Virtual Care Perceptions Shift: Docs On Board, Patients Willing to Pay

A study by Mass General may herald rising acceptance of virtual care among physicians at systems where the technology has been established for several years.

A Massachusetts General Hospital (MGH) virtual care study published online by the American Journal of Managed Care this week revealed a surprising trend about physicians' perceptions and explored a subject that hasn't been heavily investigated: how much patients are willing to pay for video visits.

Following years of resistance, except by enthusiastic early adopters, nearly two-thirds of physicians in this study reported that virtual visits are similar in quality to in-person appointments.

Last July, as reported by HealthLeaders, the Deloitte 2018 Surveys of US Health Care Consumers and Physicians found that while 90% of physicians see the benefits of virtual care technologies, of those who have capabilities, only a third used it regularly. Furthermore, only 14% have capabilities, and the study indicated that only 18% of the remainder plan to add them in the next couple of years.

While the two studies are not parallel, and don't compare "apples to apples," the MGH research documented significant support among physicians for the practice. The study perhaps heralds a changing acceptance among physicians at systems where virtual care has been established for several years.

Mass General Study Documents Physician's Support of Virtual Care
 

Due to the increasing and widespread availability of personal technology, authors of the MGH study proposed that patients and clinicians have the opportunity to utilize real-time virtual communication to enhance access to health services. According to the report, "Understanding the perceived value of different modes of care may help to shape the future use of technology."

Highlights related to physician's responses include:

• Two-thirds of clinicians felt the video visit was similar in quality to in-person visits.
   
• 70.5% of reported that virtual video visits are superior to office visits for timely scheduling of patient appointments.
   
• 52.5%  said that video visits are a better way to enhance visit efficiency.

One reason for these positive results may be the history and relative longevity of the practice at MGH. According to a news release, the MGH TeleHealth Program was launched in 2012 after 10 years of successful experience developing a TeleNeurology program. The health system began offering virtual video visits in 2013, and the program has continued to grow.

At the time this study was conducted, established psychiatry, neurology, cardiology, primary care, and oncology patients were eligible for virtual video visits for follow-up care. The study examines survey responses from 254 patients after their first virtual visit and from 61 clinicians who participated in the first full year of the program.

Show Me the Money: How Much Will Patients Pay for Video Visits?
 

The study also addressed how much patients were willing to pay for virtual care. While patients in the study were not charged co-payments, the majority said a co-payment of up to $50 would be acceptable. Among those willing to bear the full cost of the visit, more than one-third had no current co-payment and all had private (versus public) insurance.

Researchers also analyzed patients' willingness to make co-payments by self-reported travel time and cost of attending office visits:

• Among those who traveled more than 90 minutes to an office visit, 51.5% indicated a co-payment of more than $50 for a video visit was acceptable compared with 30.4% of those who traveled less than 30 minutes.
   
• Among patients who spent $25 or more on travel to attend an office visit, 73.2% would pay a co-payment of $26 to $50 for a video visit, and 97.6% would pay a co-payment of $10 to $25.

Consumers Have a Positive Experience With Virtual Care
 

Feedback from consumers was also positive, but along the lines of what other studies have documented. Related highlights include:

• 79% of patients felt that finding a convenient time for a follow-up virtual video visit was easier than for a traditional office visit.
   
• 62% of patients reported the quality of virtual video visits was no different from that of office visits, and 21% thought virtual visits' overall quality was better.
   
• 68% of patients rated virtual video visits a 9 or 10 on a 10-point scale. Patients who rated the visits lower experienced technical issues during their first use of the system. Those issues were usually resolved with technical assistance.

"Our findings confirm what I felt in my gut, which is that what patients' value most is uninterrupted time with their doctor, and they put up with all the other challenges required to come see us," said senior study author Lee Schwamm, MD, director of the MGH Center for TeleHealth and of the MGH Comprehensive Stroke Center and executive vice chairman of the department of neurology, in a news release. Schwamm has used virtual video visits extensively in his own practice.

"Telehealth gives them more of what they want most and gets rid of the stuff they don't want," Schwamm said. "With a telehealth visit, 95% of the time spent by the patient is face-to-face with the doctor, compared to less than 20% of a traditional visit, in which most time is spent traveling and waiting. Seen through that lens, our results are not surprising."

"Personal connection" was one area where clinicians' and patients' perceptions differed. Some 46% of clinicians said they thought office visits were better than video visits related to this dynamic, compared to 33% of patients. As the practice of virtual care forges ahead, there is still plenty of opportunity for improvement.