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    How telemedicine will change care delivery and costs in 2018

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    Direct-to-consumer (DTC) telemedicine is growing at an ever-expanding rate due to new phone, computer, app technology and patient demand. Now, patients can quickly assess healthcare providers for phone or video visits via their personal devices. For hospitals and providers, the big draw with virtual visits is the potential savings involved in replacing physician office visits and ER visits.

    By delivering care on demand, patients don’t have to delay visits or treatment. In some cases, this can help prevent more serious complications and ultimately cut costs, says Angela Pantelas, director of telehealth strategy and operations at Allegheny Health Network. Under the umbrella of telemedicine, the large healthcare system located in the Pittsburgh metro area offers two types of visits: e-visits and video visits.

    “When we refer to e-visits, we are talking about nonsynchronous electronic encounters with patients. The patient completes a logic-embedded questionnaire specific to a primary care condition he is experiencing, and a provider responds,” says Pantelas. Typically, patients seek treatment via e-visits for sinus issues, urinary issues, and cough, she says.

    There is very limited, if any, reimbursement for e-visits, and patients pay out of pocket. “However, this has not stopped patients from seeking care in this manner, given the low patient cost of $38 per encounter,” says Pantelas. “That’s the market value for this service.”

    Pantelas says reimbursement is more prevalent for video telemedicine visits, for both primary care encounters and specialty consults, and that video visits are significantly on the rise for both primary care and specialty care.

    The health system recently launched an oncology genetic counseling video visit, which connects patients in the northern-most region of Pennsylvania with genetic counselors in Pittsburgh, so patients don’t have to travel two hours for counseling. “We’ve now tripled the number of monthly clinics, and can now offer urgent consults,” says Pantelas.

    High growth expected

    In December 2017, Teladoc, Inc., the world’s largest virtual care delivery services provider, announced record growth of greater than 100% in the hospital and health system market. The company now supports more than 200 hospitals, more than doubling its total in 2017.

    Teladoc provides virtual visits and consults in more than 450 medical subspecialty areas, including those related to chronic medical conditions such as cancer and congestive heart failure.

    “As health systems are realizing that telehealth can help them achieve a wide range of objectives, from care coordination to readmission avoidance and market share expansion, we are seeing a significant increase in telehealth adoption and utilization,” says Alan Roga, MD, president of the provider division for Teladoc. He says solving the business needs with a telehealth solution will continue to fuel future growth.

    Lori Uscher-Pines, senior policy researcher at the RAND Corporation, says when telemedicine first began picking up traction, companies focused on treating patients with minor acute illnesses. However, companies have recently expanded their services and increasingly look like a “one-stop-shop.”

    “They continue to offer services for minor acute illnesses, but have also expanded into teledermatology, telemental health, telelactation, telecontraception, etc,” she says.

    Private payers and employers are increasingly covering telemedicine, but Medicare typically does not provide reimbursement. “Medicare only reimburses for telemedicine when a patient in a rural area presents to a healthcare facility for care [and that patient then receives a telemedicine consult with a physician elsewhere],” says Uscher-Pines. Because DTC telemedicine visits typically occur in a patient’s home, this type of visit is not reimbursed.”

    Next: Cost impact

     

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