The Slow Rise of Telehealth

One of the reasons I wake up early each day is to have (hopefully) around 30 minutes to catch up on the news or some health policy research. Today I hit the snooze button a few too many times, but still managed to sneak in a glance through the December issue of Health Affairs. This month is all about telehealth — the practice of medicine utilizing a range to technologies to connect health professionals to each other and their patients.

One of the articles in this edition reported the first nationally representative evaluation of physician use of telemedicine. It found that in 2016, only 15.4% of physicians worked in practices that utilized telemedicine for interaction with patients, including e-visits and diagnoses from radiologists. In the same year, 11.2% of physicians worked in practices that used telemedicine for communication between physicians and other health professionals. The study breaks the data down to look at telemedicine utilization by specialty, practice type, practice size, and location. The Affordable Care Act only implemented the use of telehealth modalities as part of selected circumstances in the Medicare program.

The Use Of Telemedicine By Physicians: Still The Exception Rather Than The Rule (Health Affairs, December 2018)

This has resulted in varied telehealth implementation on a state by state basis in terms of how providers are reimbursed and for which services. Remember that before the ACA, states were primarily responsible for determined what benefits were covered by private insurance plans offered in their state. Anything not specified by the ACA or otherwise federally mandated is still within the purview of the state–including telehealth coverage by private plans. The research presented in this article found that videoconferencing had the most widespread adoption among physicians, most likely attributable to insurance coverage.

A significant “selling point” of telehealth services is the ability of physicians to diagnose and treat patients remotely, as well as manage patients with chronic conditions. One study in the December edition investigated the impact of electronic consultations for specialty care (dermatology, endocrinology, gastroenterology, and orthopedics) on Medicaid. The researchers found that patients who utilized the eConsult service had, on average, specialty related episode cost-of-care of $82 per patient per month less than those who had a face-to-face visit. The discussion in this article notes that this finding could have an impact across payers, as rates of reimbursement for speciality care continue to climb.

However, in terms of the management of chronic conditions, a systematic review and meta-analysis of home telemonitoring for congestive heart failure did not report favorable health outcomes. The findings indicated that telemonitoring of these patients actually increased all-cause emergency department visits and did not significantly affect heart failure-related hospitalization at 180 days. As the researchers point out, home telemonitoring can improve access to and frequency of care, but there was no evidence that it improves access for disparity populations living with heart failure. This is not to say that other clinical conditions would not show better health outcomes with the utilization of telehealth in general, or home telemonitoring specifically.

There are far too many articles in this edition to discuss here, so I’ll stop and tell you to bookmark it for your winter vacation reading. [And yes, since you asked, I do like to catch up on my health policy research reading on vacation.] Next time you need to go to the doctor, see if your provider offers telemedicine services (and if your insurance company covers it…). I haven’t personally done a videoconference visit with my doctor but I know friends who have–they loved the convenience, flexibility, and immediacy of the option! 

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