Article by Bill Siwicki, HealthcareITNews.com
With the advent of urgent care, people suddenly were able to see a primary care physician within a matter of hours without having to go to an emergency room. Urgent care changed the way a big chunk of healthcare is delivered.
But what about urgent care for seeing a specialist? Sometimes people do have an urgent need to see a specialist – for example, some psychiatric problems. In other cases, people need to see specialists a lot sooner than they can get an appointment to see one. Specialist wait times easily can stretch out many months, if not longer.
Dr. Anne Allen is a dermatologist and pediatric dermatologist with extensive experience in both in-person and virtual dermatologic care. In person, Allen specializes in complex pediatric dermatology. In telehealth, she sees a full array of skin conditions in both adult and pediatric patients via virtual care provider platform Miiskin.
She sees patients in 36 states and responds to these consultations in less than 48 hours on weekdays and most often within 24 hours.
No such thing as quick
“There’s really no such thing as same-day or even ‘quick’ urgent specialist care in the traditional healthcare system,” she said. “Most specialists simply don’t have that flexibility unless a colleague calls in a personal favor and they overbook.
“A big part of the issue is supply and demand,” she continued. “Across many specialties – dermatology and ophthalmology are good examples – there just aren’t enough specialists to keep up with the volume of referrals. Wait times of three to six months are common, even for issues that may resolve in a few weeks.”
Allen added that primary care is referring more patients to dermatologists than ever before.
“People are more aware of their skin and health concerns – thanks in part to online information – and primary care clinicians are understandably cautious,” she explained. “That increased awareness, combined with a shortage of specialists, means long waits have become the norm.
“So, the status quo is really a combination of insufficient specialist capacity, higher referral volume, and a system that’s simply not designed to offer fast, affordable specialty access,” she added.
Seeing specialists much faster
Telehealth dramatically speeds up access to specialists – not just in dermatology, but across specialties, Allen said.
“Every telehealth organization I’ve worked with requires that patients are seen within 48 hours, and most providers respond within 12-24 hours,” she noted. “Compared to the traditional three-to-six-month wait, the difference is enormous.
“On the cost side, telehealth lowers expenses because there’s no brick-and-mortar overhead,” she continued. “Patients aren’t paying for a physical clinic, exam rooms, front-desk staff, or all of the infrastructure that goes into running a traditional practice. They’re essentially paying for the specialist’s time plus minimal administrative and platform costs.”
That’s why the price difference can be so significant. A typical in-person initial dermatology visit runs between $150 and $400. Follow-up visits, while less expensive, still typically run in the hundreds. Telehealth visits, depending on the platform, typically range from $25 to $100. On Miiskin, for example, dermatologists set their own consultation fees – most offer a flat $59 fee for a new visit and $39 for medication refills.
“Even with insurance, many patients find that the telehealth visit is cheaper than their specialist copay – especially for conditions requiring multiple visits, like acne or Accutane management,” Allen noted.
Real-world examples
Recently, Allen saw a breastfeeding mother submit what she thought was an acne flare. When Allen looked at the photos, it was clearly shingles – something that is urgent, especially because the mother could transmit chickenpox to her baby. Shingles can also threaten vision depending on the location, so it’s not something that should wait.
“I saw her within an hour of getting her message, prescribed valacyclovir, and she had the medication in hand at her pharmacy within another hour,” Allen recalled. “That entire care cycle was completed in about two hours.
“In traditional care, that visit would have been billed as a higher-level code because medication was prescribed, typically $250 to $300 for the visit alone – and she would have waited weeks to get in,” she continued. “By then, the virus would likely have resolved or, worse, caused chickenpox in her infant. We see cases like this all day long – urgent issues that are treated quickly and safely through telehealth.”
Another example Allen offered from a recent telehealth consult was a spreading fungal infection that wasn’t responding to any over-the-counter treatments. She prescribed a two-week course of oral terbinafine. Without that timely intervention, it would have continued to spread on the patient and to others around them, she explained.
What can health systems do?
Health systems and group practices could dramatically improve access and reduce costs by integrating telehealth into their triage process, she suggested.
“They should be hiring online specialists, or assigning their existing specialists to cover telehealth shifts, to review cases marked as urgent or semi-urgent,” she said. “This allows specialists to quickly identify which patients need to be seen tomorrow and which can wait a few months.
“For example, a growing or changing mole isn’t ideal for full telehealth diagnosis, but a teledermatologist can flag it as needing immediate in-person evaluation if it looks concerning in photos,” she continued. “Shingles, acne that is affecting mental health or scarring, and many other conditions that genuinely need timely treatment can be addressed same-day or next-day.”
Telehealth triage not only speeds patient care but also helps health systems use their in-person capacity more efficiently – instead of long waitlists filled with non-urgent cases, specialists are seeing the right patients at the right time, she added.
“Whether health systems use independent teledermatologists like me or build internal telehealth capacity, the model is the same: telehealth triage first, in-person care when needed,” Allen said. “This approach improves outcomes, shortens waits and saves significant cost across the board.
“Telehealth is not a replacement for in-person dermatology, but practices that integrate both approaches are more efficient and able to deliver higher-quality care,” she concluded.
