THE TELEHEALTH PROMISE
High-speed Internet connections and innovative health care applications are improving…even saving…lives. The following is a Q&A with telemedicine expert Dr. Alexander H. Vo from the AT&T Center for Telehealth Research and Policy at the University of Texas Medical Branch, Galveston, TX.
Dr. Vo discusses his new study, The Teleheath Promise: Better Health care and Cost Savings for the 21st Century
Q: Can telemedicine really save health care cost?
Dr. Vo: The growing cost of medical care and gaps in coverage are creating enormous pressure on both providers and public policymakers to identify new strategies for delivering cost-effective and quality care to all citizens. Many health care experts believe that part of the answer lies with telehealth applications made possible by the increasing power of information technology and the spread of broadband connectivity. Indeed, we believe widespread implementation of telehealth could save the U.S. health care system $4.28 billion just from reducing transfers of patients from one location, such as a nursing home, for medical exams at hospitals, physicians’ offices, or other caregiver locations. When appropriate diagnosis and care can be provided remotely via telemedicine, a patient transfer creates unnecessary cost as well as hardship for the patient.
Q: Rural areas in Texas are having trouble finding enough doctors and proper health care. How can rural Texans benefit from telemedicine?
Dr. Vo: Preliminary data from small telehealth initiatives have yielded promising results. The ability to transmit medical images and data in real time and to simultaneously link care providers for direct consultation means care can be provided with little regard for geography. With telemedicine, physicians at remote hospitals can link to distant specialists for real-time guidance in emergency situations to save lives without the delay of long ambulance rides while a patient’s condition deteriorates. Difficult transfers of patients to doctors’ offices from nursing homes, between emergency rooms, or from institutions such as prisons to medical care providers can be substantially reduced by resorting to online communications. Expectant mothers living long distances from medical care providers can receive quality prenatal care through online consultations and remote monitoring. Individuals with chronic illnesses or those recently released from hospital care can take advantage of remote monitoring programs to go about their daily routine with confidence that they can be followed by their providers.
Q: Health care seems to be getting more and more expensive every year, how will telemedicine save Texans money?
Dr. Vo: Based on our study, instituting telehealth technologies on a national basis will require substantial infrastructure investment and benefits would not exceed costs until the fourth year of implementation. By year six, the cost-benefit ratio would reach steady state and achieve a peak level of net savings that continue year after year. The steady state savings follow:
o A 38% reduction in transfer from one hospital emergency department to the emergency room at a second hospital for a cost savings of $537 million annually.
o A 79% cut in transfers from correctional facilities to physicians’ offices and a 42% reduction in transfers to emergency rooms would generate a combined cost savings of $270.3 million a year.
o A 14% cut in transfers from nursing homes to emergency rooms for a cost savings of $327 million a year.
o A 68% cut in transfers form nursing homes to physicians’ offices for a cost savings of $479 million.
o A $3.61 billion savings as a result of physician-to-physician consults, primarily from a 45% reduction in unnecessary or redundant tests.
Q: With the current Internet system, what are the challenges ahead if telemedicine can work for every Texans in the near future?
Dr. Vo: The current economics of telehealth may reduce the incentive for its adoption by caregivers. While society and individual patients benefit from more cost-efficient care, providers of care worry that their revenues may decline in a telehealth environment. Providers must bear the cost of required infrastructure investments, but current insurance reimbursement policies tend to favor traditional medicine, including face to- face consultations, and may not adequately compensate them for telehealth services. Maximizing telehealth’s potential also requires intelligent broadband networks to provide secure transmission over the public Internet in a way that minimizes the latency risks that can ruin images or disrupt real-time communications. Providers and health care institutions may be able to take advantage of recent FCC grants to expand public data networks as well as provide connectivity for rural areas.
Q: So much of the medical needs required by those that are sick can be done on an out-patient basis. How can telemedicine help with these out-patient cases?
Dr. Vo: In the outpatient setting, numerous studies show that patients can receive specialty care through store and- forward technologies or videoconferencing that eliminate the need for a separate visit to a referred specialist. A series of reports from the United Kingdom has shown that fewer tests and procedures are ordered at a teleconsult than at an in-person visit, most likely because of the early involvement of the specialist and their ability to order targeted testing for their patient’s condition. In addition, in a teleconsult, specialists have access to test results ordered by the primary care provider that are frequently unavailable at the time of an in-person specialty consultation.
Q: Are there any current barriers to implementing telemedicine in Texas and the United States?
Dr. Vo: A report by the U.S. Commerce Department’s Office of Technology Policy observed that telehealth does not easily fit with today’s economic model in which most health care is paid by a third party (a private insurer or a government program) rather than by the patient. While an individual would have no difficulty in recognizing a telehealth intervention as cost-effective, a third party payor usually reimburses on the basis of pre-set rules. Traditionally, third party payments have been based on patient “visits” in the same location as the caregiver and also for certain services, such as an X-ray, in which the patient visits a facility. Telehealth does not fit within those rules and third party payors are adjusting their definitions at a varying pace. Caregivers must bear the upfront costs of moving towards telemedicine. Unless they are assured of payment for such services, caregivers will not have an economic incentive to embrace telemedicine. Additionally, with the shortage of providers in many areas, it would be extremely beneficial if the current licensing restrictions on providers providing telemedicine services across state lines were amended. Members of the European Union have not had to deal with these restrictions and it would certainly benefit U.S. providers as well as patients if these restrictions were removed.
