AcuteCare Telemedicine Blog


Telemedicine Finding Support Among the Young and Affluent

According to a new RAND Corporation study, people who are younger, more affluent and do not have established health care relationships are more likely to use a telemedicine program that allows patients to get medical help by talking to a doctor over the telephone. Patients who used the service suffered from a wide assortment of acute medical problems such as respiratory illnesses and skin problems, and researchers found little evidence of misdiagnosis or treatment failure among those who used the service.  The findings, published in the February edition of the journal Health Affairs, are from the first assessment of a telemedicine program offered to a large, diverse group of patients across the United States.

“Telemedicine services such as the one we studied that directly links physicians and patients via telephone or Internet have the potential to expand access to care and lower costs,” said Lori Uscher-Pines, lead author of the study and a policy researcher at RAND, a nonprofit research organization. “However, little is known about how these services are being used and whether they provide good quality care. Our study provides a first step to better understand this growing health care trend.”

Among patients studied, the most common problems treated during a visit were acute respiratory conditions, urinary tract infections and skin problems, which accounted for more than half the cases. Other frequent reasons for were abdominal pain, back and joint problems, viral illnesses, eye problems and ear infections. More than a third of the visits occurred on weekends or holidays. Interest has grown in telemedicine programs because of the shortage of primary care physicians, which will likely worsen as more Americans acquire medical coverage under the Affordable Care Act. Telemedicine is one of the alternatives touted as a way to better provide primary health care without greatly expanding the number of doctors.

The implementation of the Patient Protection and Affordable Care Act is leading to increased demand that physicians interact with more patients, pointing to telemedicine as a potential solution. Most physicians believe that the quality of patient care is not compromised by telemedicine because it is delivered through different channels. Physicians can consult with more patients, and patients can meet with their physicians in a shorter time period. In terms of economic advantages, telemedicine can save a great deal of time for patients who otherwise would have to leave work, and it can reduce ER visits. According to Kenneth McConnochie, M.D., M.P.H., director of the Health-e-Access Telemedicine Program and professor of pediatrics at the University of Rochester Medical Center in Rochester, N.Y., parents with young children consider time and lower expenses to be valuable commodities. By increasing its use of telemedicine, the medical center reported a 22 percent reduction in ER visits among schoolchildren. McConnochie pointed out that the average telemedicine visit costs $75 compared with $750 for a typical ER visit.

“The people who are attracted to this type of telemedicine may be a more technologically savvy group that has less time to obtain medical care through traditional settings,” said Dr. Ateev Mehrotra, a RAND researcher, co-author and an associate professor at the Harvard Medical School. However, researchers caution that more research is necessary to further assess the quality and safety of telemedicine services and to more adequately address concerns that expanded use of this type of telemedicine may lead to fragmentation of care. Still, the general consensus among patients and parents who used the service appeared to indicate that they believed that accessing medical services via telemedicine technology was much more convenient, saving them time and money.  For these consumers the convenience factor dominated over other concerns.



States are Leading the Way on Telemedicine Expansion

The states of Missouri and Kentucky are the two most recent states that are making significant strides in increased implementation and utilization of telemedicine.  Effective Jan. 1, 2014, a Missouri law (House Bill 986) makes private insurers responsible for reimbursing providers offering telehealth services just as these payers are for in-person services.  The bill states that insurers “shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.”  While the new legislation benefits patients with private insurance payers, Missouri law still lacks provision for Medicaid beneficiaries.

In Kentucky, where state laws are in place for private and public payers, the legislators have expanded coverage of telemedicine services for Medicaid beneficiaries so long as these are delivered exclusively by way of interactive video-conferencing. The telehealth services covered by the law are extensive, ranging from mental health evaluations and care management to diabetes and physical therapy consultations.

These most recent events are indicative of individual state legislatures making the most aggressive progress towards removing regulations and passing legislation to accommodate the new technology’s use, while the federal government continues to focus on achieving a last place finish in the race for expansion.

American Telemedicine Association (ATA) CEO Jonathan Linkous said in a public statement recently. “The federal government places unnecessarily strict barriers and restraints on how Medicare patients are served when they deserve access to quality healthcare, regardless of geographic location and technology used.”

Kentucky and Missouri are joining a growing list of states that are realizing the benefit of telemedicine as a cost-effective delivery model for quality healthcare even though the two states have taken different approaches to expand access to telemedicine services. “This is a true win-win scenario,” said Jonathan Linkous, “First, it is a big victory for patients in Kentucky and Missouri, who now have greater access to the best-possible healthcare. It’s also a win for the treasury and taxpayers in those states, who will save significantly on public healthcare costs.”

With healthcare costs rising rapidly and access to specialized care diminishing for many Americans, it is well past a reasonable period of time for the top payer of medical services, the federal healthcare agencies and the U.S. Congress, to pick up the pace on making advances in passing and implementing legislation that will promote the advancement of telemedicine throughout the entire country.