Doctor visits go online with Doctor2Go
Doctor visits will be the latest service to go online with the launch next month of Doctor2Go, a premium-priced "medical concierge" service that lets patients consult GPs by video through their web browser.
Doctor2Go is targeting corporate clients as well as individuals, arguing companies that enroll executives can expect improved productivity as a result of staff getting medical advice early and spending less time travelling to and sitting around in waiting rooms.
The service is a joint venture between Waitemata-registered GP clinic Third Age Health and private equity firm Hatch Equity and will initially only be available to Auckland residents.
But Third Age Health's American-born chief executive and Hatch Equity investor Michael Haskell later hopes to license its technology to the Health Ministry or district health boards (DHBs) who he believes could subsidise the service for low income or rural patients. Discussions are also taking place with a possible customer in Britain, he says.
Doctor2Go looks set to test both the rules on GP capitation funding and consumers' expectations of what to pay for GP visits.
It hopes to persuade clients to make it their official primary healthcare provider. But its service will not come cheap, with on an ongoing charge of $99 a month plus a minimum fee of $59 per 15 minute video-consultation for individuals. Discounts will be available to companies that enroll at least three staff.
Doctors will be on hand 24 hours a day and will visit clients on request at their home or office for a minimum extra fee of $199, or $299 after-hours.
Haskell explains it doesn't expect to be a "monster practice" and instead hopes to attract between 3000 and 5000 Auckland patients.
"I know it is going to be seen as valuable to corporate human resources departments for senior executives.
"We want to be a practice for people who are time-poor and value their time at $80 to $100 an hour or above. Folks who are happy sit in a waiting room for hours to get a six or eight minute consultation with a doctor aren't our target market."
Haskell says the fees would come down if Doctor2Go achieves its goal of qualifying for capitation funding, which entitles GP clinics to an annual subsidy of between $63 and $238 per adult patient, depending on patients' age and gender. Higher subsidies apply for children and patients with major ongoing medical conditions.
"Our expectation is we will receive some capitation funding but that is not set in stone," he says.
New Zealand Medical Association deputy chairman Dr Kate Baddock believes Doctor2Go may face challenges in that regard because of its charges.
Based on the information on its website, she doubts Doctor2Go would end up providing a complete service to patients "irrespective of how they are marketing it", because not all types of consultation could be conducted online and its fees deterred face-to-face visits.
"If you are going to provide a complete GP service you have got to provide full screening, and how are you going to do a cervical smear or provide vaccinations online?
"If they are saying you can have a 'face-to-face' for $200, that is going to deter a number of people getting access to the entire comprehensive service we are referring to."
As far as she is aware there are no other similar services currently operating in New Zealand. But Baddock says many GPs are setting up patient portals that let patients book appointments and check test results online, and sometimes seek advice from their GP via secure email for an extra fee.
Such portals, developed as a "natural extension" to existing surgeries, might prove a better alternative to "stand-alone" online medical concierge services, she believes. Many GPs see following-up consultations with a short phone call when required as part of their service, she adds.
Doctor2Go also appears set to test some boundaries set out in a non-binding "position statement" on telehealth issued last year by the Medical Council of New Zealand.
The council's advice is that doctors should see a patient face-to-face or have a colleague verify their identity before issuing a new prescription for any medicine.
It says doctors have the right to decide whether a remote consultation is appropriate but need to be aware of the "inherent risks in providing treatment when a physical examination of the patient was not possible".
Haskell says the guidelines are good and there to safeguard everyone but believes it is inevitable that as a new advance Doctor2Go will result in the profession "relooking at how we do things".
He estimates three-quarters of consultations could take place by video and its GPs could prescribe new medications to patients after video-consultations if it was "100 per cent obvious" what was needed.
"This service is not designed for people to get a prescription from a doctor who has no knowledge of them or to step out of the current ethical responsibilities. It is designed purely to enhance the quality, timeliness and accessibility of care.
"If it is obvious what the patient needs, I would say it is in the patient's best interest to get that prescription sooner."
Third Age Health is already something of a pioneer in the sector. It doesn't have a physical clinic and its 15 GPs instead travel to patients, specialising in providing care to people in rest homes.
"All of our doctors have laptops and smartphone and all of our patient data is cloud-stored."
It was out of that business that the idea for Doctor2Go was born, Haskell says.
"What we realised is we had a big problem reaching our rural patients in a timely fashion. None of the suppliers in New Zealand or Australia had a video-based solution that worked so we decided to build it. We then realised the New Zealand market was void of this style of medical concierge service.
"The technology stack is very secure and the unique component is none of our communications ever leave New Zealand's shores, unlike a video-conferencing service such as Skype."
Another of Hatch Equity's investors is Matthew Jackson, co-founder of Bypass Network Services, the company behind the "Global Mode" service that lets Slingshot and Orcon internet users access blocked overseas websites such as the United States version of Netflix.
Haskell describes Hatch Equity as a group of four technology entrepreneurs, plus himself, who created the company to build out software platforms, primarily in healthcare, adding it has another couple of projects on the horizon.