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09/17/20 12:49 PM EDT
Field Notes | TDOC ONEM MASI | "Telemedicine is really making more space for more complex patients"
Takeaway: Does TDOC have a long- term advantage?

Earlier this week, we spoke to the Director of Telemedicine at Beth Israel Deaconess Hospital in Boston.  Below is the full interview with Sector Head, Tom Tobin, followed by our team's field notes from the call: 





Doximity has been the most widely used tool to connect to patients, but physicians are free to choose. 

We were surprised there was less focus on system integration, EHR, billing, and it seems like there were several quality vendors to choose from.   As we see telemedicine visits revert from the COVID-19 peak, the question is how much regression there will be.  The opinion here is the long-term adoption will land at 10%.

Some tailwinds for the doc include increasing the mix of higher acuity patients in the office.   Telemedicine will open remote monitoring, although in the near term, data collected is unlikely to be very complex.  The key will be to develop strict protocols, establish medical utility, and avoid "data overload."

The longer-term advantage of TDOC sounds less certain with telemedicine becoming more commonplace in the physician office.  The most dramatic impact will be in the dermatology.

Field Notes

  • The path runs from telemedicine, to remote monitoring, to AI and enhanced care
  • The revenue in this in telemedicine is really a making more space for more complex patients, you're not going to make more money off of that patient that you saw telemedicine. It's really the opportunity to see more patients.
  • Doximity is commonly used at Beth Israel Deaconess
  • Staffed models like Teladoc are less likely to maintain their advantage which is convenience
  • Telephone still used 25% to 50%  of the time for telemedicine visits
  • There are two types of consent; adoption consent, to the use of technology, and consent to bill
  • "So you know grandma's talking on the phone with her cardiologist and she's like, wait, you know, two years ago, I would talk to you on the phone and you know it would be a free conversation"
  • Adoption limited by ease of use for seniors and security, logins are problematic
  • The next step in telemedicine is remote data collection, remote monitoring
  • The convenience factor is important for the patient
  • One tailwind for telemedicine is it keeps lower acuity patients out of the office and frees up physician for more complex patients, higher billing
  • Longer term, virtual care will settle out at 10% of total visits
  • Dermatology will be higher than average, where remote is huge
  • Sending a picture and getting asynchronous care to work will be 
  • An apparently low acuity visit, for stomach pain, is higher risk for a 70-year-old than a 20-year-old
  • Patient consent is a significant component of the visit, permission to bill
  • Patients will now be billed for a telemedicine visit, where a call from the doc was free before
  • "So you know grandma's talking on the phone with her cardiologist cardiologist doesn't send the submitted bill and she's like, wait, you know, two years ago, I would talk to you on the phone and you know it would be a free conversation"
  • Remote monitoring: the issue with that is that you can also get information overload, you need a strict protocol
  • "So, suddenly you open the floodgates with access, which I think the benefits to the patient." 
  • Branding becomes increasingly important where there is integration across a provider network
  • AI is more likely going to be a doctor enhancement rather than a replacement, and it is a long way off in terms of years
  • "I think we can have to start with basics, you know, remote stethoscopes"
  • Dermatology adoption will be high because diagnosing or at least triage in the skin lesions
  • "From the, you know, remote care is huge, that that the way time I think through dermatology and any metropolitan area is right around 60 days."

All data available upon request. Please reach out to HealthCareTeam@Hedgeye.com with any inquiries.

Thomas Tobin
Managing Director

William McMahon

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