December Issue Devoted to Telehealth

Several authors of articles appearing in the Health Affairs December Issue dedicated to Telehealth, spoke at the National Press Club recently to present their ideas and thoughts on the extensive reach of telehealth to continually provide better healthcare to populated but also rural communities.

Opening the event, Alan Weil, Editor-in-Chief, for Health Affairs said, “He realizes how complex the topic telehealth is and how clinics, patients, quality, and utilization play an important role in delivering telehealth today.”

Carol Kane, Director Division of Economic and Health Policy Research and Kurt Gillis at the AMA in the new study “The Use of Telemedicine by Physicians: Still the Exception Rather than the Rule”, found that physician practices use of telemedicine varies by specialty and practice size. The study authors suggest that despite regulatory and legislative efforts to encourage the use of telemedicine, the financial burden of implementing it may be a barrier for small practices.

“It has been shown that the use of teledentistry can reduce costs and improve access to pediatric dental care”, according to Dorota Kopycha-Kedzierawski, Associate Professor, Eastman Institute for Oral Health University of Rochester plus co-authors in their study related to advancing teledentistry.

The authors assessed the teledentistry program at the Eastman Institute for Oral Health and found that synchronous and asynchronous teledentistry can help reduce the costs and barriers to accessing oral healthcare, improve oral health outcomes, increase the use of oral healthcare resources, and lead to the establishment of a dental home for underserved children.

Addressing neonatal telehealth and how it can reduce hospital transfers and at the same time, save money, Jordan Albritton of Intermountain Healthcare plus co-authors of the study “The Effect of a Newborn Telehealth Program on Transfers Avoided, A Multiple Baseline Study” examined a newborn telehealth program implemented at eight Intermountain Healthcare community hospitals in 2014-2015.

The study shows that video-assisted resuscitation was associated with a reduction of 0.70 transfers per facility a month and a 29.4 percent reduction in a newborn’s odds of being transferred. This resulted in fewer transfers and an estimated cost savings of $1.2 million per year. However, the authors report that there is a lack of reimbursement for telehealth services which limits widespread implementation.

Sachin Shah, Assistant Professor of Medicine, University of California, San Francisco and co-authors found that after examining data on more than 35,000 patients at an ACO-based medical specialty practice in Massachusetts in 2014-2017, the researchers concluded that virtual visits only replaced in-person doctor visits about a third of the time.

In addition, the researchers found that patients saw their doctors in person significantly less in the first three months after enrolling in the virtual visit program, after one year. Patients using virtual visits saw their doctors in person just as frequently as patients that did not enroll in the program. Therefore, while virtual visits may be a viable tool for ACOs seeking alternatives to traditional high cost specialty care, more work is needed to determine how virtual visits can substitute for in-person care in the long term.

Lori Uscher-Pines, Senior Policy Researcher, RAND Corporation discussing the paper “How is Telemedicine Being Used in Opioid and Other Substance Use Disorder Treatment?” pointed out that only a small proportion of people with a Substance Use Disorders (SUD) receive treatment since there is a shortage of SUD treatment providers particularly in rural areas.

The study points out that while telemedicine addressing SUDs does exist, the study identified the characteristics of tele-SUD users and examined how tele-SUD is being used along with in- person SUD care. Although it has been shown that the use of telemedicine could expand treatment options, several key regulatory and reimbursement barriers are preventing greater use of telemedicine by individuals with SUDs.

Health Affairs appreciates Joseph Kvedar, Vice President for Connected Health at Partners HealthCare for serving as theme advisor and Mitchell Krebs, Director, for the Rural Healthcare Program at the Leona M. and Harry B. Helmsley Charitable Trust for supporting the December 2018 issue.

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