Doctors are running out of excuses for not embracing telemedicine, remote patient monitoring, and other forms of telehealth services, attendees at the Institute for Health Technology Transformation Health IT Summit heard this week.

Many physicians still resist telehealth for a variety of reasons. Video consultations take away the tactile part of a patient exam. Insurance companies don't cover electronic communications with patients. Some doctors still view online services, even with established patients, in the same light as prescribing drugs over the Internet for people they don't have an existing relationship with.

But healthcare providers tend to view insurance companies, not patients, as their customers, since health plans pay most of the bills, Scott Simmons, telehealth director at the University of Miami School of Medicine, said Wednesday in Fort Lauderdale, Fla. Patients might be willing to pay for extra services such as secure electronic communications and video chats with their doctors if they perceive a convenience factor.

"Parents will pay for it for their kids," concurred Claudia Tessier, co-founder and president of the mHealth Initiative, a Boston-based organization that promotes mobile and wireless technologies in healthcare. It may be worth an extra fee to working parents not to have to leave work to bring a sick child to the doctor.

Tessier said that some forward-thinking physicians are effectively volunteering their time for secure online consultations with patients to gain new patients.

The Mayo Clinic has taken this type of approach with robots in emergency departments at outlying hospitals, allowing specialists on main campuses in Rochester, Minn., Jacksonville, Fla., and Scottsdale, Ariz., to help in the treatment of seriously ill or wounded patients. "That is sort of a loss-leader model" that anticipates revenue for "downstream services" such as critical care and surgeries, said Mayo's director of digital imaging, Dr. James Bolling.

Bolling said Mayo has four business models for telehealth. In addition to the loss-leader approach, the clinic generates revenue via some limited fee-for-service reimbursement; contracts with businesses and schools; and a Web portal for self-insured companies that offer employee health services.

That is similar to how the University of Miami sustains its telehealth services. "In the state of Florida, the reimbursement for telehealth is pretty lousy," Simmons said. Instead of relying on insurance reimbursements, Miami provides telemedicine services through annual contracts with community hospitals and physician practices that pay the university per consult.

The telehealth department collaborates with the department of family medicine to treat children at six schools in Miami-Dade County who would not otherwise have access to primary and urgent care, or even a school nurse. Miami also provides remote consultations for Royal Caribbean cruise ships.

Telehealth also allows primary care physicians to "quarterback and really stay in the loop" with patients who have been referred to specialists, Simmons said. This is the whole idea behind the patient-centered medical home, a concept that stresses care coordination and prevention.

Another way to justify the investment in technology is to calculate the savings in postage from sending appointment reminders by SMS rather than snail mail, Tessier said. The immediacy of texting could help reduce costly no-shows, too.

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