In today’s podcast, we’re going to be talking about Rheumatologists and the broader access to telehealth specialty care brought to you by One Touch Telehealth. 

We have an amazing guest with us today, Dr. Diana Girnita Founder and CEO of Rheumatologist OnCall direct care telemedicine company actively seeing patients in 6 states. Her practice focus is a highly personalized, evidence-based, and integrative medicine approach for patients with autoimmune diseases and arthritis.

She provides instant access to specialized care in a digital format to meet the needs of her patient’s lifestyle, accelerating the diagnosis and treatment of autoimmune and inflammatory conditions. 

Since you’re a pioneer and innovator, today I want to learn about the ins and outs of how you’re flipping the table with Rheumatologists, utilizing telehealth. In addition, you are providing direct care across multiple states, and other things that are considered out of the box.


What’s the backstory on how you became a Direct Rheumatologist? 

I was born in Romania where I graduated from medical school and soon after I started as a cardiologist, where during my training, I became interested in immunology. I came here to the United States with a passion to invest in some research with the intention I will go back, but my life became complicated with marriage and kids. I realized that education is second to none here in the United States and after doing some research, I moved into clinical work again. There is where rediscovered being a rheumatologist and I fell in love with this specialty. After I graduated my fellowship, I practiced in the traditional model. I did teach, but I also had a private practice. 

Working there, I realized that patients do not have the access that they need and for some of them, it wasn’t convenient for them to travel long distances to come to see me when I could only spend a short amount of time with them. As an educator with an interest to share more, it was very hard to find the required time with the patient. Later, I saw that many patients try to delay care because the cost of their healthcare was exceedingly expensive. As a result, I thought about what I can do to change the current situation for my patients and that’s how I came up with the idea. I thought to myself, we have the technology here, so why not use it? Your phone, your computer, we carry these powerful tools in our pockets. We do everything from banking to entertainment to scheduling. So why can’t we have access to a doctor? And that’s how I came up with the idea.

What is the average patient wait time in Specialty Medicine? 

In specialty medicine, there’s typically a long wait, whether it’s, nephrologists, rheumatologists, cardiologists. To your point, if you live in a rural area, you may be driving a couple of hours to get access to care due to the shortages in specialty medicine, as doctors typically don’t want to live in those areas. Tell me a little bit about how the model is different from the first time a patient contacts you versus the traditional model that’s used in practice where they would come see you in person. How’s that different?

Dr. Girnita, explains, as you mentioned Rheumatology and specialties, in general, are very hard to access. But in Rheumatology, there’s a huge shortage of specialists across the United States and probably even worldwide. The average time it takes to see a specialist is between 4 and 6 months. I try to cut that time to less than a week. Then the time that they spend with the physicians after waiting for 4 to 6 months is between 20 and 30 minutes if you’re lucky. From those 20 to 30 minutes, you spend half of the time filling out forms, signing in, and time with the nurse. So that’s something that I didn’t like. Many of these patients are in pain and as you said, sometimes they have conditions that could be life-threatening. If you don’t give them the access they need when they need it, you put them in danger and the quality of life for that patient is tremendously affected. In my model, the time to access is a week and you spend all the time with the physician. You can fill up your forms at home whenever you have time. Everything is done with full transparency because I don’t want to become a financial burden for my patients. I don’t want them to be scared and thinking about how much the test will cost and how much the imaging will cost. Everything is disclosed upfront between me and the patient, I can decide what is needed to be done right away or decide what can be postponed meeting their financial needs.

What are the differences in Telehealth Rheumatologist vs. Office-Based? 

Yeah, I think in addition to the virtual care, the price transparency is great because obviously in a physical location, you have to check some boxes for insurance that may not be needed. Then you end up getting the bill in the mail of what you must pay. So that’s great. Taking the provider’s side of things, having this virtual care rheumatologists’ practice, tell me about some of the benefits to you as the provider. I know a lot of folks that own practices, they start going back during this post-pandemic time but for three, four months, they were doing nothing but telehealth. A lot of folks that may not be as innovative as you from a practice standpoint, went back to doing what they know which is having people walk through the front door. 

  1. Work/life balance. 
  2. Cost of Practice Operations. I think the biggest struggle of independent physicians is figuring out how to cover the cost of their practice. The overhead is very, very high in the traditional practice. Then you have to think about your front desk staff, the person that has to take you to the room, the person who can build or code for you, and more. These are an additional cost, and when you add everything up, you’re going to realize the cost of care increases artificially due to this disconnect. There are many layers between the physicians and patients. When you remove all these layers, the cost of care becomes much more affordable. 
  3. Time Spent with Patients. When you remove some of these layers, the time spent with the patient becomes more valuable. From my perspective, cutting down the cost offers me the possibility to spend more time with the patient. If you have more people, you’ll have to make sacrifices somewhere. Usually, that sacrifice comes from the time you spend with your patients because you’ll have to see more patients generate more revenue. But with telemedicine as a rheumatologist, you can remove some of the intermediaries between the patient and the physician.

Right, and I’ve heard from a lot of providers that in person they’re having to see 3:1 patients make the same type of revenue, just because of all those overhead costs. But with telehealth and removing some of those barriers, from a reimbursement perspective, they’re able to have a better work-life balance to see fewer patients while making more money. Has that been the same result for you in that model?

What are the cost model differences for direct care vs. traditional in-person office care? 

When the patient comes to us, they have to pay a copayment. After they leave the office, you bill the insurance. Since many patients have high deductibles, they will be responsible for paying a huge amount of their visit in the traditional practice. But in some situations, they will be responsible for paying 20% of that amount. When you add all that in, the co-payment and whatever you must pay from your insurance, you’ll generate a lot of stress for that patient as well as a lot of stress for the physician. Because as a physician, you must pay the bills and you must pay the people that you work with. In the direct care model, the patient pays directly to you. I don’t charge anything extra, whatever you see on my website, that’s the price that you’re going to pay. There is nothing hidden and there is nothing upfront. Usually, the payment is done after you see me, nothing before. So, I was bothered when I went with my kids to the doctor and the first thing that they ask me, without even greeting me, is for my insurance card and my copayment. That’s stressful. That disrupts the relationship between you and the office, and I don’t think it should be that way. If I don’t provide the copayment and if I don’t show you my insurance card, you won’t provide me with care. I think that concept is very stressful for someone that is already in pain and that is already struggling with their health.

How have you expanded your Rheumatologist Virtual Practice Across 6 States? 

You are seeing patients across 6 states and you’re able to do that from your location without having to have physical offices in those states or traveling. When we look at the cost of a physical location, in a traditional model, to see patients in 6 states you’d have to have 6 office locations with the front desk and nursing staff but you’re able to do that from where you are today. Tell me about some of those benefits. 1. Cost of physical buildings

2. Costs of reception, nursing, and administrative staffing. 

3. Broader patient access to care. 

4. No patient long traveling (up to 2 hours in some areas. 

5. The convenience of being seen from the comfort of your own home, without arranging for kids to be taken care of or taking off work.

The Convenience of Telehealth in Rheumatology Patients

In rheumatology, the prevalence of our diseases has been increasing in the past few years. In 2015, there were about 52 million people in the United States with arthritis and it was predicted that in 10 years from then, it will increase to 60 million. 10 years after that, it will increase to 72 million. And out of those people, a third had problems traveling. They had problems getting to a doctor because of their pain and their deformities. So that convenience is second to none for patients. As you said, many, many places in the United States have no specialists or few patients will travel two hours to go to a specialist and two hours to come back. That requires a lot of time spent in the car and it’s a lot of discomforts as well. The convenience of telemedicine for rheumatology allows access to these regions, it’s all about access and convenience. If we can make everything transparent and offer access and convenience in a shorter time without delay of care, I think we will achieve a very important goal.

What is Your Advice for Practice Groups and Providers? 

Telemedicine is here to stay, it will not go away. It will expand to be practiced by multiple physicians because the patients have been interested in that. A few years ago, when I was talking about telemedicine, everybody looked at me like I was talking about a unicorn and they would say, how are we going to be paid? You can be paid. There are resources to be paid. You make the payments for your bank or any bill you have from your computer. It’s the same with medical care and I think as you said, the younger generation is going to push the world to implement that. Today, I heard that in Congress, they are fighting to keep telemedicine ongoing even after the pandemic.

During the pandemic to keep seniors and folks with chronic care issues safe, telehealth was essential. It’s amazing to me looking at survey results across a wide variety of practices. I think seniors were very hesitant, probably the first ones to say “Hey, is there going to be a doctor on the other side?” They didn’t know what to expect that first time but seeing their results to your point of when you’re talking about a senior and traveling, typically, you’re now taking the caregiver out of work too. So, if I’m taking one of my parents to an appointment, I’m taking off work and I’m traveling to pick them up. You have Gen Xers that are now taking care of their parents, they’re also making healthcare decisions based on convenience. So, when I was dealing with my father, who had many chronic care conditions, I was making the calls on health care. If a doctor offered telehealth and I didn’t have to take off work and go pick him up, that’s a doctor we would go with. Especially in your industry, people that find it very hard to get in the car might need assistance, or they might have to have a neighbor drive them or whatever. You’re now coordinating multiple schedules and multiple people getting off work. Collaboration with caregivers on care and various other things will become more apparent as Gen Xers make decisions for their parents. 

Dr. Girnita says, “I have to agree, chronic care is something that will be required. And as you said, it will involve many people and many layers. So, I think telemedicine will solve many of these issues. In rheumatology, many of the patients I see require chronic care. Why would you have to travel to me to review your labs and just make small adjustments to treatment when you can do that from the comfort of your home. I think the concept of care or medical care should be broadened at this point, I think it should be accepted that we have the technology, we just have to use it. Even people that are elderly love it. It can seem scary in the beginning, but once they’ve seen what they can do with the technology, there’s no hesitation the second time.”

To learn more about Dr. Girnita and Rheumatologist OnCall or to learn more about telehealth in practice groups.