In The Hastings Center’s 2008 publication, “Health Care Costs and Medical Technology,” Daniel Callahan states that “Health care economists estimate that 40–50% of annual cost increases can be traced to new technologies or the intensified use of old ones. That makes the control of technology the most important factor in bringing costs down.” Callahan illuminates the ethical implications of continuing to develop technologies that only marginally improve a patient’s quality or length of life but exponentially increase the overall cost of care.
While there are numerous examples of technological advancements, which illustrate Callahan’s supposition (MRIs, CT scanners, implantable defibrillators, biologics, DNA precision therapies, etc.), there are other technologies which have significantly improved the delivery of care without significant requirements for capital investment. Examples of these technologies include telehealth and telemedicine.
Definitions describing the nuances between telehealth and telemedicine abound. The U.S. Department of Health and Human Services (HRSA) identifies telehealth’s definition as broader in scope than that of Telemedicine, covering remote healthcare services that are both clinical and non-clinical. The term “Telemedicine,” on the other hand, refers solely to remote clinical services.
Regardless of the definitions, the telehealth industry is here to stay and growing exponentially. According to telehealth statistics and projections from IHS Technology, telehealth spending per year in the United States will rise from just $240 million in 2014 to $2.2 billion in 2018. It is predicted that there will be 7 million telehealth encounters of all types by 2018.
The evolution of telehealth has produced dramatic changes not only in equipment but even more so in pricing. While the telehealth networks requiring T1 lines and telemedicine carts costing upwards of $20K have served their purpose, mobile communication networks and the proliferation of smart devices such as phones and tablets have enabled telehealth to become as easy as downloading a HIPAA compliant app and initiating a live telehealth session between a physician or nurse and a provider or patient in a matter of minutes.
In my experience as both a healthcare provider utilizing telehealth and as a telehealth consultant, inevitably the sixty-four-thousand dollar question is always “Well, who is going to pay for that?”
I understand that an investment in telehealth must produce positive outcomes - both clinical and financial. But the days of requiring a billable code for every telehealth encounter are coming to a screeching halt. By the end of 2018, 50% of CMS payments will be through alternative models (ACOs, Bundles, etc.). Telehealth statistics show that telehealth improves care transitions and coordination between providers and patients, and reduces unnecessary rehospitalizations and ER utilization. Telehealth also increases patient engagement and satisfaction.
There will always be naysayers, but I would suggest that those who have not experienced a positive ROI from telehealth are those that invested the dollars but never took the necessary steps to hardwire telehealth into their care delivery model. That’s like supplying smart phones to your clinical staff but never activating their cellular service.
The use of telehealth is embedded in the care delivery model of Corstrata. Corstrata uses board certified wound care clinicians to increase access to expert wound care across various provider settings. In home health and hospice, the return on investment results from reduction in RN visits due to less frequent dressing changes, enhanced wound care supply formulary, access to a wound certified nurse without the commitment to an expensive FTE, and overall increased risk management. Corstrata uses HIPAA compliant mobile technologies for both photo documentation of the wound and initiation of live video consults.