Tired of feeling "like the walking dead" but worried about the cost of a doctor's visit, Amber Young sat on her bed near tears one recent Friday night in Woodbury, Minn.
That's when she logged on to an Internet site run by NowClinic online care, a subsidiary of UnitedHealth Group (which also owns UnitedHealthcare), and "met" with a doctor in Texas. After talking with the physician via instant messaging and then by telephone, Young was diagnosed with an upper respiratory illness and prescribed an antibiotic that her husband picked up at a local pharmacy. The doctor's "visit" cost $45.
"I was as suspicious as anyone about getting treated over the computer," said Young, 34, who was uninsured then. "But I could not have been happier with the service."
NowClinic, which started in 2010 and has expanded into 22 states, is part of the explosion of Web- and telephone-based medical services that experts say are transforming the delivery of primary health care, giving consumers access to inexpensive, round-the-clock care for routine problems — often without having to leave home or work.
Insurers such as UnitedHealthcare, Aetna, and Cigna, and large employers such as General Electric and Delta Air Lines are getting on board, pushing telemedicine as a way to make doctor "visits" cheaper and more accessible. Proponents also see it as an answer to a worsening doctor shortage.
But some physician and consumer groups worry about the trend.
"Getting medical advice over a computer or telephone is appropriate only when patients already know their doctors," said Glen Stream, president of the American Academy of Family Physicians. "Even for a minor illness, I think people are going to be shortchanged," he said.
Carmen Balber, a spokeswoman for Consumer Watchdog in Santa Monica, Calif., is concerned that lower co-payments, and other incentives, will spur consumers to see doctors or nurses online just to save money. "People will choose the more economical option, even if it is not the option they want," she said.
Employers, however, say they're getting mostly positive reviews.
"Our employees just love the convenience, the low cost, and the efficiency," said Lynn Zonakis, managing director of health strategy and resources at Delta Air Lines, which offers NowClinic to some employees for $10 a consultation.
The global telemedicine business is projected to almost triple to $27.3 billion in 2016, according to a recent report by BBC Research, a Wellesley, Mass., research firm.
"Virtual care is a form of communication whose time has come and can be instrumental in fixing our current state of affairs within the health care system," said Robert L. Smith, a family doctor in Canandaigua, N.Y., and co-founder of NowDox, a telemedicine consulting firm.
Although the field developed more than 40 years ago as a way to deliver care to geographically isolated patients, its growth was slow. That has changed in the past decade thanks to the development of high-speed communications networks and the push to lower health costs.
"It's the wave of the future," said Joe Kvedar, director of the Center for Connected Health, founded by Harvard Medical School.
One major obstacle has remained, however: Many state medical boards make it difficult for doctors to practice telemedicine, especially interstate care, by requiring a prior doctor-patient relationship, sometimes involving a prior medical exam, said Gary Capistrant, senior director of public policy at the American Telemedicine Association, a trade group. "The situation seems to be getting worse, not better," he said. He cited a 2010 ruling by the Texas Medical Board that effectively blocks a physician from treating new patients via telemedicine. The only exception is if the patient has been referred by another physician who evaluated him or her in person.
"It's about accountability," said Dr. Humayun Chaudhry, CEO of the Federation of State Medical Boards. State boards insist on licensing doctors treating patients in their states so that if patients are injured, they have a state agency they can go to for help.
"We want to enable telemedicine to flourish, but at the end of the day we want patients protected," Chaudhry said. Some medical boards are loosening restrictions, he noted, citing nine, mostly rural, states, including Tennessee, Nevada, and New Mexico, which in recent years passed rules to ease the licensing process.
Companies marketing telemedicine services say they are seeing strong demand. Bloomington, Minn.-based HealthPartners, a health system with four hospitals and 1.4 million health-plan members, began an online service in fall 2010 that allows anyone in Minnesota or Wisconsin to consult a nurse practitioner for $40 or less.
Using an online interactive tool called Virtuwell, 23,000 patients have received a treatment plan often including a prescription, after answering questions about their condition and medical history.
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