Despite New Jersey’s lack of regulatory guidance when it comes to telemedicine, a California-based group that provides certain urgent care treatment electronically has now opened for business in the Garden State.
PlushCare, already operating in 17 states, announced Monday it would start treating patients here using an online service designed to make it easier to see a top-notch doctor without even leaving home. The service is not intended for broken bones, wounds or other injuries, but has become popular among patients suffering from bronchitis, sinus infections, pink eye, sore throat and urinary tract infections.
Users can pick an appointment time that works for them, select an available doctor, and log onto a video consultation from their home computer or portable device. Visits with the provider do not have a time limit and, if patients don’t recover within a month, they can get a free follow-up. Prescriptions can be filled at local branches of several national pharmacy chains. An online tool allows patients with insurance to calculate their costs before they book an appointment; they can also pay by credit card. (First visits cost $99, and $69 after that.)
Telemedicine is a growing industry nationwide and is often cited as an important innovation for reforming healthcare, especially helping to reach patients in underserved communities, although some physicians’ groups have raised concerns about quality control. PlushCare is one of a number of companies seeking to capitalize on new technology to expand access, improve outcomes and reduce costs.
Lack of regulation an incentive
New Jersey — one of a few states that lack a legal definition of the practice, let alone regulations — had been seen as less hospitable to these new models, which tend to prefer clear government guidelines. Proposals to address this issue have been considered for several years and remain pending in the state Legislature.
But that did not give PlushCare pause. In fact, the lack of regulation served as an incentive, explained Dr. James Wantuck, the company’s co-founder and chief medical officer. Plus, New Jersey has lots of residents with plenty of healthcare needs, many of whom have had problems getting quick, high-quality care in a convenient setting, he said.
“Fortunately there are not any regulations against telemedicine” in New Jersey, Wantuck said, noting that virtual care provides multiple patient benefits, allowing them to remain at home, or work, and eliminating any waiting-room time.
“We really believe we’re providing medicine that is not so different from traditional healthcare,” Wantuck added. Whether the doctor-patient consultation is held in person or virtually, he said “the conversations are really the same.”
The company started in 2014, in San Francisco, and now provides virtual services in a number of states on the West Coast and Southwest, as well as in Illinois, Ohio, Pennsylvania and New York. Wantuck said they have selected locations where there is a need and “are favorable from a regulatory standpoint.” (The company also offers house calls in the Bay Area.)
Free follow-up for patients who are not cured
Wantuck said PlushCare has treated tens of thousands of patients in these states and now works with about 50 primary care specialists — including several licensed to practice in New Jersey — all trained at top-flight medical schools. The Garden State passed a law in 2014 that provided for “reciprocal” medical licenses that enabled doctors elsewhere to treat New Jersey-based patients, as long as their home state had similar licensing requirements.
“We think that having premium physicians gives (potential patients) some security in trying us,” Wantuck said. The hardest part may be “getting people to understand this option exists,” he added.
Patients’ medical records are stored in a secure, cloud-based system that is accessible to all PlushCare physicians and the system is designed to perform additional safety checks to avoid allergic reactions or prescription interactions. “No system is perfect,” he said, “but we try and do everything we can to help the patient in any way.”
In addition to the free follow-up visit for patients who aren’t cured, users are encouraged to email or communicate with the doctor they saw if they have additional questions. (While video appointments are preferable, Wantuck said patients in New Jersey could also conduct follow-up visits by phone.)
The announcement came as good news to Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, who has advocated for expanded telemedicine — and a clear policy — in the Garden State. “I do think that their marketing fills a niche that we know that people say they want: convenience and relatively lower costs,” she said.
While the service is too costly for low-income patients or Medicaid members, she said it “may be a good option” for people without insurance or for those in high-deductible plans. “I say ‘may be’ because that comes down to the quality of their care and experience,” she said. “The reason why we would like to see a clear law and regulations on telehealth is because from a consumer protection standpoint, I want patients to have assurances that the services are provided by licensed health-care professionals and that NJ has oversight over those providers,” Schwimmer added.
A bipartisan measure now under discussion (S-291, A-4231) passed a Senate committee in November but awaits a hearing in the Assembly. It would authorize a diverse array of healthcare providers to diagnose and treat patients using two-way video conferencing or similar technology; it does not currently permit consultations by telephone, text or email. To be eligible, providers would need to have a New Jersey medical license, or a reciprocal license. The bill requires Medicaid, NJ FamilyCare, policies that cover public workers and other managed care plans to cover the service at the same rate the plans pay for traditional visits.