FRANKFORT — Kentucky is about 3,700 physicians short of the number it needs, and it’s unlikely that gap will be closed anytime soon.

Dr. William C. Thornbury, a family physician from Glasgow, believes there’s a better way to serve patients and to increase the capacity of family doctors to treat more patients.

He told the Interim Joint Committee on Health and Welfare Monday that Kentucky has a large population of chronically ill patients who can be effectively treated through online telehealth technology most of the time.

“We can deliver care to people where they are, when they need it, and by their own doctor,” Thornbury told the committee.

He said chronically ill patients represent about 40 percent of a typical family physician's patient case load. And for every one of those patients he can treat through telehealth, it allows him to treat another in person at his office. Studies have indicated the use of technology could increase family physician capacity by 19 percent.

Available technology could take family medical care “from the horse and buggy era to the automobile era,” Thornbury said.

But to invest in the technology, Thornbury said, doctors and providers must receive payments from insurers and other third-party payers on par with those they receive for patient visits to the doctors’ offices.

Physicians would likely also face a higher liability risk treating patients through technology, another reason they need on par payment from insurers.

Rep. Steve Riley, R-Glasgow, introduced legislation last spring to require such on par payments and allow online doctor-patient consultations but he said the short, non-budget session didn’t allow sufficient time to address questions about the bill. He plans to reintroduce the legislation in the 2018 session.

Concerns from the insurance industry have been a significant obstacle, but Riley said Monday he is conferring with insurers to address or allay their concerns.

Thornbury said such online consultations won’t replace traditional on-site visits to the doctor.

“Sooner or later when you’re providing chronic illness care, you’re going to have to see patients in person,” Thornbury said.

But that doesn’t mean a physician can’t adjust medications such as insulin for diabetes patients through online consultations. That saves the patient a trip to the doctor’s office as well as wait time for those who may have to leave work to visit the doctor.

Nor would such online visits eliminate the ongoing, traditional doctor-patient relationship, he said.

“Chronic disease care has to be provided by people who know the patient’s history.”

Indeed, Riley’s legislation would require payment from insurers — if the provider and patient have “an ongoing medical relationship.”

That relationship is critical both to the quality of care and the costs of that care, Thornbury said.

“Studies indicate patients who see a doctor they know get better medical results at more efficient cost,” he told the committee.

Sen. Ralph Alvarado, R-Winchester, who is also a physician, said the online technology could also extend medical assistance at lower costs to jails, prisons, nursing homes and schools.

Ronnie Ellis writes for CNHI News Service and is based in Frankfort. Reach him at Follow him on Twitter @cnhifrankfort.

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