NEW YORK (AP) _ Doctors with the nation's largest hospital company are starting to treat patients from afar with video cameras to save money by exchanging office visits for online appointments.

Columbia/HCA Healthcare Corp.'s test of the ``telemedicine'' technology, announced Thursday, takes doctors one step further away from patients in the name of holding down medical costs.

With a nurse at the patient's home, the video is beamed to the doctor through a camera-equipped laptop computer and telephone lines.

With video medicine, ``we can improve home care and customer service while reducing costs,'' said Ann Schmidt, who heads Columbia's home-health care operation.

Nashville, Tenn.-based Columbia's entry into telemedicine adds momentum to a trend just beginning to take hold among managed-care companies. The treatment brings medical care to rural areas that lack access to nearby hospitals. But health care watchdogs fear the practice may replace routine doctor visits nationwide.

``This is a front line battle in medical ethics,'' said Jamie Court, director of the Santa Monica, Calif.-based advocacy group Consumers for Quality Care. ``The issue here is that profiteering companies are trying to apply telemedicine in areas where it simply doesn't belong as a way to cut costs and produce a better rate of return for Wall Street investors.''

The group supports a bill in the California Assembly that would allow only a doctor who has physically examined a patient to deny coverage.

Columbia spokesman Jeff Prescott said the company is moving slowly to test the system to ensure that the video hookups improve rather than replace existing patient care.

``You have to be very considerate, and that's one of the reasons you field test something like this,'' he said. ``You never want to get into a position where you're replacing something that can and should only be done on an outpatient basis or in an actual hospital.''

The manufacturer of the $12,500 computerized conferencing machines, HealthCare Vision Inc. of Fort Worth, Texas, says the insurer isn't the only one who saves money through video visits.

During a test of the system last year, a dermatologist was able to treat several workers who had developed a rash on a Reading and Bates Co. offshore oil rig in the Gulf of Mexico without shutting down the operation and moving them to a hospital, HealthCare Vision's Jerry Graves said.

And when a 47-year-old immigrant laborer's leg was mangled in a chain saw accident in 1995 near Fort Worth, Texas, the employer saved transportation and other costs, Graves said. Columbia orthopedic surgeon James Heerwagen more than 40 miles away in Lewisville, walked an on-site health care worker through draining and closing the wound.

``The employer did not have to spend thousands of dollars by going to a hospital operating room,'' HealthCare Vision official Deborah Jenkins said.

Consumer watchdogs agree that telemedicine can offer improved care in some cases, but fear it may offer less attentive care overall.

``I am concerned that you lose something. It's not the same as a physician visit,'' said Geri Dallek, health policy director for Families USA, a nonprofit advocacy group based in Washington, D.C. ``I think sometimes technology runs away from us. We get a good thing and we have to be very careful how we use it.''

The HealthCare Vision system uses a Toshiba Corp. laptop computer mounted with a digital camera, video and audio conferencing technology and a speech recognition system.

The voice recognition software lets the on-scene nurse or physician assistant stop the video to capture high-resolution images, transmit them or pull up the patients' files by verbal commands, leaving hands free to treat the patient.

Unlike the systems some research hospitals have tested for years, the device uses regular phone lines instead of dedicated broad-band lines between hospitals.

Online medicine has lagged behind other online technology over the past decade, largely because the systems until recently cost as much as $50,0000.

The nation's largest nonprofit health maintenance organization, Kaiser Permanente of Oakland, Calif., has been testing a similar system for patient visits with psychiatrists and other specialists. Kaiser started using video systems about a year and a half ago, largely because of the lower cost, said Peter Juhn, Kaiser's vice president for health strategies development.

Now, hundreds of experimental telemedicine programs have been sponsored by federal, state and independent agencies in 40 states, according a Feb. 14 report by the General Accounting Office, the investigative arm of Congress.

``The way we're approaching this is, this is not for everyone. It's providing another set of options,'' Juhn said. ``We're into telemedicine because we believe this enables us to provide state-of-the-art health care anytime, anyplace, therefore overcoming the barriers of distance, time and place.''