1. Environmental
1.1. Long walk from parking lot
1.1.1. Patient with Chronic pain
1.1.2. Patients with SOB
1.2. Patient skepticism
1.2.1. MC visits not well advertised
1.2.2. Patients suspicious
1.3. Patient Expectations
1.3.1. If it's free, it's not worth it
1.3.2. Co-ins for different visits
2. Political
2.1. Medicare doesn't advertise
2.1.1. Patient lack of understanding
2.2. Safe Medicare money
2.2.1. Taxes will go up
2.2.2. Healthy patients robbing Medicare
2.3. Lack of trust in system
2.3.1. Patients not truthful about depression, etc
2.3.2. Privacy, confidentiality
3. Legal
3.1. Advanced Directives
3.1.1. Patients not prepared
3.1.2. Negative experience
3.2. Patients think they need legal counsel
3.2.1. Need for witnesses
3.3. Providers not comfortable or experienced
3.3.1. DNRs
3.3.2. Advanced Directives
4. Ethical
4.1. Reimbursement for healthy patients
4.1.1. Feels like double dipping
4.1.2. Patients seen throughout the year
4.2. Balancing patient needs
5. Social
5.1. Patient Familiarity
5.1.1. No Shows/Cancels
5.1.2. Patient Declines
5.2. Patient confusion
5.2.1. Low satisfaction with visit
5.2.2. Relevance to healthy patient
5.3. Provider culture
5.3.1. No support for visits
5.3.2. Pt. centered culture does not push visits
6. Technical
6.1. Patients more receptive to phone visits
6.1.1. Patients not as confused
6.1.2. Easy, convenient
6.2. Complicated scheduling system
6.2.1. Can't search in advance
6.2.2. Visits are long
6.3. Appt. reminders
6.3.1. Limits video visits
6.4. Patients not using portal
6.4.1. Portal not friendly
7. Economic
7.1. Travel
7.1.1. Increase # of video visits
7.1.2. Increase # of phone visits
7.2. Parking
7.2.1. Medicare Advantage transportation
7.2.2. Parking validation
7.3. Patient Back up
7.3.1. Patients leave without being seen
7.3.1.1. Slots can't be filled for other visits
7.3.2. Time is money