Telemedicine visits were paid out at an average of $38 — a much lower price tag than the $114 cost of a face-to-face consultation, according to a yearlong study from Humana. Researchers used 2,740 patient pairs that were matched for diagnosis, profession, pharmacy coverage, age, net worth, location and other factors.
The payer used virtual care company Doctor On Demand’s data and found comparable rates of follow-up visits between telemedicine and in-office visits within two weeks. At the same time, telemedicine had slightly higher numbers for physician (6.6%), ER (1.3%) and urgent care referrals (0.9%) compared to in-office for those referrals (5.1%, 1.1% and 0.1%, respectively).
As for prescribing practices, doctors who saw patients remotely prescribed antibiotics at a lower rate (36.1%) than doctors in-office (40.1%).
The study has not yet been peer reviewed, but Doctor On Demand officials are currently working on shepherding it through the publication process.
Virtual care is an area that researchers say holds big promise to help boost access and control healthcare costs. But innovations are ongoing and the evidence is murky on whether it will meet these expectations.
One objection raised by telehealth skeptics is that visits could cost more over the longer term because of the need for excessive follow-up with in person appointments. This study may ease those concerns, with the suggestion of potential for cost savings with similar rates of follow-up visits between telehealth and in-office.
While follow-up referrals were slightly higher for telehealth over a two-week period, during the first two months referrals were lower overall through telemedicine visits (56.4% compared to 60.1% in-office).
Ian Tong, chief medical officer at Doctor On Demand, told Healthcare Dive he was not surprised by the slightly higher initial urgent care referral rates. A telehealth visit by definition cannot offer physical services like a needed diagnostic test.
“If they think a patient has strep, our doctors, who are following evidence-based protocols, are going to send them in for a strep test.” he said: “There are limitations to telemedicine. One is the fact that the doctor and the patient are not in the same place. And so if I need to swab you for the flu, I can’t do that virtually. If I want you to get a strep test, I can’t do that virtually. I need you to go in.”
“I don’t think it’s a clinically significant difference,” Tong concluded.
In 2017, nearly 60% of the nation’s big employers provided medical coverage for telehealth, and the telemedicine market is forecasted to reach $16.8 billion by 2020 — an exponential reach propelled by rising healthcare costs and other barriers to care.
One big potential benefit of virtual care is overcoming these barriers.
A University of Iowa study showed that patients were seen six times more quickly at rural hospitals using telemedicine in their ERs than in those without. Following the rampage of Hurricane Harvey across Texas and Florida, companies like Teladoc and American Well delivered virtual care to thousands of storm victims.
Beyond intensive or urgent care settings, patients seem to like the access, at least according to some industry surveys. Video-based telehealth tripled between 2015 and 2016 and had a stunning satisfaction rate among consumers — 83% were moderately or extremely satisfied, according to a study by America's Health Insurance Plans.
Some reports tout the financial benefits of virtual care as well. By some estimates, the U.S. could save as much as $4.28 billion on healthcare spending per year by implementing increased virtual care measures. The Department of Veterans Affairs, TRICARE and Medicaid have all been making telehealth services more available (and though Medicare is more sluggish, Congress has extended Medicare telehealth care access to people with chronic conditions to go into effect in 2020).
Yet determining telehealth’s return on investment is still a challenge, as several studies have conflicting conclusions. A 2017 Health Affairs study found that although telehealth increased access, it didn't decrease spending — in fact, net annual spending on acute respiratory illness grew by $45 for each telehealth user.
Concern over spending is one of the biggest challenges to telehealth expansion. Major barriers to virtual care adoption according to both providers and consumers are reimbursement (41%) and program costs (40%), according to a 2017 Avizia white paper.
Other roadblocks include state licensure of participating doctors, restrictive and inconsistent state and federal laws, quality measurement and IT capabilities.
A possible path forward for telehealth is symbiosis with in-office care.
“What I see in the future,” Tong said, “is there’s a virtual primary care model or platform that does not replace in-office primary care but complements it. You get patients another tier of care that they can use.”