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Why Telemedicine? Patients Save

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In this series we discuss the advantages to telemedicine across clinical settings and medical specialties. These are evidence-based mini-reviews of how and why telemedicine offers advantages to patients, healthcare providers, and communities. This week’s blog post explores how patients save time and money when participating in telemedicine care models.

A primary objective of telemedicine is to increase health care access for those people facing geographical barriers to care engagement. However, on closer inspection, in addition to lowering these barriers the benefits of telemedicine extend beyond increased access to healthcare providers. There are cost, quality of care, clinical outcomes, and patient satisfaction implications to telemedicine as well. The latter, patient satisfaction, is likely to be affected by the increasingly clear savings patents experience when engaging telemedicine programs. A previous blog post regarding our efforts to expand diabetes care briefly touched on these savings. They include distance traveled, time, costs, work participation, and school attendance. Below, we explore some of the published research that is helping paint a clear picture as to the extent to which patients save with telemedicine. 

It is important to appreciate the costs of healthcare travel on already economically challenged communities, in particular rural communities. Multiple studies demonstrate how telemedicine can save patients time and money while simultaneously increasing access to health care. Transportation costs for rural patients are often both under measured and under-appreciated burden to traditional care engagement. However, as Table 1: Telemedicine Distance, Time and Cost Savings Summary demonstrates, studies show the distance, time, and cost saving provided by telemedicine platforms for rural and isolated communities. A study by the Veterans Administration in Vermont found telemedicine visits saved patients 145 miles and 142 minutes per visit, saving their travel reimbursement program an average annual cost saving of over $18,000 per year1. These findings document the potential savings for patients, in particular rural residents and their families, in terms of the costs and times savings associated with avoiding travel to obtain expert medical care or visit hospitalized family members.

Table 1: Telemedicine Distance, Time and Cost Savings Summary

Reference

Population Served

Distance Savings 

(in miles per visit)

Time Savings

(minutes per visit)

Cost Savings (annual)

Russo (2016)2

Rural Vermont, Across disciplines

145

142

$18,555 average/$63,804 final year

Thaker (2013)3

Remote Australia, Oncology

2,089

n/a

$165,737

Dullet(2017)4

California, University-based outpatient clinics

278

245

$443,393

Chu (2015)5

Greater Los Angeles, Urology

277

290

$12,998

Samii (2006)6

Washington State, Parkinson's Patients

621

900

$12,333

 

This data suggests that the majority of rural patients would benefit from the described savings in Table 1. A single study of 410 telemedicine consults in rural Arkansas showed that without telemedicine 94% of participants would have had to travel greater than 70 miles; 84% would have missed a day of work; and 74% would have spent an additional $75-$150.7 These findings appear to be even more significant for patients living alone and in smaller rural communities. These findings are intriguing in that they indicate these benefits are widespread amongst participants in single telemedicine programs. 

The above savings are important in that they show how telemedicine supports patients to lead more productive lives. In addition to saving patient time and money, a study of pediatric Rheumatology patients found that telemedicine equalized travel times to medical visits when comparing urban and rural patients.8 It also showed significant saved time from missing work for parents. Additionally, there was significant save time from missing school for pediatric patients. Remaining productive, continuing to meet obligations, and avoiding absenteeism can be seen as further benefits to the cost saving aspects of telemedicine. 

The patient saving benefits of telemedicine also extend beyond traditional patient-provider engagement and clinic based encounters. Home monitoring of medical devices via telemedicine can provide time, travel, and financial savings. Telemedicine programs to monitor implantable cardiac devices (ICDs) have both reduced the costs per visit by an average of $215 and the number of visits required annually.9 In this study cost savings and the onset of cost saving were higher for patients living farther from the responsible health care facility.  This form of patient monitoring can be seen in annually required procedures as well. For example, diabetic retinal screening, to monitor for diabetes related vision loss, is an annual procedure recommended by experts for all patients with diabetes. This procedure has also demonstrated similar savings when examined for its cost-effectiveness.10  More research and increased adoption of telemedicine approaches to these vital forms of patient monitoring, those outside the traditional patient-provider interaction, will continue to help us understand the beneficial impacts of these and similar interventions. 

The benefits of telemedicine are not restricted to rural populations. The above described savings can support metropolitan populations as well. Patients in the Los Angeles area undergoing preoperative assessment via telemedicine saved on average 63 miles of travel, 137 minutes of travel time, and $67 in direct and opportunity costs. Of the patients involved, 98% reported high levels of satisfaction with the telemedicine visit.11 In these respects, telemedicine has benefits to offer metropolitan communities by mitigating urban related challenges such as congestion, air quality, and traffic requirements. 

Our current understanding of the benefits of telemedicine for patients continues to evolve. One question remains is how often and to what extent do telemedicine encounters lead to or necessitate an in person evaluation, possibly negating said benefits. For example, a single study of a surgical clinic found that 2% of telemedicine encounters required a second in person visit within 90 days.12  Although research has established an appreciation for patients' savings, further understanding of the clinical and social limits to said saving will help us further understand the global picture of telemedicine's impact and how to tailor telemedicine programs to maximize such impacts while being mindful of its limitations. 

The above findings demonstrate how the benefits of telemedicine bridge many specialties and patient populations. It points to more efficient means of health care delivery in which reductions in the geographic barriers to care engagement lead to significant reductions in the financial and time requirements placed on patients.  Knowing this, Beam Healthcare is excited to engage healthcare systems and communities to design and employee telemedicine systems that both increase access to care provision and provide an array of savings for patients.

1Russo, J. E., McCool, R. R., & Davies, L. (2016). VA telemedicine: an analysis of cost and time savings. Telemedicine and e-Health, 22(3), 209-215.

2Russo, J. E., McCool, R. R., & Davies, L. (2016). VA telemedicine: an analysis of cost and time savings. Telemedicine and e-Health, 22(3), 209-215.

3Thaker, D. A., Monypenny, R., Olver, I., & Sabesan, S. (2013). Cost savings from a telemedicine model of care in northern Queensland, Australia. Medical Journal of Australia, 199(6), 414-417.

4Dullet, N. W., Geraghty, E. M., Kaufman, T., Kissee, J. L., King, J., Dharmar, M., ... & Marcin, J. P. (2017). Impact of a university-based outpatient telemedicine program on time savings, travel costs, and environmental pollutants. Value in Health, 20(4), 542-546.

5Chu, S., Boxer, R., Madison, P., Kleinman, L., Skolarus, T., Altman, L., ... & Shelton, J. (2015). Veterans Affairs telemedicine: bringing urologic care to remote clinics. Urology, 86(2), 255-261.

6Samii, A., Ryan-Dykes, P., Tsukuda, R. A., Zink, C., Franks, R., & Nichol, W. P. (2006). Telemedicine for delivery of health care in Parkinson's disease. Journal of telemedicine and telecare, 12(1), 16-18.

7 Bynum, A. B., Irwin, C. A., Cranford, C. O., & Denny, G. S. (2003). The impact of telemedicine on patients' cost savings: some preliminary findings. Telemedicine Journal and e-Health, 9(4), 361-367.

8 Kessler, E. A., Sherman, A. K., & Becker, M. L. (2016). Decreasing patient cost and travel time through pediatric rheumatology telemedicine visits. Pediatric Rheumatology, 14(1), 54

9 Fauchier, L., Sadoul, N., Kouakam, C., Briand, F., Chauvin, M., Babuty, D., & Clementy, J. (2005). Potential cost savings by telemedicine‐assisted long‐term care of implantable cardioverter defibrillator recipients. Pacing and clinical electrophysiology, 28, S255-S259.

10 Lee, J. Y., & Lee, S. W. H. (2018). Telemedicine cost–effectiveness for diabetes management: A systematic review. Diabetes technology & therapeutics, 20(7), 492-500.

11Kamdar, N. V., Huverserian, A., Jalilian, L., Thi, W., Duval, V., Beck, L., ... & Cannesson, M. (2020). Development, implementation, and evaluation of a telemedicine preoperative evaluation initiative at a major academic medical center. Anesthesia and analgesia.

12 Zheng, F., Park, K. W., Thi, W. J., Ro, C. C., Bass, B. L., & Yeh, M. W. (2019). Financial implications of telemedicine visits in an academic endocrine surgery program. Surgery, 165(3), 617-621.