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    How telemedicine will change care delivery and costs in 2018

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    Cost impact

    Lew Levy, MD, chief medical officer for Teladoc, says e-visit growth will continue if such visits prove to deliver better outcomes and value than the status quo. He says e-visits can save approximately $36,000 per expert opinion report (for cancer, heart disease, gastrointestinal disorders, and musculoskeletal).

    “One study reports an average wait time of 24 days to see a doctor,” Levy says. “Virtual care delivery has the power to alter the unnecessary financial and emotional toll of misdiagnoses and medical errors, saving on average $36,000 per case.”

    Uscher-Pines and her colleagues reviewed commercial claims data of more than 300,000 patients and explored patterns of utilization and spending for acute respiratory illnesses. They estimated that 12% of telehealth visits replaced visits to other providers. However, they concluded that the net annual spending for acute respiratory illness increased $45 for each telehealth user because of increased utilization (in other words, they may be receiving care that they would otherwise have skipped due to the increased convenience of a telemedicine visit).  

    Uscher-Pines says that because the new demand for DTC e-visits is being fueled by growing smartphone use, Internet access, and customer demand for convenience, it is unknown just how valuable they are. The technology, i.e., the smartphones, and the ease of using it, is driving the increased growth.  That raises questions about whether these visits really are needed.

    “This is the case with many innovations in healthcare delivery,” says Uscher-Pines. “The research takes time and in the meantime, patients, payers, employers, and policymakers are confronted with real decisions regarding using, covering, and regulating these services”

    Recently, researchers looked at the quality of telemedicine websites and smartphone apps diagnosing and treating skin disease and revealed concerns about the quality of skin disease diagnosis and treatment provided. The researchers, who published their article in JAMA Dermatology, found that some patients may risk using services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination.

    With a huge growth spurt expected in telemedicine, there more oversight and regulation may be necessary.  Uscher-Pines says millions of Americans already are accessing telemedicine for an increasingly diverse set of healthcare needs, so there is an urgent need for more research on how it impacts access, quality, and costs.

    John Schieszer, MA, is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.  He can be reached at [email protected].

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