Everybody dreads the long hours wasted sitting in emergency rooms, the unnecessary tests and the redundant questioning. The subsequent bills that arrive weeks later are salt on wounds.

Going to the ED for ankle sprains, minor lacerations and sore throats is part of what has driven the cost of healthcare sky high. A new telemedicine company, SwiftMD (New York), staffed exclusively with board-certified emergency medicine physicians, aims to provide 24/7 access to diagnose and treat non-critical healthcare problems.

"The future of healthcare is virtual and virtually unlimited for those who want to embrace change," SwiftMD founder/CEO Elliot Justin, MD, told Diagnostics & Imaging Week. "Exams take place in patients' homes, workplace or in transit."

Justin, a physician with 30 years of emergency medicine experience, came up with the idea for SwiftMD after a day on the job seeing several patients who didn't really need to be in the ER, but had spent hours waiting to be seen after being told by primary care doctors that they should go to the ER and even have unnecessary tests.

"After that shift, I decided that we need to build a system to give people the healthcare that they need and not what I can bill for," he said. "Our healthcare system is in need of drastic change. There are roughly 40 problems that represent close to 95% of what you see in urgent care centers. SwiftMD has algorithms that help the doctors to deliver consistent care for these issues."

A large percentage of patients show up in the ER, urgent care centers and primary care offices for advice and prescriptions. "When people call the ER or their doctor, they are typically told that they can't be diagnosed over the phone, but that's simply not true for many conditions," Justin said.

For example, when a patient calls into SwiftMD with an ankle sprain, the doctor on call can ask the patient several very specific questions to determine if it's just a simple sprain or if it sounds serious enough to warrant a trip for X-rays and further treatment. In many cases, an ice pack, rest and over-the-counter pain relievers will suffice. Patients are always told if their condition worsens or doesn't improve within a certain period of time that they should seek in-office or ER care.

"Once you enter the healthcare system, there's a profound push to over-test and it''s all driven by the reimbursement system,'" he said.

SwiftMD, which launched in the New York area just one month ago, treats patients via phone but by the end of the year expects to be able to offer bi-directional web encounters which will allow patients to send photos of their rashes or cuts in real time to the physician on the other end for quick review and for conversations via the computer.

SwiftMD also is building electronic healthcare records for all subscribing patients.

The company is targeting its services to companies that are self-insured and as a benefit for people with plans that include consumer-directed options like flexible savings accounts, health savings accounts and health reimbursement arrangements.

Justin said that many insurance companies have indicated they will soon cover telemedicine consultations or e-visits via e-mail if they aren't already.

SwiftMD can either be used on a one-time basis or individuals can purchase a monthly membership for $8 to $9. When services are used, the consultation fee is $59. Costs for group plans to companies varies depending on the number of participants.

Justin said that reimbursement from insurers is averaging between $25 and $50 per consultation.

Members also have 24/7 access to their electronic healthcare records. Updates are made in real time so that when a consultation is performed, patients can actually see what their doctors entered into the records. Patients rarely see their physical records at doctors' offices.

In addition to urgent care needs, SwiftMD will offer second-opinion services, well care such as flu shot reminders, and chronic disease management.

"In healthcare, we make money when people come to us. But if somebody is at home with a glucometer, we can manage the disease without the inconveniences of coming into an office," he said.

Justin started the company with funding from a group of ER physicians. "Most ER doctors work for companies or hospitals and they have the mindset of shift workers. We want all of our doctors to be owners of the business and we think, this way, it will improve the quality of care to patients."

Although SwiftMD services are available now in New York only, they will be available in Pennsylvania by November. "We would like to go nationwide, but there are issues with national licensure," Justin said, adding that several groups are working on national legislation to create a nationwide telemedicine license.