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TheAssociatedPress WASHINGTON MarkMatu- laitis holds out his arms so the Parkinson's specialist can check his tremors. But this is no doctor's office: Mat- ulaitis sits in his rural Mary- land home as a neurologist a few hundred miles away ex- amines him via the camera in his laptop. Welcome to the virtual house call, the latest twist on telemedicine. It's increas- ingly getting attention as a way to conveniently diag- nose simple maladies, such as whether that runny nose and cough is a cold or the flu. One company even of- fers a smartphone app that lets tech-savvy consumers connect to a doctor for $49 a visit. Now patient groups and technology advocates are pushing to expand the dig- ital care to people with com- plex chronic diseases that make a doctor's trip more than just an inconvenience. "Why can't we provide care to people wherever they are?" asks Dr. Ray Dorsey, a neurologist at the University of Rochester Medical Center. "Think of taking your mom with Alzheimer's to a big urban medical cen- ter. Just getting through the parking lot they're dis- oriented," he adds. "That's the standard of care but is it what we should be doing?" Among the hurdles: While Medicare covers some forms of telehealth, it doesn't typ- ically pay for in-home video exams. Plus, doctors who practice by video-chat must be licensed in whatever states their long-distance patients live. Some states restrict the kind of care and prescribing available via telemedicine. About 40 percent of Par- kinson's patients don't see a specialist, in part because they live too far away, even though research suggests those who do fare better, ac- cording to the Parkinson's Action Network. When Matulaitis first was diagnosed in 2011, his wife had to take a day off work to drive him more than two hours to a Parkinson's clinic. Once he was stabilized on medication, Dorsey enrolled the Salisbury, Md., man in a pilot study of video house calls. Set-up was simple: The doctor emailed a link to video software designed for patient privacy. He's thrilled with the care. "It's just the same as if you've ever done Facetime on an iPhone," explained Matulaitis, 59, who continues his virtual checkups with Dorsey a few times a year. "It allows the doctor to see the patient at a point where they are at their best." Telemedicine is broader than a Skype-like doctor visit. For years, doctors have delivered different forms of care remotely, from the old- fashioned phone call to at- home monitors that measure someone's blood pressure and beam the information to a clinic. Hospitals routinely set up on-site video consul- tations with specialists. But the virtual house call is gaining interest. Some in- surers offer versions, such as Wellpoint Inc.'s LiveHealth Online service. Telemedi- cine provider American Well is making headlines with its direct-to-consumer service, offered in 44 states. Psychi- atrists are exploring men- tal health follow-up counsel- ing from the privacy of a pa- tient's home computer. New guidelines from the Federation of State Medical Boards say telemedicine can be OK without a prior in-per- son visit, a change expected to influence licensing regu- lations in a number of states, said federation president Dr. Humayun Chaudhry. The guidelines hold vir- tual visits to the same stan- dards as an office visit, in- cluding a full medical history and informed consent, and say patients should be able to choose among participat- ing doctors. But does a vir- tual exam translate into bet- ter outcomes for the chron- ically ill? "There's an evidence gap that needs to be filled," said Romana Hasnain-Wynia of the Patient-Centered Out- comes Research Institute, an agency created under the new health care law to study which medical treat- ments and procedures work best. With a $1.7 million grant from PCORI, Dorsey's study is randomly assigning about 200 Parkinson's patients from around the country to receive either their usual care or added virtual check- ups from a specialist. His pi- lot studies have suggested telemedicine allows needed care such as medication ad- justments while saving pa- tients time. As for people seeking even a seemingly simple diagnosis, there are other questions such as how to avoid overprescribing anti- biotics. Yes, a smartphone camera may spot signs of strep throat. But national guidelines urge a strep test before giv- ing antibiotics, to be sure a virus isn't to blame. "You have to be a touch more thoughtful when you're talking about new patient relationships," said Dr. Jo- seph Kvedar of the Center for Connected Health, a di- vision of Boston's Partners Healthcare. But he predicts at-home infection tests one day could supplement tele- health. Then there's cost. The key is whether telehealth re- places doctor visits or adds to them, Dr. Ateev Mehrotra of Harvard and the RAND Corp., said in recent testi- mony for a House Energy and Commerce subcommit- tee that is studying how to enhance telemedicine. "Telehealth may be too convenient," said Mehro- tra, urging that it be imple- mented in a cost-effective way that provides high-qual- ity care. TELEHEALTH Do ct or s us in g we bc am s fo r ho us e ca ll s Thedownside: Medicare doesn't pay for home video exams PATRICKSEMANSKY—THEASSOCIATEDPRESS Colleen Matulaitis helps her husband, Mark Matulaitis, a Parkinson's patient, May 8with a neck brace he wears a er an operation, while he uses a laptop during a virtual house call with his neurologist in his home in Salisbury, Md. "It's just the same as if you've ever done Facetime on an iPhone. 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