Stop Unnecessary Medical Visits

July 27, 2015

Telemedicine has brought up the issue of whether some visits could be better achieved by an in-person visit or a tele-visit. However, when it comes to unnecessary visits, the best option is eliminating them altogether.

The telemedicine argument goes that many patients would "show" for their visit if they didn't have to go through all the hassle of a face-to-face one. In addition, they argue that no one actually examined them during the face-to-face visit anyway so what was the point? The point is not whether to see patients face to face or via telemedicine when the visit was worthless. The issue is eliminating unnecessary visits.

There is increasing awareness of what constitutes an unnecessary visit. Culprits include annual executive or routine physical exams, drug monitoring that can be done using online technologies, and "routine" postoperative visits that can be more accurately determined by a call to the patient or family the night of surgery e.g. following placement of ear tubes or tonsillectomy.

Unnecessary visits have many causes. Best case, the doctor is genuinely concerned about the patient's progress and wants to check it face to face. Many times, patients want the comfort knowing "things are going fine." However, there are many other reasons, like defensive medicine or perverse financial incentives, that add to cost and inconvenience and are wasteful and unnecessary. In addition, given lengthening times to get an appointment, we need all the appropriate slots we can get. Doctors would like it, too, since they get paid more to see new patients compared to post-op patients included in the global billing time.

It is probably impossible to total the number of unnecessary medical visits. But, even just reducing them by a rounding error would add up quickly. Of course it is possible that bundled payment as part of risk sharing agreements might make the entire problem go away.