Virtual Office Visits


I’m sure you’ve seen the article in the WSJ

Metro Medical Direct in New York city is a web-based primary care house calls practice that offers secure portal communications via the Med Fusion patient portal system. This practice takes the best of the old way of rendering care and combines it with current technology therby allowing the patient to avoid many of the hassles associated with accessing health care.

At Metro Medical Direct patients can send secure messages, request appointments, request refills and referrals , and pay their bill without having to wait on hold. The added feature of having the Nurse Practitioner come to your home or office allows you to do something productive with your time that would have otherwise been wasted in traveling to and sitting in a waiting room. Patients can also have video consultations in real time for certain health conditions.

People often try to liken this practice to a concierge medical practice. It is actually a traditional fee for service practice. Patients in this practice do not pay a retainer fee.  This practice however is still somewhat ahead of the current health care industry curve in that not all the services offered have the option for insurance reimbursements.  Specifically the video consults.  Many insurance companies still require a face-to-face consultation in order for the service to be billed or reimbursed.  For this reason Metro Medical Direct participates as an out-of-network provider to all 3rd party payers.

This is still a new practice and clearly ideal for some, but not all people.  This perhaps will become a more popular option as the Face Book,  Twitter, and My Space generations start using health care.  The most likely patient for a practice like this will probably be someone who uses the internet to do their research before coming to see a health care provider.  They may even use a personal health record (  to keep track of their care.

Technology may finally be able to restore the personal connection that seems to have gotten lost in traditional health care.

3 Responses to “Virtual Office Visits”

  1. 1 lesliekarendeutsch

    I wonder if there’s been any thinking about how mental health needs might be incorporated into this type of practice. I’ve found that people who could benefit most from treatment are reluctant to see therapists face to face. For instance, those suffering from social anxiety and agoraphobia just cannot get to a psychotherapy office, but may be able to venture out after establishing a trusting clinical relationship on the phone or the internet.

  2. 2 Susan Farrell

    great service……..doesn’t this count as Telemedicine? I thought Telemedicine was reimbursed by insurance companies……besides being a NP I also have a Masters in Health Informatics and studied telemedicine…….derm and psych do very well using telemedicine…….I am curious about your collaborative requirements in NY…..Texas is very restrictive…… hat is off to you and this creative approach to health care….all the best….Susan

    • This is tele-med to a degree. Officially doing it over the telephone counts as tele-med at its most basic. This phone consult and the like are very gray and vague particularly when it crosses state lines. For example can the NP in one state with very autonomous practice rules prescribe to a patient who hails from a state with restrictive NP rules. Usually the patient can take that script and have it filled in their home state. Further complicating the matter many patients use mail order pharmacies which are in a third state. That script from NY to the NJ patient is now filled in OH. This can constitute tele-med. One further where does e-prescribing fall into the mix. Is medications only, how about therapeutic supplies, and therapies as well as referral.
      The laws are far from clear in all of these areas.
      NY requires a collaborating physician in the same specialty, they do a quarterly chart review. The chart is selected by the NP. The number is not specified so what is common practice is at least 1 chart. The physician is not employed by the NP, but contracted as a consultant to the practice.
      Apparently there is an NP in TX I heard on a conference call who has his own practice, cash only, and is doing quite well. So there is hope.

      I also think that NPs and CNMs (certified nurse midwives) can be the saving grace of the primary care physician shortage. Currently as you know there are 14 states that are independent practice states for NPs. The physiology of the residents of those states is identical to the rest of the US. That being said it is clear that the interest of those that oppose independent NP practice are not concerned with access and affordability to quality care but maintenance of financial security of the lobbying group.

      With all of the health care debate the message should be clearly sated. NPs and CNMs can and do provide the same and sometimes a better standard of primary care than their physician colleagues. It has even been published in JAMA.

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