Doctor-founded company a phone-only practice

TelaDoc Medical Services Inc. has assembled a network of physicians around the country to offer telephone treatment for minor, nonurgent problems of patients the doctors have never seen in person.

The Dallas-based company, which officially launched its 24-hour telephone-based consultation service in April, involves two separate but affiliated for-profit entities incorporated in Texas, said Michael Gorton, TelaDoc's CEO. One is TelaDoc Medical Services, a patient-membership entity co-founded in 2002 by Gorton and two family physicians -- G. Byron Brooks, MD, of Seabrook, Texas, and Bruce Begia, MD, of San Antonio. The other is TelaDoc Physicians Assn., which provides the telephone consultations.

TelaDoc is the only company in the country focused solely on offering telephone medical consultations, its executives said.

To access the service, patients must first join the membership entity by registering and filling out a medical history online. That history, which doctors access when they are on the phone with patients, establishes a patient-physician relationship and makes members eligible to be treated by a doctor licensed to practice in the state where the member resides, said Robert Kramer, MD, TelaDoc's chief medical officer.

While not commenting specifically about TelaDoc, Michael Goldrich, MD, chair of the AMA Council on Ethical and Judicial Affairs, said that "from an ethics point of view physicians need to meet a standard of care relevant to their specialty when they work at a distance."

Generally, there are several ways physicians can appropriately interact remotely with patients, Dr. Goldrich said.

But "it is important to have a first visit at least where you have a face-to-face encounter and a comprehensive medical examination," he said.

If doctors are relying entirely on a written history and a telephone encounter to treat patients they haven't seen before, "depending on what problems they may be treating there are significant concerns as to whether they are meeting the standards of care for many specialties," Dr. Goldrich said.

But TelaDoc believes its service meets all legal and state regulatory requirements related to the practice of medicine. "We feel just generally that what we're doing is no different than what doctors have been doing since the invention of the telephone," Gorton said. TelaDoc physicians take care only of problems that can be appropriately handled over the phone as opposed to those that require patients to be "touched" by physicians, he said.

However, other companies trying to legitimize remote-only health services have run into roadblocks.

MyDoc, started in 2002 by Roche Diagnostics in Indianapolis, offered Web-based consultations in Indiana and Illinois, but the latter state ruled that the online practice of medicine by doctors who had not previously seen a patient violated its laws. Roche eventually sold MyDoc to Standard Management, an Indianapolis-based health care company, which said it is no longer operating the online physician service.

Still, TelaDoc has recruited internists, family physicians and urgent care physicians in all 50 states through locum tenens organizations, Gorton said. He would not say how many physicians the company has signed up.

The doctors, who are independent contractors rather than employees of TelaDoc, can write prescriptions but are not allowed to prescribe narcotics or controlled substances. The service also is not intended to replace a patient's primary care physician, Gorton said. TelaDoc is marketing the service to self-insured employers, small businesses, the uninsured and those who want to reach a physician after hours or on weekends.

So far, TelaDoc says it has 20,000 members who pay monthly fees ranging from $4.25 for an individual membership to $7 for a family membership in addition to a one-time registration fee of $18. Members also pay $35 per consultation, of which $20.50 goes to the physician. The remainder covers TelaDoc's expenses, which include providing liability insurance for physicians and also billing and call center expenses.

Insurers do not reimburse for the service, but patients can use health savings accounts and flexible spending accounts to pay for it, Dr. Kramer said.

TelaDoc recommends that doctors do no more than four consultations hourly.