Original Contribution
On-demand synchronous audio video telemedicine visits are cost effective

https://doi.org/10.1016/j.ajem.2018.08.017Get rights and content

Abstract

Introduction

Claims data raises the possibility that on demand telemedicine programs might increase new utilization, offsetting the cost benefits described in some retrospective analyses.

We prospectively evaluated the cost of a synchronous audio-video on-demand telemedicine taking into account both what patients would have done instead of the telemedicine visit as well as the care patients received after the visit.

Materials and methods

We conducted a prospective observational study of patients who received care from an on-demand telemedicine program. At the time of the visit, we surveyed patients about the alternative care that would have been requested, if they had not done the telemedicine visit. We also obtained information following the visit about what further care was received. Using cost data derived from the literature we performed a sensitivity analysis to determine the cost impact of the on-demand telemedicine visit.

Results

There were 650 patients enrolled with a mean age of 37 who were 68% female; 74% had their care concerns resolved on the telemedicine visit; only 16% would have “done nothing” if they had not done the telemedicine visit, representing possible new utilization. Net cost savings per telemedicine visit was calculated to range from $19–$121 per visit.

Conclusions

In our on-demand telemedicine program, we found the majority of health concerns could be resolved in a single consultation and new utilization was infrequent. Synchronous audio-video telemedicine consults resulted in short-term cost savings by diverting patients from more expensive care settings.

Introduction

Improvements in multimedia technology and expansion of internet access have enabled increased access to online services as well as convenient alternatives to traditional hospital-based or office-based services [1]. Virtual visits are a type of direct-to-consumer telemedicine in which a patient communicates with a provider via audio and video. Telemedicine visits are offered by a number of private and commercial providers and have grown in prevalence with one commercial provider network citing over 17.5 million members and completing over 952,000 virtual visits in 2016 [2]. Further growth may arise from alternative reimbursement policies, as the Bipartisan Budget Act of 2018 significantly broadened payment policy for telehealth [3]. Support for growth of telemedicine visits in particular comes from offering a unique value proposition in that they can both expand access to patients [4,5] while also reducing costs when compared to alternative care settings [6,7]. The acute care setting is a particularly interesting target for the deployment of telemedicine given the potential to serve as a replacement for more costly visit to the emergency department.

Published data regarding cost-savings from use of telemedicine in the acute care setting is limited and not well defined [8]. Recent work, using commercial claims data has found mixed results regarding cost savings [9,10]. Most “literature” discussing cost-savings for on-demand telemedicine is presented simply stating that a telemedicine costs less than the alternative visit (for example, emergency department, urgent care, office visit) and often comes commercial marketing materials [6,11,12].

The objective of this study is to determine the financial impact of a synchronous audio and video on demand telemedicine visit in episodic based cost of care, taking into account both what patients would have done had telemedicine not been available, as well what the patients did following the telemedicine visit. Cost and cost effectiveness is one of the 4 domains included in the National Quality Forum (NQF) telehealth measures framework [13]. No prospective studies have evaluated taking into account the actual alternatives that the patients would have used, had the telemedicine option not be available [13].

Section snippets

Study design

We conducted a prospective observational study of patients who sought care from an academic medical center synchronous audio video on-demand telemedicine program.

Setting & patient population

Jefferson Health launched a pilot program in July 2015 with medical center employees to provide access to an on-demand telemedicine call with an emergency physician. This service was expanded to the general public in September 2015. The platform used, JeffConnect, is available on computer, iOS, and Android devices and provides patients

Results

During the study period, 650 patients completed an on-demand video visit (Table 1). The average age of patients was 37 years old and 68% were female. Age and gender demographics for the two surveys were similar.

Discussion

The net cost savings to the patient or payer per telemedicine visit of $19–$121 represents a meaningful cost savings when compared with the $49 cost of an on-demand visit. The primary source of the generated savings is from avoidance of the emergency department, as this is by far the most expensive of the alternative care options provided. Each visit that successfully diverted an emergency department visit to a telemedicine visit generated, on average, cost savings ranging from $309 to $1,546.

Conclusions

For on-demand care, our results indicate that telemedicine visits represent a short-term cost savings opportunity as they divert patients from more expensive care settings.

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