How I practice

Modern-day house calls: Missouri DO embraces telemedicine

Michael Brown, DO, explains how telemedicine takes access to care to a new level, bringing convenience and cost savings to his patients.


“The doctor will see you now.” That’s the text message patients receive when a physician from Mosaic Life Care is ready to see them remotely. And with a simple click, the eVisit begins.

As the medical profession looks for ways to provide high-quality care to patients at lower costs, telemedicine is one solution physicians are exploring. Mosaic Life Care, an accountable care organization in northwest Missouri, rolled out its telemedicine program in 2014.

In this edited conversation, Michael R. Brown, DO, the assistant chief medical informatics officer at Mosaic Life Care, explains the benefits and challenges of adopting telemedicine.

How did telemedicine become part of Mosaic Life Care’s services?

Patients told us they wished physicians still made house calls, and these “modern day house calls” help us fulfill this demand.

Since implementing the program, patients have been very happy with it. Our satisfaction rates have been incredible and, at times, exceed those of in-patient visits.

Our eVisit program started out as a way to address acute care. And, our long-term focus is to use telemedicine for more follow-up visits with patients and to help manage their chronic conditions. I hope that one day programs like this will be fully integrated into health care.

What are the benefits and challenges of the program?

With the majority of northwest Missouri considered rural, one of the primary benefits has been increasing access to care for residents in these areas.

State law requires that an individual be an established patient prior to an eVisit so we don’t see patients remotely until we’ve seen them in person at one of our locations. If someone isn’t a current patient, we ask him or her to schedule a wellness visit with us. After that initial visit, our eVisits are another option for access to a physician.

Our patients often tell us, “You saved me an hour’s drive.” They especially appreciate the convenience when we can handle the medical issue entirely through the eVisit, but of course there are times when we tell them we need to see them in person.

Another plus: eVisit patients see cost savings on their medical expenses.

Instead of a $75 copay for an ER or urgent care visit, our patients pay a $50 fee for the eVisit.

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The fee is in place because not all telemedicine visits are reimbursed. Right now, Medicare only reimburses remote visits for patients who live in rural areas. We’re working with the major insurers in the area to cover telemedicine, but it’s not part of their plans at this time.

When we launched the program, the biggest challenge we saw was that some patients were hesitant to try it out. They were used to the traditional physician visit. However, this mindset is shifting.

As patients begin to see the convenience of the program and savings in fuel, medical costs and time, the number of repeat eVisit users is growing.

Does part of the patient-physician connection get lost with telemedicine?

Although an eVisit means that the physician and patient aren’t in the same room, that doesn’t diminish their connection. On the contrary, the remote setting can strengthen it.

As DOs, one of the best tools we have is our ears. Physicians can get so focused on completing the physical examination that we sometimes forget to stop and listen to the patient. During eVisits, I don’t have the opportunity to use my hands to examine and connect with patients. However, the connection is still there because I find myself listening to them more closely.

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