The virtual house call

As the debate on health care reform rages in the United States, one thing is exceedingly clear: chronic disease accounts for a growing majority of American health care costs.¹ Many chronic diseases, particularly Parkinson disease (PD), can benefit from specialty care. Patients with PD show more improvements in motor symptoms and less frequently receive inappropriate medications when treated by a specialist.^2,3 However, reduced mobility due to PD, combined with the physical distance to the specialist's office, poses substantial travel burdens and may limit access to care. Telemedicine, utilizing video and audio conferencing technology to connect patients and clinicians, can mitigate this problem. However, Centers for Medicare Services (CMS) currently only covers telemedicine encounters under specific criteria: the patient lives in a rural area seen in a covered entity by a consulting physician licensed in the state in which the patient resides.⁴ Even if the rural designation were removed, requiring travel to a center that offers telemedicine consultation may preclude many patients from using this approach. Modern Internet-based technologies, utilizing Health Information Portability and Accountability Act–compliant software, allow physicians to perform virtual house calls, thus minimizing travel. This has the potential to increase access to care for patients with a debilitating disease dramatically. While remote examiners cannot perform rigidity and balance testing, they can perform a modified motor examination of similar clinical utility without these components.⁵