How to reduce spending with telehealth: Is it ‘too convenient’?

Telemedicine has gathered momentum as a solution to improve convenience and access to healthcare. However, a careful parsing of the numbers is still necessary to determine whether telehealth is really reducing spending and providing adequate value, two physicians wrote in an opinion piece published April 10 in the Annals of Internal Medicine.

For one thing, people shouldn’t assume all telehealth visits are substitutes for in-person physician visits. Because of the ease of scheduling telehealth visits, consumers may go that route with a condition they previously would’ve self-diagnosed and handled with over-the-counter medication.

“In previous work, we estimated that for telehealth for low-acuity conditions, such as sinusitis, roughly 90 percent of visits are new use and only 10 percent are substitution, thereby increasing spending,” wrote Adam M. Licurse, MD, MHS, and Ateev Mehrotra, MD—both with Harvard Medical School. “The prime advantage of telehealth—its ability to make care convenient and thus improve access—also may be its Achilles' heel. In some clinical circumstances, telehealth may indeed be ‘too convenient.’”

The authors suggested three ways to ensure that more telehealth visits are actually replacing in-person care: targeting nondiscretionary conditions—things more serious than rashes or sinus infections—that are less ripe for overuse; incentivizing providers to prevent overuse in payment models; and making patients share costs through copayments that are equal or near-equal to in-person visits. If telehealth visits are free or significantly cheaper for the consumer, they’re likely to use the service far more often, the editorialists pointed out.

Another important consideration, according to Licurse and Mehrotra, is whether telehealth can decrease the occurrence of more expensive downstream events. Although upfront costs for telehealth could be higher than no intervention at all, it still could be a valuable treatment if future emergency room visits or hospital admissions are avoided. Nursing home residents and other high-risk populations could be good targets for this approach, the authors wrote.

Finally, they suggested telehealth be evaluated the same way new drugs are—by calculating the dollar amount per quality-adjusted life year gained by the intervention.

“As proponents continue to argue that telehealth will save money, the reality in practice is that spending will decrease only in specific scenarios,” Licurse and Mehrotra wrote. “We believe these situations are determined by the balance between new use and substitutive care, the relative reimbursement versus in-person care, and the likelihood of preventing costly downstream events. Ignoring these factors may mean that telehealth expansion improves access, convenience, and patient experience—but at a price.”