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If you don't live in a major city, it can be hard to find medical specialists. And that is especially true for people with chronic disorders like Parkinson's disease, who need frequent care.
And today in Your Health, we look at patients who are turning to specialists hundreds of miles away to get the attention they need by video. Doctors and patients like the video appointments, but insurance companies are not yet convinced. NPR's Nancy Shute reports.
NANCY SHUTE: Deanna Ventura was seeing a neurologist for her Parkinson's. But she was still having trouble walking, bathing, and doing her housework.
Ms. DEANNA VENTURA: I knew that I needed more than what he was doing for me.
SHUTE: Managing Parkinson's symptoms is a tricky business, and the drugs used can have serious side effects. You need a specialist. But for Ventura the closest was two hours away from her home in upstate New York. And she doesn't drive. So the specialist comes to her.
Dr. RAY DORSEY (Johns Hopkins Medical Center): So I last saw you in February. And how have you been doing since February?
SHUTE: If it sounds like Ray Dorsey�is far away, that's because he is - 343 miles away at Johns Hopkins Medical Center in Baltimore. He's a movement disorders specialist and he's been Ventura's doctor for the last four years.
Dr. DORSEY: How about your Parkinson's disease? Any complaints related to your Parkinson's?
Ms. VENTURA: I find that I drop things a lot more. I'm finding that my balance is worse, which wasn't good anyways.
SHUTE: Ventra is 68 years old, a cheerful grandmother with white hair. She's sitting in the conference room of a nursing home, just down the street from her apartment in New Hartford, New York. She sees the doctor on a flat-screen TV. He can see her on his laptop. It's health care by video call.
Dr. DORSEY: Do you know what today's date is?
Ms. VENTURA: Yes. Today is May 20. And the year is 2011.
Dr. DORSEY: And who's the secretary of state?
Ms. VENTURA: Hillary Clinton.
Dr. DORSEY: Pretty good.
SHUTE: People with Parkinson's can have trouble with memory and speech. They often have tremors and stiff movements, so Dorsey needs to test Ms. Ventura's motor skills.
Dr. DORSEY: Can I see you put your hands out like this?
SHUTE: He sticks his hands straight out and holds them steady. Ventura tries it.
Dr. DORSEY: So you have a little bit of shaking in your right hand.
Ms. VENTURA: Yes.
SHUTE: By observing that tremor in each visit, Dorsey can get a good sense of the disease's progression. He checks on her medications too.
Dr. DORSEY: So you look good as usual, Ms. Ventura.
Ms. VENTURA: Thank you.
Dr. DORSEY: The one thing I want you to work on is exercise. How are we doing on that front?
SHUTE: He can see his patient's guilty smile.
Ms. VENTURA: My hesitation tells you.
(Soundbite of laughter)
SHUTE: Studies of telemedicine have found that the care patients receive is at least as good as in office visits. Patients also say it's much more convenient. And it's often cheaper. Ventura thinks she knows why.
Ms. VENTURA: Believe me when I tell you, he doesn't miss a thing, because I never noticed that my lower chin was quivering.
SHUTE: But Dr. Dorsey from 300 miles away did notice. And he adjusted her medication to control the tremor. Ventura says her symptoms have improved to the point where she can now use a cane instead of a walker. And she's not the only patient who's happy. Tony Joseph is the administrator of the Presbyterian Home, which hosts the video visits.
Mr. TONY JOSEPH (Administrator, Presbyterian Home): The Parkinson's people said, Tony, this is better than when I used to go to the doctor's office, because I'm spending actually more time with that neurologist.
SHUTE: But there is one big problem with specialty care via telemedicine. In most cases insurance won't pay for it.
Mr. JOSEPH: Right now if I were to try to bill a Blue Cross Blue Shield or anybody else for a neurological consult like we're doing right now, they're not going to cover it.
SHUTE: So Tony Joseph has taken to running fundraisers to pay Dr. Dorsey and the other neurologist who provides Parkinson's care. That costs about $40,000 a year.
Mr. JOSEPH: We do a Parkinson's awareness walk, and we've been very successful with that.
SHUTE: Those fundraisers have kept the New Hartford program going for four years. But why won't insurers pay for telemedicine? Dr. Jay Sanders helped pioneer remote health care in the 1990s.
Dr. JAY SANDERS: Traditionally payment has always been made based upon the physical presence of the doctor with the patient.
SHUTE: That's to protect against insurance fraud. And there's yet another stumbling block. Doctors have to be licensed to practice in the state their patents live.
Ray Dorsey knows that even if telemedicine overcame those barriers, it wouldn't cure all ills. That becomes clear during the video call when Deanna Ventura reaches up to rub her neck.
Ms. VENTURA: And as I'm stretching I can feel it. And I haven't had this. Like this is something new for me.
Dr. DORSEY: This is one of the limitations of telemedicine, is you know, I can't fully assess your neck.
SHUTE: He doesn't think it's anything serious, but he wants someone to actually feel that neck. So he asked her to get it checked out by her family doctor.
Ms. VENTURA: Well, thank you, Dr. Dorsey. You take care of yourself and your family.
Dr. DORSEY: And we'll see you in August. Sandy will give you a time.
SHUTE: Making for a good visit even from far away.
Nancy Shute, NPR News.
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