A growing number of health care providers say that telemedicine is the key to health reform, arguing that the technology can enhance record keeping, reduce waiting times, cut unnecessary hospitalizations and reduce costs.
There also are those who view telemedicine as an expensive, intrusive technology, ostensibly a gimmick promoting exotic health care reform.
U.S. Health Care Spending
As background, the U.S. devotes 16% of its gross domestic product to medical care --- more per capita than any other nation. The total U.S. health care spending in 2009 was $2.5 trillion --- some $650 billion above expected levels. Two-thirds of the "excess" health care spending went toward outpatient care -- the fastest-growing categories being same-day hospital care and physician office visits.
Looking at the issue from another dollar perspective, reportedly 20% of all ailments represent 80% of the health costs. Typically, health care for the elderly and treatment for chronic diseases account for 75% of health care spending. The high costs are attributed to multiple readmissions caused by a fragmented health system focused on acute care.
Readmission costs are staggering. One in five Medicare hospital patients returns to the hospital within 30 days at a cost of $12 billion to $15 billion a year.
Telemedicine Offers Promise
Reportedly, half of the ailments in the U.S. can be treated via technology-driven delivery systems. It has been estimated that health care costs could be reduced by as much as 40% using advanced tele-diagnostic techniques.
Meanwhile, medical services delivered to the workplace electronically, rather than sending sick employees home or to a traditional clinic can realize significant savings. Such services would be most needed where access to doctors' offices is limited because of distance, wait times or cost.
Providing telehealth services in proximity to rural schools means less classroom time missed to travel to health appointments and less work time missed by parents to take their children to health appointments.
Telehealth alternatives have successfully been used for homebound patients over the years. In 2009, the Children's Partnership reported positive results with over a dozen telehealth applications ranging from acute care to diabetes management. The satisfaction rates of patients surveyed were well over 90%.
Interestingly, the elderly were found to be at ease and adapted well to remote monitoring technology. Seniors who rely on remote monitoring technology did not view it as intrusive or impersonal.
Another study by New Courtland Elder Services reported that even seniors with little or no prior exposure to telemedicine can adapt once they realize the improved quality of life it offers.
In an unpublished study at Fairleigh Dickinson University, 78% of health care professionals/providers see telehealth service as an advantage in receiving qualified referrals. Of all respondents, more than 71% feel that telehealth can benefit patients in time-sensitive diagnoses, will provide value to the patients and will help provide health care to those who cannot afford their prescription and/or alternative treatment.
Privacy, Cost and Reimbursement Barriers
Privacy issues continue to haunt telehealth applications. Who has control and/or access to medical records? Just recently, hackers demanded $10 million from the state of Virginia to return millions of patient records they were holding hostage. The hackers were not successful, but it reinforces the need for greater security to ensure privacy when sensitive medical information is being transmitted or stored electronically.
Ultimately, the costs for acquiring, operating and maintaining sophisticated telemedicine technology could be a backbreaker. The start-up investment can be prohibitive for any one institution. The initial hardware costs must be low enough to realize greater economic viability than presently exists in traditional health clinics or mini-clinics. Training and maintenance to effectively use the hardware can also be expensive, and not having the expertise at the patient location compounds the problem.
Reimbursement concerns continue to negatively impact telemedicine. There is proposed legislation to improve reimbursement provisions for telehealth services for both Medicare and other insurance companies. However, for now, a physician will be less inclined to treat a patient using an electronic alternative if the insurance reimbursement is significantly less than a traditional office visit.
Future of Telemedicine
There are some attributes of telemedicine that are indeed unique. The coverage is truly ubiquitous -- anytime, anywhere. Patients in remote areas have access to specialists and services not available in local clinics. Telemedicine provides convenience, quality of care, and timeliness that is cost-attractive compared with alternatives. It has also been observed that telemedicine can dramatically reduce anxiety, knowing that emergency care is available, if needed.
On a futuristic note, what if telehealth services were available in unmanned clinics in publicly accessible locations? It is estimated that the service would cost half of what manned clinics charge, or about the cost of some insurance copayments.
The concept of unmanned clinics sets a new standard in telemedicine for primary health care, offering the convenience of self-service now available at airport check-in counters, store checkouts, gas stations and banks. The predicted spread of unmanned clinics to urban, suburban and rural locations in the near future promises to make health care more affordable for all by concentrating medical personnel resources at certified medical call centers.
How dramatic and intensive a role will telemedicine play in health reform? Arguably, we know that telemedicine is more than a novelty, but it is not the complete or ideal solution for comprehensive health reform. It is a tool that many believe can make a difference. The fact that other countries have successfully institutionalized telemedicine cannot be ignored. The U.S. is far behind in adopting health care technologies.
Ostensibly, there will be significant costs to implement comprehensive telemedicine networks, and there are numerous technical and programmatic constraints that could seriously inhibit the adoption of telemedicine. Telemedicine may not be the total solution, but it is not the problem. Its economic viability has yet to be proven conclusively, but its unrealized potential merits serious consideration in our nation's health reform.