Is Telehealth the New House Call?
In the 1930s, it wasn’t at all uncommon for a sick patient to see their doctor from the comfort of their own home. Back then, about 40% of doctor visits took place in the patient home. By 1950, that number dropped to around 10%. Today, thanks in large part to telehealth technologies, checking in with your doctor from home is once again on the rise.
What is Telehealth?
Telehealth provides support and enhancement of healthcare through the use of digital information and communication technologies. It may include remote clinical services (often referred to as telemedicine), as well as remote patient monitoring, training for healthcare providers, and patient education.
Improved Access through Telehealth
A 2016 Commonwealth Fund study found that just over half of US adults were unable to get evening or weekend medical care without visiting the emergency department. In 2017, another survey found that residents in 15 major metropolitan areas waited nearly a month for an appointment with a new family medicine physician. That problem is likely to get worse. The Association of American Medical Colleges predicts that shortages of primary care physicians (PCP) will increase significantly by 2025. Today, an estimated 64 million Americans live in an area where the total number of primary care physicians can only meet 50% or less of the population’s needs.
Telehealth technologies can help alleviate some of these challenges by giving patients access to physicians that may be outside their usual geographic area. Patients may interact with the physician via video, talk, or text, depending on the service, and appointments can take place at any time of day, every day of the week.
Access to Specialist
Telehealth can be used for more than virtual visits to a PCP, and that’s a good thing. Access to specialists can be even more difficult to schedule, particularly in rural areas where there are roughly 40 specialists for every 10,000 Americans (compared to 134 per 10,000 in urban locales.) An example of this in practice is PSLG portfolio company DermatologistOnCall, which provides an online care delivery platform that connects patients with online dermatologists for skin care diagnoses and treatment plans.
The average cost of an in-person doctor visit is $125. Conversely, telehealth visits average about $45. A 2016 article by the American Council on Science and Health reported that an average of $86.64 is saved every time a patient received care online at UPMC instead of visiting the ER or urgent care. Up to 40% of those patients also indicated that without the option of telehealth visits, they would have skipped care altogether.
Improved Follow-Up Care
Telehealth technologies include wearables and digital health apps that allow patients and doctors to monitor health between visits. This exchange of information can help doctors and patients coordinate long-term care and monitor progress. In addition to having a potentially positive impact on patient adherence, monitoring can also help doctors identify when treatment plans aren’t working so changes can be made.
Lack of Broadband as a Health Issue
Telehealth depends on internet access. Without affordable broadband to support reliable access to the technology, adoption of telehealth will be hampered. Unfortunately, rural communities, which are more likely to face physician shortages (both specialists and primary care), are also less likely to have access to the internet connection speeds required to support the transmission of data for telehealth services.
Policy Needs to Catch Up to Technology
As the American Hospital Association aptly suggests in their most recent fact sheet on telehealth, today’s limited Medicare coverage is impeding the expansion of telehealth services. The current statute limits access to services based on geographic locations, the types of technology that may be used, and the list of services covered.
Telehealth also requires compliance with federal and state regulations. Particularly with variances in laws between each state, providers and insurers may be limited on what services can be provided based on legal and regulatory challenges, ranging from coverage and payment to licensure, credentialing, and privileging, among other factors. If telehealth is going to become a viable, value-based care solution, federal and state hurdles must be addressed.
The Future is Now
Telehealth isn’t necessarily new. Nascent applications stretch back as early as the 1940s when radiology images were sent 24 miles between two Pennsylvania towns via a telephone line. Today’s technology, however, has brought telehealth applications into the mainstream as a viable and necessary healthcare service. While challenges remain to widespread adoption, many hurdles have already been overcome. The introduction of 5G networks and the ongoing evolution of government policy pertaining to telehealth will continue to pave the way to improved access of services.