Mary Castaneda had a sinus infection that just wouldn't go away, and she was feeling awful. She knew she needed to see a doctor, but her timing was off.
"It was after-hours so I couldn't get in to see my doctor," says the 35-year-old Mission Viejo real estate agent.
She'd recently heard about a new service that would quickly connect her with a doctor by video via her smartphone, and she decided to give it a shot.
She downloaded the app and after just a few minutes was connected with a board-certified doctor. Fifteen minutes later, she had a prescription to ease her symptoms and a list of tips from the doctor about how to fight off future infections.
"The doctor was amazing," Castaneda said. "He was as thorough, or even more thorough, than my regular physician."
The experience was so positive that Castaneda used the service again a few months later. "For me, it was worth it to pay $40 to avoid spending two hours at the doctor's office," she says.
Consumers seeking convenience and predictable prices are being driven to search for medical services available at extended hours and for a fixed fee. But critics of the services say there is no substitute for a face-to-face examination and a firsthand diagnosis.
Online medical exams and retail clinics offer a convenient, low-cost alternative to long waits at primary-care offices — especially for patients with little need for intensive intervention. These services may even help to avoid unnecessary trips to the emergency room.
Like patients, some doctors are also finding new primary care models appealing.
They can get reimbursed right away and avoid the red tape of insurance contracts, says David E. Williams, a Boston healthcare consultant. "Everyone realizes they need primary care, but it hasn't been a very satisfying experience for patients," he says.
It also turns out, he says, that "it hasn't been very satisfying for physicians, which is why we're seeing a lot of changes," he says.
Here are a few fixed-price sources for primary care to consider:
Web-based services. Technology-powered tools like the one Castaneda used are being made available by a growing number of companies.
Remote video medical exams are offered by Doctors on Demand, American Well, MDLive Inc. and Teledoc Inc.
For a flat fee of roughly $40 to $50 for a 15-minute visit, patients can connect with a licensed physician, usually within a few minutes by smartphone, tablet or computer. During the visit, a doctor will evaluate symptoms and offer a diagnosis, if appropriate, and provide a prescription if needed.
The most common treatments cover respiratory illness, fever, ear and urinary tract infections, concerns about a child's minor health condition, and skin or eye problems.
"We treat hundreds of cases every day for things you'd use the doctor's office or emergency room for," says Dr. Pat Basu, chief medical officer with Doctor on Demand, based in San Francisco. In about 90% of cases, he says, patients have their problems resolved during the visit.
These services can also be useful when patients have been diagnosed with an illness and want a second opinion.
Employers and insurers are beginning to offer these products as part of their benefits packages.
Anthem Blue Cross, for instance, recently announced that policyholders would have access to video consultations through American Well at livehealthonline.com for $49. The cost may be partly covered by insurance depending on the health plan.
Text your doctor: First Opinion is a text-messaging service that connects patients within nine minutes to a physician who can answer medical questions — all in writing. "We're meant to be the very first place you go when you have a question," says McKay Thomas, First Opinion's chief executive.
The text messages are exchanged anonymously, though if patients want to text about more than one concern, they'll maintain their relationship with the same doctor over time.
Unlike with video consultation, the doctors working with this service cannot give a prescription. One text message consultation per month is offered for free. If patients need more contact, they can buy it for $12 or get unlimited access for $25 a month.
Treatment via online video and text is convenient and cost-effective but not right for everyone or every situation.
"If you have a bone sticking out of your body or you absolutely know it's a 911 situation, we won't be able to treat you," Basu of Doctor on Demand says. "Now you've just been told by a board-certified doctor that you need to" get to the emergency room, he says.
If patients are being treated for cancer or another complex chronic disease, these services also aren't appropriate. They won't take the place of an ongoing relationship with a doctor, including a good primary care physician.
Finally, there's the matter of personal preference. "If you feel comfortable having a diagnostic conversation this way, the care you'll get is great," says Dr. Jennifer Schneider, a vice president at Castlight Health, a technology firm that sells health information tools. Some people, however, find there's no replacement for an in-person doctor visit, she says.
Retail clinics. Retail clinics provide primary medical care and are based in retail drugstores and supermarkets. They can treat ailments such as strep throat, infections, minor wounds and joint sprains. They also offer vaccinations and physicals.
Retail clinics tend to be staffed by nurse practitioners and physician assistants, but are supervised by physicians who are on-call for consultation when needed.
At CVS, the largest provider of retail clinics nationwide, the average cost of services at its in-store MinuteClinics is $79 to $89, spokesman Brent Burhardt said. Prices for the services are openly posted on the company's website and on electronic message boards in the clinics.
They also accept a wide range of insurance plans, which are also listed on the company's website.
Urgent care centers. Urgent care centers are usually staffed and often owned by physicians — and sometimes hospitals. Nationwide, there are roughly 9,300 clinics in operation, according to the American Academy of Urgent Care Medicine.
These clinics treat conditions that require immediate medical attention that don't rise to the level of an emergency, such as infections, lacerations and bone fractures. They offer convenience and lower-cost care than the emergency room.
Prices vary depending on the center and the service, but they are typically posted where they can be easily seen. Many are now also included in insurance company provider networks.
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