Telemedicine can be an efficient, cost-effective alternative to traditional health care delivery that increases the patient's overall quality of life and satisfaction with their health care. Data estimates on the growth of telemedicine suggest a considerable increase in use over the next decade, increasing from approximately 350 000 to 7 million by 2018. Research analysis also shows that the global telemedicine market is expected to grow at an annual rate of 18.5% between 2012 and 2018. ... [B]y the end of 2014, an estimated 100 million e-visits across the world will result in as much as $5 billion in savings for the health care system. As many as three quarters of those visits could be from North American patients. ...
Telemedicine has been used for over a decade by Veterans Affairs; in fiscal year 2013, more than 600 000 veterans received nearly 1.8 million episodes of remote care from 150 VHA medical centers and 750 outpatient clinics. ... The VHA's Care Coordination/Home Telehealth program, with the purpose of coordinating care of veteran patients with chronic conditions, grew 1500% over 4 years and saw a 25% reduction in the number of bed days, a 19% reduction in numbers of hospital readmissions, and a patient mean satisfaction score of 86% ...
The Mayo Clinic telestroke program uses a “hub-and-spoke” system that allows stroke patients to remain in their home communities, considered a “spoke” site, while a team of physicians, neurologists, and health professionals consult from a larger medical center that serves as the “hub” site. A study on this program found that a patient treated in a telestroke network, consisting of 1 hub hospital and 7 spoke hospitals, reduced costs by $1436 and gained 0.02 years of quality-adjusted life-years over a lifetime compared with a patient receiving care at a rural community hospital ...
The Antenatal and Neonatal Guidelines, Education and Learning System program at the University of Arkansas for Medical Sciences used telemedicine technologies to provide rural women with high-risk pregnancies access to physicians and subspecialists at the University of Arkansas. In addition, the program operated a call center 24 hours a day to answer questions or help coordinate care for these women and created evidence-based guidelines on common issues that arise during high-risk pregnancies. The program is widely considered to be successful and has reduced infant mortality rates in the state. ...Most of this seems reasonable enough, except for that pesky estimate up in the first paragraph that the global savings from telemedicine will amount to $5 billion per year on a global basis. The US health care system alone has average spending of more than $8 billion per day, every day of the years. Thus, this vision of telemedicine is that it will mostly just rearrange existing care--reach out to bring some additional people into the system, help reduce health care expenditures on certain conditions with better follow-up--but not be a truly disruptive force.
An analysis of cost savings during a telehealth project at the University of Arkansas for Medical Sciences between 1998 and 2002 suggested that 94% of participants would have to travel more than 70 miles for medical care. ... Beyond the rural setting, telemedicine may aid in facilitating care for underserved patients in both rural and urban settings. Two thirds of the patients who participated in the Extension for Community Healthcare Outcomes program were part of minority groups, suggesting that telemedicine could be beneficial in helping underserved patients connect with subspecialists they would not have had access to before, either through direct connections or training for primary care physicians in their communities, regardless of geographic location.
In his editorial essay in the same issue, David Asch points out: "If there is something fundamentally different about telemedicine, it is that many of the costs it increases or decreases have been off the books." He offers a number of examples:
"Some patients who would have visited the physician face to face instead have a telemedicine "visit." They potentially gain a lot. There are no travel costs or parking fees. They might have to wait, but presumably they wait at home or at work where they can do something else (like many of us do when placed on hold). There is no waiting at all in asynchronous settings (the photograph of your rash is sent to your dermatologist, but you do not need a response right away). The costs avoided do not appear on the balance sheets of insurance companies or providers ... However, the costs avoided are meaningful even if they are not counted in official ways. There are the patients who would have forgone care entirely because the alternative was not a face-to-face visit but no visit. There are no neurologists who treat movement disorders in your region. The emergency department in your area could not possibly have a stroke specialist available at all times. ... We leave patients out when we ask how telemedicine visits compare with face-to-face visits: all of the patients who, without telemedicine, get no visit at all.
Savings for physicians, hospitals, and other providers are potentially enormous. Clinician-patient time in telemedicine is almost certainly shorter, requiring less of the chitchat that is hard to avoid in face-to-face interactions. There is no check-in at the desk. There is no need to devote space to waiting rooms (in some facilities, waiting rooms occupy nearly one half of usable space). No one needs to clean a room; heat it; or, in the long run, build it. That is the real opportunity of telemedicine. ...I find myself wondering about ways in which telemedicine will be more disruptive. For example, consider the combination of telemedicine with technologies that enable remote monitoring of blood pressure, or blood sugar, or whether medications are being taken on schedule. Or consider telemedicine not just as a method of communicating with members of the American College of Physicians, but also as a way of communicating with nursing professionals, those who know about providing at-home care, various kinds of physical and mental therapists, along with social workers and others. There will be a wave of jobs in being the "telemedicine gatekeeper" who can answer the first wave of questions that most people ask, and then have access to resources for follow-up concerns. My guess is that these kinds of changes will be considerably more disruptive to traditional medical practice than a worldwide cost savings of $5 billion would seem to imply.
On the other hand, payers worry that if they reimburse for telemedicine, then every skin blemish that can be photographed risks turning from something that patients used to ignore into a payable insurance claim. Indeed, it is almost certainly true that if you make it easy to access care by telemedicine, telemedicine will promote too much care. However, the same concern could be reframed this way: An advantage of requiring face-to-face visits is that their inconvenience limits their use. Do we really want to ration care by inconvenience, or do we want to find ways to deliver valuable care as conveniently and inexpensively as possible?
Homage: I ran across a mention of these reports at the always-interesting Marginal Revolution website.
