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Telemedicine Helps Patients And Cuts Costs, But Mass. Is Far Behind

University of Miami dermatologist Dr. Anne Burdick checks the computer screen as she discusses telemedicine on April 8, 2014. (J Pat Carter/AP)MoreCloseclosemore
University of Miami dermatologist Dr. Anne Burdick checks the computer screen as she discusses telemedicine on April 8, 2014. (J Pat Carter/AP)

Every so often, there comes a technology with benefits so indisputable that it becomes inevitable. Such is the case with telemedicine, or telehealth — care provided remotely using technology, from Skype to email to apps.

It’s rare for the American Medical Association, American College of Physicians, American Hospital Association and American Health Insurance Plans to agree on anything, but they all support the expansion of telemedicine.

It’s easy to see why. For the most frequent consumers of health care services, the hassle of constantly making and keeping appointments can be prohibitive to living a normal life.

Take the example of Carson Domey, a 13-year-old boy from Bellingham with Crohn’s disease.

With over 60 medical appointments last year, he missed 40 days of school. Long wait times before an appointment can prevent Carson from receiving timely help during a flareup, but telemedicine can offer immediate support.

Carson testified in July to a committee in the Legislature about the difference that expanding telemedicine could make in his life. The bills he spoke in support of have the backing of the Massachusetts Medical Society, patient groups and others.

While there must be a conversation around reimbursement rates, these proposals are immense steps forward for telemedicine and deserve serious consideration.

When picturing telemedicine, you probably imagine a phone call or Skype conversation — that’s known as a live-interactive appointment. But it can also include other approaches:

Store-and-forward, using email or other asynchronous means between a doctor and a patient or another doctor.

• Remote patient monitoring, using devices that periodically transmit measurements to a remote doctor. They can allow post-surgical patients to go home earlier, and improve care for patients with chronic conditions.

• Live-interactive appointments, with Skype or other video calling, have consistently been shown to improve patient satisfaction without sacrificing quality of care or outcomes.

All these approaches would save money and time for doctors and patients, while freeing both from the need to get to where the other is.

As Massachusetts struggles to contain our highest-in-the-nation health care costs, we need to use every available avenue.

The American Telemedicine Association estimates that telemedicine would save roughly $2 billion nationally each year in transportation costs for nursing homes, emergency rooms and correctional facilities alone. Chronic condition care costs could drop by a tenth.

Even though the verdict is in, many states have been slow to adopt telemedicine. Notwithstanding our reputation as a health care leader, Massachusetts is even further behind than most. We are one of only two states that don’t mandate telemedicine access for all Medicaid recipients.

Why so slow? The short answer: Health care is so complex, and the stakes so high, that even if change looks inevitable, as it does with telehealth, the details may be difficult.

In many cases, the private sector is not waiting for the state’s direction. Many insurers and providers are pursuing their own experiments with telemedicine, such as Harvard Pilgrim Health Care’s Doctor on Demand program, which allows patients to seek quick answers to simple medical questions.

Beyond convenience and cost savings, telemedicine also plays a crucial role in ensuring better access to our health care system for rural residents. Waitlists for primary care appointments can stretch over 100 days in Berkshire County.

The list of its benefits goes on. Telemedicine can allow physicians to follow up more easily with mental health and addiction patients. And as the state moves away from "fee-for-service" medicine and toward "accountable care," telemedicine lets doctors reach outside their offices and into the lives of patients to help them foster their own health.

Patients with one or more chronic conditions account for upwards of three-quarters of all health care spending, but telemedicine would help them spend less time in hospitals, pay less for care, and stick to treatment plans. If the health cost curve in Massachusetts is going to be tamed, our efforts should start with the highest-cost population.

Despite the opinions of their national organizations, health insurers and providers are typically hesitant to deviate from the status quo unless there is a meaningful incentive. While it may seem counterintuitive, telemedicine should at first be reimbursed at or near the current rates for in-person services.

Yes, that would undercut one of telemedicine’s biggest selling points — cutting costs — but this approach would ensure that telemedicine becomes integrated into the entire health care system. Once it is established, reimbursement rates should be reduced.

Telemedicine is a toolkit that can save money while improving virtually every part of the health care system. If Massachusetts is serious about controlling its high costs, there is no better next step than to expand its use.

Scott Haller is the Lovett C. Peters fellow in health care at the Pioneer Institute for Public Policy Research.

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