Authored by Mariana Savastano
Art by Sabrina Chen
As medical professionals were catapulted into using remote medical services during the COVID-19 pandemic in 2020, the U.S. healthcare system has been propelled into exploring this technology’s potential in expanding the accessibility of care. The utilization surge of Telehealth in 2020 reflects an emerging trend of employing remote systems to connect patients to clinical care and increasing acceptance of virtual care methods [1]. While Telehealth poses the potential to reshape the landscape of medical care and enhance accessibility, it still warrants careful analysis to determine its readiness for widespread integration into our medical infrastructure.
Telemedicine offers an alternate form of in-person medical care provision, providing potential cost-saving strategies for healthcare spending. Between March and May of 2020, there was a 56% decline in in-person visits and a 2-fold increase in visits via telephone or video, suggesting that Telehealth holds the potential to work in unison or in place of certain in-person visits [2]. While complete substitution of in-person care is unrealistic, Telehealth can be a viable substitute to consultations, specialty visits, and even emergency cases while promoting significant savings through productivity gains, reductions in secondary care, and telemonitoring [3].
Virtual care, substituting for primary care, behavioral health visits, and specialty consultations, significantly cuts costs, reducing the need for in-person secondary care. Virtual visits mitigate accessibility barriers from transportation means or time constraints, lowering no-show rates. Savings on transportation costs improve access to primary care, particularly for patients in underserved rural areas with limited access to facilities [4]. Overcoming such constraints reduces missed appointments, promotes use of preventative care, and can prevent the escalation of health issues and associated expenses. The virtual primary care model redirects patients away from unnecessary costs of procedures, tests, or specialist follow-ups that stem from fee-for-service payment incentives [5]. Shifting to a virtual model for primary care may reduce patient costs, realigning patient and physician incentives towards prioritizing preventative care and avoiding unnecessary future healthcare expenditures [3].
Telehealth further boosts productivity in the delivery of treatment, offering cost-saving potential, and enabling physicians to expand patient capacity. Substituting in-person visits demanded the development of an effective agenda for virtual visit models, benefiting both patients and physicians. Shorter consultations increase patient flexibility, reduce lost labor time, and lower visit expenses due to less time billed. Reduced consultation time also increases the number of patients physicians are capable of overseeing. Increased patient capacity and fewer missed appointments result in lower marginal costs per patient, reducing monetary losses and the opportunity cost of a no-show [3]. A virtual consultation model also provides specialists or physicians more time to review clinical notes, maximizing productivity and the value of healthcare spending for both patients and healthcare providers.
Finally, cost reductions may come from implementing telemonitoring to remotely monitor vitals and medication adherence, preventing costly follow-up visits and boosting patient satisfaction. Periodic remote check-ins allow specialists to intervene and adjust treatments, reducing hospitalizations, where patients would incur large costs from stay and travel, and improve a hospital’s capacity to treat more patients [4]. Patient engagement in remote monitoring reduces follow-up visits associated with long wait times and extended undesirable stay periods in hospitals [3]. Telemonitoring’s convenience ultimately enhances the patient experience and addresses financial challenges that come with in-person monitoring and visits, offering a cost-effective strategy that maximizes care quality, hospital capacity, and attitudes toward virtual care.
So why hasn’t Telehealth been fully integrated into our healthcare system if it inherently promotes and simplifies access to preventative care? Ultimately, security and infrastructural limitations, particularly privacy concerns and vulnerability to data breaches, remain a critical obstacle [6]. Telehealth must comply with HIPAA confidentiality rules; however, the exchange of patient information online increases the risks of a third party intercepting confidential data. Addressing these security concerns is paramount to establishing Telehealth as a secure option for the future of healthcare, yet introduces ongoing costs for developing anti-hacking hardware and software that may offset the cost-benefits of virtual care [7]. Patients accustomed to traditional care models may also struggle to trust and build relationships through virtual care, posing another challenge in Telehealth’s implementation.
In addition, infrastructural limitations counteract the accessibility goal of Telehealth. Creating patient portals run clinics significant administrative costs that may have insufficient justification [8]. Furthermore, training physicians to use virtual care incurs its own set of opportunity costs of lost labor. Patients living in underserved rural areas may encounter connectivity issues or limited access to host devices for virtual care, reflecting a reach issue Telehealth must find a way to combat [4]. Efficient investments towards overcoming infrastructural and security challenges become imperative if we hope to achieve broader adoption of Telehealth.
Telehealth has promising potential for integration into our healthcare system, given its rapid adoption and evolving patient acceptance in the post-pandemic era. While Telehealth offers productivity gains and reduces healthcare costs, higher administrative and software development costs to support growing demands may offset these benefits, complicating the cost-effectiveness analysis. Due to the novelty of Telehealth’s use on a larger scale, there is insufficient data to generate long-term evaluation studies of its cost-effectiveness. Nonetheless, Telehealth is on the brink of universal integration into our methods of medical care, provided policymakers see its value and allocate sufficient funds to improve and support its adoption.
References
Staff, N., & Center, C. T. R. (2023, August 30). Home. National Consortium of Telehealth Resource Centers. https://telehealthresourcecenter.org/
NCQA. (2020, September 15). Taskforce on Telehealth Policy findings and recommendations – telehealth effect on total cost of care. NCQA. https://www.ncqa.org/programs/data-and-information-technology/telehealth/taskforce-on-telehealth-policy/taskforce-on-telehealth-policy-findings-and-recommendations-telehealth-effect-on-total-cost-of-care/.
Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10). https://doi.org/10.2196/17298
Bestsennyy, O., Gilbert, G., Harris, A., & Rost, J. (2021, July 9). Telehealth: A quarter-trillion-dollar post-covid-19 reality?. McKinsey & Company. https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
Centers for Disease Control and Prevention. (2022, September 8). Telehealth in rural communities. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/telehealth-in-rural-communities.htm
Cascella, L. M. (2022). Risk management tools & resources. Risk Perspectives in Telehealth: Privacy and Security | MedPro Group.
Tanikawa, T. (2019, December 5). Where does telemedicine achieve a cost reduction effect? cost ... Mary Ann Libert Publishers. https://www.liebertpub.com/doi/10.1089/tmj.2018.0244
Houser, S. H. (2023). Privacy and Security Risk Factors Related to Telehealth Services – A Systematic Review. National Library of Medicine. https://doi.org/PMC9860467