Experts consider telemedicine’s cost questions

Telehealth has been shown to improve quality of care, not least in rural areas where access to clinicians is limited. But does it really reduce costs?

That was among the questions taken up by a panel of experts in a May 15 webinar organized by the Harvard T.H. Chan School of Public Health in Boston in collaboration with The Huffington Post.

“My overall sense is that the opportunity for saving money here is substantial,” said Ashish Jha, MD, a professor at the Chan school. “This is a technology that should replace a lot of the things that we do now. Much of the data suggests that it has been an additive, not necessarily a replacement. That is not to say that it will never save money. To me it means not just that the technology has to get better, although that may be true, but that we also have to identify the processes that let you use the technology in ways that allow you to save money. We are still early in the journey of figuring that out.”

“To that point, historically even within institutions we’ve operated in silos," added Randall Moore, MD, president of soon-to-open Mercy Virtual in Missouri. “Certainly across institutions we’re in silos. And that creates a lot of duplication, replication and inefficiency that in many ways financially we’ve all been rewarded for.”

Technology merely facilitates

As reimbursement shifts from volume-based to value-based, rewarding outcomes for individuals and populations, the rules will change—and for the better, Moore hopes.

“I have been involved in many programs over the years that showed tremendous improvements in outcomes,” he said. “Most of those became pilot projects that never went anywhere. And the reason is, the elephant in the room is, value is being created—but into whose pocket is the value going?”

Moore pointed out that myriad pieces will need to be coordinated if telehealth is to realize its potential to reduce costs while not sacrificing on care quality.

“Technology is only an enabler,” he said. “For every $1 you spend on technology, you’ll spend $5 or $6 putting the people and processes behind it. But the lack of recognition of what's required for a whole solution has really held us up. We put technology in place and it goes into a system that works the way it’s always been incentivized to work. So we need the bright thinking of people who are dedicated to this and focused on it so that we can show the power of what can be done.”

A call for systemwide assessment

Marc Mitchell, MD, founder and president of D-tree International, a Massachusetts nonprofit working to bring mobile care access to developing nations, said the problem in quantifying tele’s savings is the technology’s sheer reach.

“It may be that the cost is going up, or it may be going up for one piece and coming down for another piece,” said Mitchell. “But few people are looking at the whole system and asking what is the net change in total cost to the system. Because certainly in this country there is no system. In most other places there are just a multitude of players, each of whom only has a particular lens on the problem. So some kind of systemwide look at what is changing and how we are going to measure costs in a rigorous way is really needed.”

Maureen McCarthy, MD, acting chief consultant for telehealth services in the VA, noted that wringing value from the technology will require outgrowing the vision of healthcare as a bricks-and-mortar, hospital-based enterprise.

Telehealth “is a technology that crosses all of that,” she said. “We are all caught in some real administrative barriers as a result. Our system as a whole doesn’t want to adapt sometimes because of those barriers—how we measure RVUs or how we capture workload or how we determine a standard visit. I think the connections, the information security and all that we’re used to in our bricks and mortar world, are challenges. But the administrative challenges, I think, are bigger than any others that we face.”

As good as being at the bedside?

Moore added that incorporating telehealth as a go-to component of the U.S. healthcare system will require confronting providers’ perceptions of compromise on quality.

“One pushback that comes [from physicians] is, ‘This can’t be as my good as seeing the patient in person.’ And the answer is, ‘Absolutely right—it can’t be,” said Moore. “But it’s not that the clinic or live care ever goes away; it’s that we can see the heart patient two days earlier via video and give a little extra diuretic and tell the patient to rest and then we check back—and avoid an ICU intubation two days later.

“Was that as good as being there with the patient in the clinic or hospital? No. But what was its effect? Potentially huge. We’ve got to recognize both. Know what people do today and give them new tools and the support they need to use them.”

The hourlong session is posted for viewing in its entirety.