Reuters Health: Telemedicine surging in US but still uncommon

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“Although telemedicine visits have increased sharply in the U.S. in recent years, the vast majority of American adults still receive care from doctors in person rather than via remote technology, a new study suggests. The goal of telemedicine is to help improve access to specialty care, particularly in rural, underserved areas of the country, researchers note in JAMA. As of 2016, 32 states have passed so-called “parity” laws requiring insurance coverage and reimbursement for telemedicine visits”

I think this is a classic misunderstanding of what Telemedicine actually is by researchers who for a variety of reasons want it to be all about remote Doctor video consultations.

In the real world successful mHealth applications were commonplace in 2009.

TeleMedicine is a Bust because Mobile killed it.

Is fraud the biggest driver of telemedicine revenues.

“To see whether these laws translate to more use of telemedicine, researchers examined private health insurance claims data from 2005 to 2017 from OptumLabs Data Warehouse. Overall, annual telemedicine visits increased from 206 visits in 2005, or less than one per 1,000 people in the study, to more than 202,000 visits in 2017, or more than seven per 1,000. Most of this increase happened over the last few years of the study, with an average annual compound growth rate of 52 percent from 2005 to 2014 and an annual average compound growth rate of 261 percent from 2015 to 2017”

Perhaps this is why the research findings are flawed. We know affluent Patients have been having FaceTime Consults with their Doctors for 6+ years in USA so perhaps Doctors who provide remote video consultations don’t bill insurers for it (or they bill for it as a normal consultation)?

“If the growth rates we are observing continue, in a decade telemedicine will be seen as quite common,” said lead study author Dr. Michael Barnett of the Harvard T. H. Chan School of Public and Brigham and Women’s Hospital in Boston. At this point, telemedicine is still rare. It’s growing most rapidly in areas where a shortage of mental health specialists is prompting more patients to consider this alternative to in-person visits, Barnett said by email”

Telemedicine was already commonplace ten years ago.

In Mental Health we should be asking not what mobiles are doing to our mental health but what they could be doing. 

“During the study period, 53 percent of telemedicine visits were for mental health visits, followed by primary care exams at 39 percent. By the final year of the study, primary care was the most common form of telemedicine”

I think we’re taking a flawed approach if we think it’s possible to categorising visits in this way.

“It does not capture telemedicine visits for which there was not an insurance claim,” Linder said by email. “Patients could have paid out of pocket or, perhaps just as likely, the physician did not think or go to the trouble of submitting an insurance claim.”

I think this sounds about right.

““The limitation is that there is no physical exam and payment options are limited (mostly to fee-for-service),” Portnoy added. “Facilitated visits (which replace in-person visits) are more difficult since there needs to be a facility to do a physical exam and a facilitator where the patient is located.”

On the converse the limitations for the Born Mobile generation are that the idea of “Go and Get Help” doesn’t make sense and for older Patients (and those who care for them) they just want their Doctors to use the same tech they use everyday.

Note: If Patients see you uncomfortable using a mobile they may doubt how current your medical knowledge is…

About David Doherty
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