Telemedicine involves the practical application of telecommunication technologies in order to provide healthcare at a distance. Although there were distant precursors, it is primarily an outcome of the advances in telecommunication technologies of the 20th century.
In fact, its origin can be traced back to a Dutch physician, Willem Einthoven, who had been transferring electrocardiograms over a long distance beginning in 1905. The first wave of organized telemedicine programs in the United States began in the late 1950s. This wave has slowly grown over the past 60 years into a number of progressively more sophisticated clinical applications, involving such medicine specialties as radiology, cardiology and surgery.
Over the past 10 years, telemedicine solutions have been adopted by a growing number of employers. A new report from global analytics firm Towers Watson found that a large number of employers – with at least 1,000 employees – will have or will be adopting telemedicine services in the near future. See the findings below:
- 37 percent of survey respondents said they expect to offer services by 2015;
- 34 percent of respondents said they are considering offering such services by 2016 or 2017; and
- 22 percent of respondents currently offer telemedicine consultations
Despite all the technological and information communication advances of the past few decades, most of these employer-based encounters will only be using a telephone to share information. In other words, telemedicine solutions adopted by employers is essentially nothing more than an employee or dependent talking to a doctor on the phone!
Though a growing percentage of these calls will include video stream, video capabilities are more for patient comfort than for enhancing the clinical information gathered by the physician. In fact, in most video-enabled telemedicine consults the physician evaluating the patient will not be able to actually examine the patient remotely to assist in their diagnosis and treatment plan. This is somewhat concerning, unless you do not buy into the direct relationship between a physical exam and diagnosis accuracy.
In addition, these physicians are typically managing only acute, episodic medical complaints and are not influencing the largest portion of the healthcare cost pie, which involves chronic diseases. Neither gaps in care, nor healthcare prevention are a mainstay of these encounters, and thus an enormous opportunity to influence the patient’s overall health and associated healthcare claims is missed.
What is even a bigger issue is that these patients do not end up going to see their family doctor in person and miss an opportunity for their own doctor to identify some of these gaps in care that, if missed, could be very costly in the future.
The real question benefits executives, CFO’s, and consultants should be asking is this:
Are the potential $5-$10 per-employee-per-month (PEPM) savings from adding telemedicine services to the benefit plan being nullified – and even overshadowed – by increased claims associated with misdiagnosis and decreased physician involvement in closing gaps in care and chronic disease care?
Sleight of hand
Physical misdirection is a well-known tool for the magician. He points at an object, a big gesture distracts and spectators fixate on a suddenly appearing dove. All are designed to distract from another movement that is vital for the trick.
Psychological misdirection is much more subtle. A good example is the false solution. This is where the magician leads spectators to believe they’ve worked out how the trick is done. Once this ‘solution’ is suggested people are much less likely to notice the clues that crop up as to how it’s really done.
I am not suggesting that the current telemedicine solution for employers is just a magic trick. Nor am I discounting the convenience and popularity of this service to the member population. However, without seeing the whole picture, any of us can be fooled into believing in something.