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Unattributed VC | Alive

Total Raised


Last Raised

$6M | 24 yrs ago

About U.S. Physicians

U.S. Physicians is a company based in Fort Washington, Pennsylvania. U.S. Physicians' investors include Mid-Atlantic Venture Funds, Lancaster Investment Partners, Keystone Venture Capital, Dominion Ventures, Edison Venture Fund and Heights Capital Management.

U.S. Physicians Headquarter Location

220 Commerce Drive, Suite 400

Fort Washington, Pennsylvania, 19034,

United States

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US Physicians’ Perspective on the Sudden Shift to Telehealth: Survey Study

Aug 12, 2021

JMIR Human Factors This paper is in the following e-collection/theme issue: December 07, 2020 US Physicians’ Perspective on the Sudden Shift to Telehealth: Survey Study Authors of this article: 2Division of Cardiology, Syracuse Veteran Affairs Medical Center, Syracuse, NY, United States Corresponding Author: Abstract Background: Given the sudden shift to telemedicine during the early COVID-19 pandemic, we conducted a survey of practicing physicians’ experience with telehealth during the prepandemic and early pandemic periods. Our survey estimates that most patient visits in the United States during the early COVID-19 pandemic period were conducted via telehealth. Given this magnitude and the potential benefits and challenges of telehealth for the US health care system, in this paper, we obtain, summarize, and analyze telehealth views and experiences of US-based practicing-physicians. Objective: The aim of this study was to examine the extent of shift toward telehealth training and care provision during the early pandemic from the US-based practicing physicians’ perspective. We also sought to determine the short- and long-term implications of this shift on the quality, access, and mode of US health care delivery. Methods: We conducted a purposive, snowball-sampled survey of US practicing-physicians. A total of 148 physician completed the survey. Data were collected from July 17, 2020, through September 4, 2020. Results: Sample training intensity scaled 21-fold during the early pandemic period, and patient-care visits conducted via telehealth increased, on average, from 13.1% directly before the pandemic to 59.7% during the early pandemic period. Surveyed physician respondents reported that telehealth patient visits and face-to-face patient visits are comparable in quality. The difference was not statistically significant based on a nonparametric sign test (P=.11). Moreover, physicians feel that telehealth care should continue to play a larger role (44.9% of total visits) in postpandemic health care in the United States. Our survey findings suggest a high market concentration in telehealth software, which is a market structural characteristic that may have implications on the cost and access of telehealth. The results varied markedly by physician employer type. Conclusions: During the shift toward telehealth, there has been a considerable discovery among physicians regarding US telehealth physicians. Physicians are now better prepared to undertake telehealth care from a training perspective. They are favorable toward a permanently expanded telehealth role, with potential for enhanced health care access, and the realization of enhanced access may depend on market structural characteristics of telehealth software platforms. JMIR Hum Factors 2021;8(3):e26336 Characteristics of Telehealth Software Used Regarding telehealth software used, 66.9% (99/148) of the respondents used CloudVisit Telemedicine, 25% (37/148) used Doximity Dialer, and 3.4% (5/148) used Chiron Health. Six other telehealth software were mentioned as the primary software used, where each featured <1% market concentration. This finding suggests a high sample market concentration among telehealth software in the US health care system. The Herfindahl-Hirschman Index (HHI) of market concentration for this sample is approximately 5171. An HHI value of 10,000 reflects pure monopolistic provision, an HHI value between 0 and 1500 indicates competitive provision according to the US Department of Justice, and an HHI value above 2500 indicates a highly concentrated market. These sample results indicate a high level of market concentration in US telehealth software; any limitations of the few leading software platforms will affect physician-patient telehealth interactions at near-market scale. Moreover, market concentration can have profound upward pressure on the price that the software consumer pays and can erode any potential cost savings from telehealth to the health care system and health care consumers. This sample result is consistent with the market concentration characteristics of both software and health care markets. Questions regarding the general quality of nonemergency telehealth care compared to face-to-face care show that the quality of telehealth was perceived as worse by a plurality of physician respondents (50/148, 33.8%), equal in quality by 31.1% (46/148), slightly better by 14.2% (21/148), much better by 14.2% (21/148), and much worse by 6.7% (10/148) physician respondents. Thus, slightly more sampled physicians reported a quality drop-off rather than a quality gain from telehealth. Eligible Visit Types and Intensity of Telehealth Use During the Early COVID-19 Pandemic Given the challenges and risks of face-to-face visits during the pandemic, physicians are relying more heavily upon telehealth visits. In the prepandemic period, sampled physicians conducted an average of 13.1% of visits via telehealth compared to 59.7% during the pandemic (unweighted means reported). Moreover, Moore et al’s [ 6 ] finding that physicians reported “considerable interest in, but limited use of, telehealth services” during prepandemic times is corroborated by our survey data. As several types of visits are not eligible for telehealth delivery, 59.7% of telehealth visits represent an aggressive deployment of telehealth delivery. Physicians have converted approximately 25.9% of telehealth visits into face-to-face visits during the pandemic, down from 32.4% before the pandemic. This finding suggests that, during the pandemic, physicians were using telehealth as a more effective filter in identifying needed face-to-face follow-up visits; patients not needing face-to-face follow-up are more often relegated to telehealth follow-up or no follow-up. Currently, patient reluctance and internet accessibility represent limiting factors for telehealth provision. On average, physicians reported that 26.6% of the patients are reluctant to participate in telehealth, whereas 29% lack connectivity to conduct a telehealth visit. A description as to the regions served by surveyed physicians may provide context with respect to patient reluctance. The sample represents physicians practicing in 25 US states and 1 US territory, where the sampled physicians serve in all CDC National Center for Health Statistics (NCHS) Urban-Rural Classification categories, including large metro (36/148, 24.3%), large fringe metro (9/148, 6%), medium metro (43/148, 29.1%), small metro (45/148, 30.4%), micropolitan (10/148, 6.8%), and noncore or rural (5/148, 3.4%) areas. Telehealth Visit Duration During the Early COVID-19 Pandemic Of the 148 physicians surveyed, 84 (56.8%) reported allocating the same average time duration to a telehealth visit as to a face-to-face visit; 4 (2.7%), spending substantially less time; 36 (24.3%), slightly less time; 16 (10.8%), slightly more time; and 8 (5.4%), substantially more time. Telehealth does not appear to be substantially distorting the time-of-visit distribution. Overall, more respondents reported allocating less time (40/148, 27%) than more time (24/148, 16.2%) to telehealth visits. Characteristics of Physician Views Toward Telehealth With regard to the postpandemic period, respondents feel that they could deliver approximately 44.9% of patient visits via telehealth. This represents more than three times the reported prepandemic delivery rate for these physicians and only a moderate decrease from the pandemic delivery rate. Many surveyed physicians (49/148, 33.1%) felt that telehealth delivery decreases the value of their clinical skills, consistent with a capital-labor substitution view of the technology. Loss of patient-physician relationship under telehealth expansion was also a moderately observed response (51/148, 34.5%). It is potentially important to note that patient-physician relationship development may not always be productive in terms of health care. For example, the literature shows that individuals can experience performance decrements as the perceived stakes associated with a task rise [ 23 - 25 ], and that this phenomenon affects surgeons [ 26 ]. A surgeon performing a risky surgery may feel more stake-associated pressure if they have formed a relationship with the patient. According to survey respondents, the five most major challenges faced while providing telehealth during the COVID-19 pandemic are (1) limitations on physician’s ability to deliver certain types of health care by the very nature of telehealth (ie, regardless of level of telehealth development), (2) inadequate telehealth technology, (3) lack of organizational support for telehealth, (4) inadequacies in reimbursement for visit, and (5) prior inadequate physician telehealth training. These results were based on a single question in the survey with categorical response options, as well as a “write-in” reply box. The most common policy recommendations regarding improvements in telehealth delivery were (1) malpractice protection for telehealth, (2) clarity regarding reimbursement policies, (3) training to use technology more efficiently, and (4) policies regarding duration per episode of care. One respondent commented that video-conferencing use, as required by some private insurances, caused problems because many patients were not equipped for videoconferencing. Discussion Present and Future Use of Telehealth The results of our physician-respondent survey suggest that the COVID-19 pandemic motivated a substantial shift toward telehealth training and care provision in the United States. Our results further suggest discovery as to the potential and value of telehealth care such that physicians perceive comparable quality of care under telehealth provision compared to a face-to-face visit. Given this discovery, physicians foresee a heavily expanded role of telehealth provision even in the post-pandemic period. However, a moderately high percentage of physician respondents also report both innate and soluble limitations of telehealth technology, as well as a loss of perceived value of their skills under telehealth expansion. Most physicians from different practices and specialties see value in continuing with telehealth provided that a few elements of telehealth provision improve—telehealth technology development, adequate training of physicians and administrative staff, clear reimbursement policies (ie, insurance policies), and clarity on malpractice regulation being the chief elements. From estimates of patient reluctance and internet accessibility, as reported in the results section, let us conservatively estimate that 30% of the patients have at least one of these limiting characteristics. These limiting factors alone would place a cap on the capacity of telehealth delivery at 70% of visits. Visit eligibility would further decrease this soft cap, such that the survey-estimated pandemic telehealth visit rate (59.7%) represents something close to the present capacity load for telehealth delivery. Given that physicians feel telehealth care should continue to play a larger role (44.9% of visits) in the postpandemic US health care, we conclude that there was substantial discovery with respect to viability of telehealth during the pandemic period that may not have occurred otherwise. In this respect, the pandemic has been something of a natural experiment for telehealth viability. This also suggests that technological adoption in health care exhibits characteristics of path-dependence or dependence on the occurrence or nonoccurrence of exogenous circumstances rather than being purely a process of optimal decision-making by well-informed firms. Indeed, health care industry policies and practices have been shown to exhibit path dependence [ 20 - 22 , 27 - 30 ]. Market concentration is a frequent issue in software markets given that software units can be scaled at essentially zero marginal cost to the seller, and software consumers are often “locked in” after learning a given system. Moreover, we observe high rates of market concentration in health care markets generally, with more than 90% of health care markets characterized as highly concentrated or super-concentrated according to HHI [ 18 ]. Telehealth software, which represents a software market within the health care industry, appears to be no exception. Telehealth software companies sometimes promote further concentration. An article from InTouchHealth, a subsidiary of Teladoc Health, states, “Telehealth would be nearly impossible unless every healthcare provider is using the same system” [ 1 ]. This statement represents the monopoly provision of telehealth platforms (eg, via a winner-take-all standards war) as an important condition toward sustained telehealth use by the health care industry. Shachar et al [ 7 ] Identified telehealth market regulation as a primary concern with respect to the postpandemic scale and the overall effect of telehealth [ 7 ]. Telehealth and US Health Care Outcomes The three core objectives of the 2010 US Patient Protection and Affordable Care Act relate to (1) increasing access to health care, chiefly through expanded Medicaid enrollment for the working poor; (2) a higher quality of care through improved medical and market decisions; and (3) reducing cost and patient risk via improved efficiency and higher rates of insured individuals [ 31 ]. Our survey results suggest that telehealth provision is largely consistent with these goals. Telehealth has increased access to nonemergency health care during the pandemic and can continue to provide improved access to rural patients and many patients who have difficulties reaching a medical facility in the postpandemic period. Telehealth could reduce the cost of care delivery, as well as the price paid by patients [ 32 ] by streamlining some of the logistical hurdles to physicians and patients during face-to-face visits. Furthermore, the survey results suggest that patients often travel long distances for a face-to-face visit. In many cases, this travel time allocation imposes loss of work time and other opportunity costs for the patient that might be minimized through the scaling of telehealth for eligible visits. However, the outcome along this dimension is potentially dependent on market structural and regulatory issues [ 7 ]. Survey responses indicate that, on average, the physician-perceived average quality of care remained roughly the same with telehealth expansion. Moreover, telehealth has been popular during the pandemic primarily because it reduces the risk of infection during health care delivery, wherein this risk reduction is an important component of health care quality. Takeaways and Future Directions This study presents a large sample physician survey on telehealth following the onset of the COVID-19 pandemic. The picture that emerges from this physician survey is that the scaling of telehealth can provide the US health care system with increased flexibility, access, and potential health care cost benefits. We acknowledge some study limitations. This was a physician survey and did not capture patients’ views. Further research is therefore needed to determine the benefits and challenges of telehealth expansion from the patients’ perspective. Furthermore, additional research can subcategorize areas of eligible treatment that are more amenable to telehealth expansion in terms of benefits yielded. The survey represents physician responses from 25 US states and 1 US territory. The advantages of the present sample notwithstanding, estimates might have been improved had it been possible to obtain survey responses from physicians in every US state and territory. Moreover, the sample was taken cross-sectionally and does not feature the benefits of a longitudinal survey. More generally, voluntary survey data is subject to recall bias and selection bias, and snowball sampling may lead to sample points that are clustered according to employer or social network. The study also does not address complementary means to improve telehealth infrastructure such as administrative operationalization and clinical care reorganization [ 33 ]. Indeed, scaling one’s software capabilities alone will not fully support continued growth in telehealth. Owing to space and scope limitations, such analyses will be considered in future research. Acknowledgments We would like to thank Katherine McDonald for editorial assistance with the manuscript and Deborah Monahan and Amy Dumas for their assistance with funding for the project. This work was supported by the funds provided by the David B. Falk College of Sport and Human Dynamics, Syracuse University, as well as by a Syracuse University Office of Research Seed Grant. Conflicts of Interest American Telemedicine Association. URL: [accessed 2020-10-12] Barnett ML, Ray KN, Souza J, Mehrotra A. Trends in telemedicine use in a large commercially insured population, 2005-2017. JAMA 2018 Nov 27;320(20):2147-2149 [ FREE Full text ] [ CrossRef ] [ Medline ] Pathipati AS, Azad TD, Jethwani K. Telemedical education: training digital natives in telemedicine. J Med Internet Res 2016 Jul 12;18(7):e193 [ FREE Full text ] [ CrossRef ] [ Medline ] Iancu AM, Kemp MT, Alam HB. Unmuting medical students' education: utilizing telemedicine during the COVID-19 pandemic and beyond. 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  • Where is U.S. Physicians's headquarters?

    U.S. Physicians's headquarters is located at 220 Commerce Drive, Suite 400, Fort Washington.

  • What is U.S. Physicians's latest funding round?

    U.S. Physicians's latest funding round is Unattributed VC.

  • How much did U.S. Physicians raise?

    U.S. Physicians raised a total of $6M.

  • Who are the investors of U.S. Physicians?

    Investors of U.S. Physicians include Dominion Ventures, Keystone Capital, Lancaster Investment Partners, Edison Partners, Mid-Atlantic Venture Funds and 3 more.

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