted.
There are safeguards in place to keep track of computer IP addresses, to ensure the same person isn't logging on repeatedly, perhaps in an effort to get a prescription drug. Dooley said Franciscan currently cannot start a new patient electronic medical record through the service, but it can add new information to an existing medical record with Franciscan.
Maguire said the $35 fee is attractive since she is between jobs and temporarily without health insurance. While health insurers don't currently cover virtual urgent care, Franciscan and KentuckyOne Health executives say they believe that will change in time as virtual medicine becomes more widely available. "There is tremendous lobbying and conversations with payers," Dooley said.