Pros and Cons of Telemedicine

Telemedicine enables real-time, two-way communication between a patient and healthcare provider. It allows patients to speak to a doctor via phone or video to discuss minor health issues that can lead to prescribing medication. Telemedicine is facilitated by video conferencing, smartphone apps, electronic health records, and online management systems.

While still in its infancy, group telehealth benefits have gradually increased over the last decade. According to the Journal of the American Medical Association (JAMA), from 2005 to 2014, benefits grew by 52 percent a year; between 2015 and 2017, that rate increased by 261 percent.

Providers both large and small are starting to adopt telehealth services in an effort to curb the loss of patients to local retail clinics and urgent care centers, which tend to offer lower cost visits and shorter wait times than in a doctor's office. Health insurers also are expanding coverage options. The more prevalent and accessible telemedicine services, the more likely their cost per "visit" is likely to drop. In 2017, a report by the Rural Broadband Association revealed that telehealth services were associated with an average annual cost savings of $20,841 per U.S. hospital. Today, more than half of all U.S. hospitals use telemedicine, and the trend is on the rise.

As the telemedicine industry continues to grow, there are both benefits and challenges to consider.

Benefits
While telemedicine offers a plethora of potential benefits, the biggest hurdle is adoption. Once patients and providers accept the medium as a viable option, the benefits of lower healthcare costs, practice efficiency, quicker access to medical advice, potentially a higher quality of care, and more engaged patients could lead to healthier patients.

Convenience – Telemedicine offers patients simple, on-demand care at their home or office, without the inconvenience of having to go to a doctor's office. This means employees can remain more productive on the job while those who are at home sick needn't endanger their health further by going to a healthcare facility. The convenience is of particular import to people who live in remote locations or are homebound, such as the elderly or disabled.

Expedience – When a patient is unsure if an office visit or urgent care is necessary, a quick telemedicine call can help triage a situation to help the patient get the right type of care at the appropriate facility within the requisite time frame.

Cost Savings – Telemedicine can eliminate unnecessary visits to the emergency room and offers a more cost-efficient means to manage ongoing chronic conditions such as diabetes and cancer. On-demand telemedicine visits generally cost less since they take less time than face-to-face visits.

In addition to savings for patients, telehealth can help boost physician office revenue through the ability to "see" more patients, convert on-call hours into billable time, attract new patients, reduce no-shows, and enable physicians to work from home.

Specialty Access – Telemedicine opens up more access to specialists who often have an excess of patients and must be booked months in advance. Furthermore, telemedicine enables specialists to reach a wider geographic region, which is particularly important for rural populations who must travel great distances to see a specialist.

One area which has proven exceptionally conducive to telemedicine is mental health. Since it does not require a physical exam, ongoing appointments may be conducted via telemedicine visits, enabling mental health providers to see more patients. It is estimated that the US has less than half the number of psychiatric providers needed to meet the needs of 65 million Americans who have a diagnosable mental health illness.

In terms of access, the FCC recently pledged to boost broadband connections in rural areas in an effort to make telemedicine more available to underserved populations.

Engagement – Engagement goes both ways, for both patient and physician. It would be rude for a physician to stare at a clipboard, tablet or computer while talking to a patient via video. In the exam room, it happens all the time. Video conferencing encourages true face-to-face interaction, which can help patients feel more connected to their physician. In turn, providers may need to rely more on reading facial expressions and reactions so they can gauge how well patients are taking in information, detect concerns and if the patient has questions they are hesitant to ask. Many of these clues are missed in the exam room, but teleconferencing behooves a higher degree of face-to-face interaction and eye contact. Perhaps that higher degree of doctor-patient interaction is one reason why a new study shows that telemedicine patients score lower for depression, anxiety, and stress, and have 38 percent fewer hospital admissions.

Care Continuity – In some circumstance, patients may visit a retail clinic or urgent care center that is not connected to his primary care provider for quick or after-hours medical care. While immediate care is a positive, long-term patient care may suffer by a lack of care continuity. In other words, the patient's primary care provider may not have access to records from those other visits and end up with an incomplete history for the patient, resulting in lost information that could provide a higher level of care. By adopting telemedicine for quick and easy, around-the-clock care, primary care physicians may preempt alternatives for better continuity of care.

Follow-up – Telemedicine can make it easy to conduct follow-up visits, which often go unheeded.

Resources – Health systems and physician offices may find that, once a telemedicine program is up and running, they require lower staffing requirements because fewer patient visits are conducted onsite.

Disadvantages

The obvious disadvantage to telemedicine is that it precludes a full physical exam. While some health systems have introduced secure, single-person "kiosks" complete with on-call video calling and medical devices, such as a thermometer and blood pressure cuff, the majority of telehealth calls are conducted via dialogue and visual observation. Clearly, there are a wide number of health conditions that cannot be diagnosed or treated this way, so telemedicine applications are limited. However, beyond the scope of the physical exam, most disadvantages are logistical in nature – which may, in time, be resolved.

Technology Requirements – For telemedicine to become more mainstream, it needs more widespread acceptance and adoption. To do that providers and health systems must invest in secure, reliable technology in which patient privacy is ensured. Depending on the scope of the program, it may require restructuring IT staff responsibilities, purchasing equipment, and training for physicians, practice managers, and other medical staff. Because a broadband connection is required, provider visits can be interrupted by a whole new range of variables, from loss of power to bad weather to outdated software. Some practitioners report smartphones and tablets offer better connections than desktop computers, but the key to creating a successful telemedicine program is investment in the resources needed to provide consistent quality of care.

Coverage – Healthcare laws, reimbursement policies and privacy protection rules are tasked with keeping up with the fast-growing telemedicine industry, much as they are with all technology-based issues. While the commercial health insurance market is increasingly promoting telemedicine among both providers and patients, government-based programs have been slow to jump onboard. In the recent past, telehealth wasn't covered by Medicare and Medicaid in most rural and even some urban areas. That's because in its efforts to reduce fraud, the Centers for Medicaid and Medicare Services preferred that patients receive telehealth treatments at a provider facility, which rather defeats the purpose.

However, in 2019 Medicare is making strides to adopt more telehealth access by relaxing geographic restrictions specifically for dialysis and stroke patients. Furthermore, Medicare offers coverage specifically for virtual consultations that help the provider determine if a patient requires an actual office visit.

HDHP+HSA Glitch – Employers who offer high-deductible health plans (HDHPs) and health savings accounts (HSAs) should be aware of a potential issue that may preclude certain benefits. Those that offer a stand-alone telemedicine benefit, particularly one with a zero or low co-pay, may run afoul of rules associated with contributions to an HSA. IRC Section 223(c)(1) specifically states that an individual with HDHP coverage is eligible to make or receive an HSA contribution only in months during which he is not covered under any other health plan which is not a HDHP – which may include the stand-alone telemedicine benefit. Presently, the IRS is aware of this conflict but has not issued relevant guidance. The general advice to avoid this conflict is for employers to ensure that their telemedicine benefits are part of the employer's HDHP.

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