Alarmed about the country’s deadly flu epidemic, Lisa Maciel knew she needed to get her 2-year-old daughter to a doctor when the toddler’s eyes began to water and she started to run a fever.
A friend suggested another option: an Uber-like app that sends the doctor to you.
At first, the working mom of three kids didn’t know what to expect when she booked an appointment with a company called Heal.com for a pediatrician to pay a house call to the family’s home in Hayward.
But when Dr. John Liou, who previously worked as a pediatrician at St. Luke’s Hospital in San Francisco, showed up to examine Elyse in the family’s living room on a frigid Friday night, Maciel instantly got it.
“It’s quick, it’s in the comfort of your own home, and you don’t expose your child to everyone else in the emergency room,” she said.
“This, to me, is just great.”
The growing market of on-demand and telemedicine appointments is booming this winter as the flu season continues its rampage across California.
Doctor’s offices and hospital emergency rooms are overflowing with flu patients as the death toll from one of the worst flu seasons in more than a decade has risen to 74, including 25 in the Bay Area.
While Maciel was comforted by a home visit from a pediatrician, despite Elyse crying every time Dr. Liou poked his otoscope into the 2-year-old’s ears, patients can also connect with physicians who examine them through video conference calls via computer or smartphone.
“In the last two months, our visit volume has increased by 100 percent,” said Dr. Ian Tong, chief medical officer at Doctor On Demand, a San Francisco-based telemedicine company co-founded in 2012 by the talk show host Dr. Phil McGraw, his son Jay, and another partner.
The Doctor On Demand app that works like FaceTime or Google Hangouts costs $75 for a 15-minute consultation for an uninsured patient.
The company—which claims to have 1.5 million registered users—treats a range of non-emergency conditions, such as colds, flu, bronchitis, sinus infections, pediatric issues, urinary tract infections, eye issues, rashes, and even mental health issues.
The average wait time to be connected to a doctor? About seven minutes, said Tong.
A typical flu patient appointment includes some give and take between doctor and patient, who can use apps on most any device with their phone, tablet or desktop computer to take their temperature, gauge their pulse and blood pressure, and with a digital camera help the doctor examine a patient’s throat.
Tong said most of the people he’s treated for flu have been in the early stages of the virus and can still be prescribed with the antiviral medication Tamiflu, which is sent to the customer’s local pharmacy.
But Dr. David Jones of Palo Alto, who founded Bay Area House Call Physicians in 2006 to improve access to medical care for elderly and disabled patients, knows telemedicine has its limitations.
“If you are young and healthy, it would be great,” he said of the technology. “But it would be a bit naive to think you could adequately care for chronically ill patients just through a screen.”
And he wonders how long some of the business models will last—even those like Heal.com. As Jones put it: “These are venture-capital-backed experiments.”
At PlushCare, a San Francisco-based competitor started in 2014, the volume of appointments in January is 105 percent higher than last year at the same time—again, due to mounting flu cases.
Co-founder and chief medical officer Dr. James Wantuck said doctors can make a flu diagnosis relying on questions and relevant information during the 15-minute-long video visit that costs $99 for uninsured patients, and about a $20 co-pay for those who are insured.
“It’s easy and convenient,” said Walnut Creek resident Kelly Davidson, 49, who has used PlushCare since 2016, each time because she came down with a serious case of the flu.
“When you’re feeling horrible and don’t want to have to go out and see your doctor, you can stay home in your pajamas and you get pretty much the same service as you would going to a doctor’s office,” said the tech saleswoman.
Wantuck said only two to three percent of patients—typically the very old and those with very severe illness—are being sent to the ER because they are too sick to be safely treated by video.
Telemedicine is by no means revolutionary. Kaiser Permanente has marketed the service to its patients, while Blue Shield of California offers telehealth to its PPO members in both remote and urban areas for access to specialists.
Still, in a 2016 survey by the National Business Group on Health, more than 70 percent of large companies offered employer-sponsored telehealth services in the states where it’s allowed, but only 3 percent of employees had used them in the first half of the year.
The biggest concerns consumers seem to have about using telehealth services, according to a Wall Street Journal story that year, are: cost, privacy, and losing the personal relationship with their doctor.
It helps, of course, that many doctor consultation app services are covered through a patient’s own health insurance; uninsured individuals can expect to pay a nominal fee, often up to $100, in many cases.
Because the Southern California-based Heal.com does not accept HMO plans, customers such as Maciel—whose family is enrolled in a Kaiser Permanente plan—are billed a flat $99 per visit. If doctors need to refer patients to services such as lab work or imaging specialists, and prescription drugs, more charges are added.
Told about the $99 full-freight fee she was probably facing, and one easily covered by Kaiser, Maciel didn’t bat an eye.
“When you’ve had no sleep for three nights because of your sick child, you will pay the $99. I don’t mind,” said Maciel, who works as a Spanish translator for the Alameda County Public Defender’s Office.
After the session with Liou ended, the doctor concluded Elyse did not have the flu, but another virus. He suggested mom buy saline nasal drops to remove the mucus from the toddler’s nose, and make sure she drinks plenty of fluids, washes her hands, and gets enough rest.
As Dr. Liou and his medical assistant packed up their black medical roller bag and left, Elyse—now smiling in her pale pink pajamas—was back in the family room, watching her favorite cartoons.
The doctor will (virtually) see you now