Interview with Dr. Mark Friedman: How First Stop Health Telemedicine Provides High Quality Healthcare Across the Nation
January 10, 2019
Mark L. Friedman, MD, FACEP, FACP
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As telemedicine attracts new patients. We are often asked about the quality of the healthcare delivered by First Stop Health (FSH) doctors: Does a telemedicine visits with an FSH doctors provide the same quality of care as a physical visit to a doctor's office? To address this question, Dr. Mark Friedman, First Stop Health's Chief Medical Officer and Co-Founder, spoke with Bruce Judson, who writes First Stop Health's healthcare newsletter.
Judson: "Dr. Friedman do you have a summary answer for people who ask about the quality of healthcare provided by First Stop Health (FSH)?"
Dr. Friedman: "Yes. In a nutshell, First Stop Health's nationwide proprietary network of doctors provide's high quality care that is as good, if not better, than a visit today to a doctor's office or an urgent care center. Today, I want to explain how we created a service to provide consistently excellent patient care."
Judson: "Terrific. Let's start with First Stop Health doctors. What you talk about FSH's proprietary doctor network what do you mean?"
Dr. Friedman: "To ensure the highest quality patient care, we made the decision several years ago that we needed the ability to choose our doctors, according to rigorous standards. As a result, we created and now manage our own network of doctors, who are licensed in all 50 states."
Judson: "Dr. Friedman, how does FSH find new doctors?"
Dr. Friedman: "Actually, they generally find us. It's gratifying to me that we now receive, on an unsolicited basis, a large volume of inquires from highly qualified, experienced physicians. I think this reflects two things: The ability of our doctors to practice medicine without the time pressure that's so evident in medical offices today, and the growing reputation of FSH as a place that welcomes physicians who want to provide excellent care."
Judson: "What's involved in selecting a First Stop Health doctor?"
Dr. Friedman: "Our application process is extensive. In fact,we hear frequently that physicians, patients, and employers who purchase our service for their employees are surprised by the many steps involved. Some doctors have joked with me that joining First Stop Health is like applying for, and completing, a second medical residency. Let me walk you through the steps involved:
First, we examine a physicians work history, his or her training, schooling, licenses and references. We are seek out excellent physicians with extensive experience in treating the types of episodic care that characterizes our medical practice. Generally, this means we examine the backgrounds of applicants who are trained in family medicine, emergency medicine, internal medicine (to treat adults), or pediatrics (to treat children).
For physicians who satisfy these criteria, we then administer a proprietary exam we created. Today, every prospective physician must pass this exam before they can work at First Stop Health. I cannot tell you how often physicians with decades of experience express surprise, and ultimately delight that we require this test. Experienced doctors don't expect to be asked to take a test, but they quickly realize this requirement means that when they pass they are joining a special team."
Judson: "What happens after a doctor is selected to join the First Stop Health network?"
Dr. Friedman: "After a doctor meets all of our rigorous criteria, he or she must then complete our proprietary training program on practicing telemedicine. Over the years in treating tens of thousands of incidents, we have developed a set of best practices for patient care: These encompass everything from ways to ensure the doctor has taken a complete medical history, to asking specific questions that are unique to the practice of telemedicine for episodic events.
Once a physician has mastered this training, he or she is ready to treat First Stop Health patients located in the state where the doctor is licensed. Our nationwide network of physicians licensed in each state is valuable for many reasons. Of course, our doctors are able to write prescriptions, when medically necessary in states where they are licensed, and we comply with each state's specific rules associated with practicing medicine. In addition, we receive many calls from First Stop Health members who are traveling outside their home states, who are sick or have forgotten their regular medication. By connecting our members with locally licensed physician, we are able to immediately address these problems or concerns."
Judson: "O.K. Let's Say I am a physician. Dr. Friedman I have jumped through all the hoops you just described, am I done?"
Dr. Friedman: "No. If you were done we would not be serving the best interests of our patients. As you know, we record every First Stop Health visit with a doctor, and every patient can listen to these recordings by logging into their personal portal on our Website. For patients, these recordings mean they can review the instructions they receive from our doctors, and don't need to worry that they will forget the advice they receive.
For the team of medical professionals that manages our physician network, these recordings are also an important means of ensuring First Stop Health provide's the highest possible care. Our HIPAA-compliant physician management team reviews the recordings of a very large percentage of the initial visits of our patients with new doctors. Our goal is to ensure that, after all our training and assessments, new doctors are, in fact, meeting our standards of high quality care.
In fact, none of our doctors are ever done. Once a doctor has passed this initial trial period, we continue to review visits based on a set of internal criteria. The medical professionals who manage our doctor network are always working to ensure that our standard of quality never slips."
Judson: "Dr. Friedman, I have heard you say that you believe we often deliver better care than urgent care centers and doctors' offices. Why is that?"
Dr. Friedman: "Yes, I do say that. And I believe it. Here's why:
One of the things you quickly learn when you practice medicine is there's really no record of what happens in a doctor's office: There's simply the doctor's notes. Since we record every call, we can review exactly what happened during a visit with a First Stop Health physician. In a physical setting, this same ability to ensure consistent quality does not exist.
At the same time, today primary care doctors, by and large, operate independently. A doctor may be part of a large practice, but the patient only see's the individual primary care provider, and there's typically no oversight of that physician, once he or she joins a practice. By proactively reviewing visits, with HIPPA-compliant privacy, First Stop Health offers greater ongoing oversight of its physicians than any physical practice I have encountered.
I think it's worth noting as well that the convenience we offer patients also means we can provide better care. Every physician will tell you it's far easier to treat and cure an illness if you catch it early. The sicker the patient, the harder it is too treat the illness. The costs of treating sicker patients are also higher. Today, one unfortunate reality is thatmany people delay doctor visits. How often have you heard someone say, "I am not sick enough to visit a doctor yet."
Patients delay visits to doctors because of cost, or the time involved in an office visit. We tell our members that we want to treat them, 24 X 7 X 365. So, a part of providing higher quality care is our ability to provide convenient, access to care before an illness grows in severity. We work to keep our member population healthy, through early action."
Judson: "Dr. Friedman, what happens if a patient raises an issue related to a visit with one of our doctors?"
Dr. Friedman: "I am happy to say that, with all the effort we put into selecting and training our doctors, the opposite situation is the norm. I can't tell you how many unsolicited calls and notes we receive from patients detailing the positive experiences they have had with our doctors.
In the very few instances where an issue is raised, our recordings of every FSH doctor visit provide us with a unique ability to examine every situation, which we do promptly.
Judson: "A final question: Is there any common complaint you hear about FSH doctors?"
Dr. Friedman: "One of the things we stress in our training is that our doctors take the time to explain their reasoning for prescribing a specific medication, or choosing not to write a prescription. We find our doctors, and our patients, really appreciate this. Today, in many physical settings, doctors don;t have the time to educate patients about medication or their treatment options.
We sometimes hear from patients who have a common cold that one of our doctors would not prescribe an antibiotic. It's rare, but it's the most consistent issue. From the perspective of providing high quality healthcare, it's a good thing. As you may know, the common cold is a virus and not an infection, which is what antibiotics cure. And, there's an ongoing issue in all of primary care medicine about over-prescribing antibiotics. So, we our doctors to prescribe antibiotics only when they are medically necessary
However, in the rare instances where a patient raises this issue, I do contact the doctor. I am happy he or she is providing excellent care. But, the patient's contact with us also means this doctor did not fully explain to the patient why he or she was not providing a prescription. Unlike most medical settings, we believe that educating the patient about why a specific treatment is appropriate is also of central importance."
Judson: "Thank you Dr. Friedman. It's clear that in building the FSH doctor network you have thought very hard about the issues that detract from the practice of medicine today, and have worked to solve them in building the FSH doctor network."