Telemedicine in America is situated between technology that is advancing at a blistering pace and rules and regulations that were developed in an era of in-person interactions.
Think of how dependent people have become on technology in other areas of life. For example, banking by phone, internet, or with ATMs has transformed how people interact with financial institutions. With telemedicine, however, the rules vary from state to state. It’s analogous to being able to use internet banking in one state but being required to see a teller in person for the same transaction in another state.
Now that technology is readily available to allow people to communicate effectively over distances, people naturally want to put that technology to use if it can make healthcare more convenient or cost-effective. Many physicians want this convenience and cost-effectiveness too, but today there is a patchwork of rules that make telemedicine legally complex, especially when it crosses state lines. Nevertheless, telemedicine is used widely enough that researchers can measure its effectiveness, and what they’re finding is encouraging.
Clinical Outcomes With Telemedicine
The Altarum Institute, a non-profit health systems research and consulting organization just released a report titled “Telemedicine Today: The State of Affairs,” and it offers encouraging news about the effects of telemedicine on clinical outcomes. Telemedicine used in primary care settings for people with chronic illnesses resulted in multiple positive outcomes, including higher patient satisfaction, better disease management, and reduced mortality.
Positive clinical outcomes with telemedicine based on a review of the literature include:
- Improved health outcomes for rural patients
- Clinically significant positive results for smoking cessation
- Better glycemic control for diabetics
- Reduced mortality rates for veterans enrolled in the VA home telehealth program
- Effectiveness of telemedicine in treating minor complaints compared to regular office visits
- Reduction in emergency room visits
- Reduced hospitalization and better quality of life for chronic heart failure (CHF) patients
- Fewer and shorter hospital admissions for people with stroke, CHF, and chronic obstructive pulmonary disease (COPD) patients
- Better management of symptoms for psychiatric patients, including depressed, low-income adults
- Improved access to care and better clinical outcomes for cancer patients
Cost Effectiveness of Telemedicine
One of the most important ways telemedicine has shown its cost-effectiveness is by reducing utilization of office visits, visits to emergency rooms, and hospitalizations for both minor health problems and management of chronic illnesses. When telemedicine visits cost around $50 or less, compared to the cost of an ER visit (which can cost hundreds or thousands of dollars) or even an office visit, the savings are obvious. The VA has found that participants in its 12-month study of the home telehealth program had statistically significant lower costs compared to veterans not enrolled in the program.
Cost savings from telemedicine are also evident when general practitioners are able to communicate remotely with on-call specialists rather than having specialists visit in person. For patients who live in rural areas or areas without specialists, telemedicine has been shown to be a cost-effective way of linking patients with specialists through their general practitioners.
In the study of telemedicine with chronic disease management, one investigation found that COPD patients receiving telemedicine services saved an average of almost $3,000 per year because of reduced office visits, fewer hospital admissions, and shorter hospital stays. Decreased costs were also measured for people managing chronic renal failure and for those with CHF who had access to telemedicine.
The Evolving Regulatory Environment Surrounding Telemedicine
Varying state regulations combined with various approaches to telemedicine reimbursement by private insurers, Medicaid, and Medicare have made for a confusing regulatory environment. For example, except in Alaska and Hawaii, Medicare coverage of telemedicine is currently limited to services furnished to people in rural areas and to synchronous video connections between designated originating and remote sites. In 2013, Medicare reimbursed less than $12 million for telemedicine services. However, Medicare is gradually loosening restrictions on telemedicine reimbursement as cost savings become more evident.
Health Resources and Services Administration (HRSA) chief Mary Wakefield acknowledged some of the barriers to better telemedicine access in a 2013 speech, saying, “Licensure requirements and barriers to cross-state practice should be seen as part of general considerations around the mobility of health professionals in order to address workforce needs and improve access to care.”
Changes are being made, however. The US Department of Defense’s healthcare system now allows credentialed healthcare providers to serve active-duty military members across the country without having to obtain licensure in different states. The 113th Congress introduced legislation to allow VA physicians to serve veterans anywhere in the US, but such a policy has not been enacted yet.
What Will Drive Telemedicine in the Future?
While technological advances will continue to improve telemedicine delivery, it is the legislative environment that must catch up before telemedicine can fulfil its promise of making healthcare delivery more convenient and cost-effective while delivering good outcomes. At the same time, telemedicine’s development is coinciding with major changes in the American healthcare system’s organizational structure. Integrated care models and outcome-based reimbursement are becoming more prominent, and telemedicine has the opportunity to make these care and reimbursement models work better.
Policymakers and legislators will have to balance need for regulation of things like practice standards with the need for further development of telemedicine services and better integration of care. As healthcare costs increase and margins are increasingly squeezed for providers, telemedicine could be a major factor in providers being able to deliver quality care to a population that is growing and aging. Studies of the existing research on telemedicine’s effects on care quality, convenience, and cost have already shown promising results, and regulatory reform should help improve access to telemedicine’s benefits even more.
At eDrugstore.com, we are watching with interest the many developments in the world of telemedicine because we know the value of providing medical services at a distance. For over 15 years, eDrugstore.com has worked with US-licensed pharmacists to dispense and deliver prescription medications to over half a million customers. Like telemedicine experts in general, eDrugstore.com understands the critical importance of secure technology, customer privacy, and utmost attention to service.
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