ANN ARBOR, MI—Although recently the subject of vigorous debate and controversy, telemedicine is expanding rapidly in many states. A new review of research on clinical outcomes and cost effectiveness related to telemedicine shows promising findings for a range of conditions, even as coverage variations and restrictions continue to pose challenges, according to a new report issued by Altarum Institute, “Telemedicine Today: The State of Affairs.”
Overall, the report finds that “telemedicine offers benefits in health outcomes and effectiveness of care,” and some studies show “cost savings as compared to usual care.” For example, in cases where low-cost (under $50) telemedicine visits can substitute for more costly office or emergency room (ER) visits, “there is potential for significant cost reduction.”
The report goes on to note, “Medical interventions using electronic devices and interconnectivity are creatively disrupting the practice of medicine, presenting a need to rethink many of the traditional rules that were developed for in-person interactions, procedures, policies and payments. But because medicine is largely governed by state rules, the changes are creating a patchwork of rules and standards that are difficult to follow for both practitioners and consumers.”
The report covers outcomes from 99 articles, out of an initial search of more than 1,600.
Telemedicine technologies reviewed for the report include phone- and video-based consultations between doctors and patients, remote monitoring of patient status via phone lines, and image-based “store-and-forward” analysis and diagnosis. The review did not include mobile apps and mobile medical apps.
Positive clinical outcomes of telemedicine interventions include better self-management of disease, reduced mortality, and high patient satisfaction. Other examples follow:
- A systematic review of the U.S. Department of Veterans Affairs home telehealth program found reduced mortality among telemedicine participants.
- Research focusing on patients with serious chronic illness such as congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) found that use of telemedicine can help reduce hospital admissions, length of stay, and ER visits.
Telemedicine has additional ancillary positive impacts, including reduced travel time and absence from work, greatly improved access to specialty health care for rural populations, and a narrowing of the “digital divide” among hard-to-reach populations. Decades of research have established that telemedicine expands access to health services for individuals living in remote and rural areas, and new evidence suggests that telemedicine may be “especially appealing” for those “who are infrequent users of health care and to those who are relatively resistant to usual outreach methods and vulnerable to untreated chronic conditions in the long run,” according to the report.
Despite these positive findings, the report notes, “Additional well-designed research is needed to definitively demonstrate the magnitude of cost savings on a per-episode basis compared to in-person care, as well as how large integrated systems, such as managed care plans, can achieve cost efficiencies over time.”
There is significant variation in how telemedicine is reimbursed by private insurers, as well as how it is treated under Medicaid. As of February 2015, 22 states and the District of Columbia have insurance parity laws that mandate comparable coverage and reimbursement for telehealth services in private insurance plans. In general, live video predominates in Medicaid reimbursement, with 10 states now also offering program reimbursement for store-and-forward telemedicine and 13 covering remote monitoring. Alaska, a leader in telemedicine, reimburses for all three and recently approved a law allowing physicians to diagnose and prescribe via telephone and online consultations.
The report highlights the importance of clinical guidelines in shaping the practice of telemedicine, including guidelines on primary and urgent care released by the American Telemedicine Association (ATA) in December 2014. ATA concludes that a range of common acute conditions, such as chronic bronchitis and conjunctivitis, as well as certain chronic illnesses, including CHF and COPD, “may be managed effectively by video-based telemedicine and, as appropriate, other interactive technologies supported by peripheral devices and ancillary tests necessary to establish a diagnosis.”
“Looking ahead, as consumers of varying ages are increasingly exposed to telemedicine, many will find it useful for accessing health care practitioners more readily and for receiving timely information and advice about managing chronic conditions and other challenges,” said lead author Anne Montgomery, project manager at Altarum Institute. “This review suggests that telemedicine is also well-suited for further development of ‘person-centered care’ models, in which informed consumers engage in shared decisionmaking with their doctors based on the best available evidence.”
With interest in telemedicine expansion growing at the state and federal levels, the report’s findings suggest that it may be prudent to balance the need for regulatory development in such areas as practice standards and scopes of practice without impeding the further development of telemedicine services and better-integrated health information technology platforms.