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Telehealth: Cost Saver or Cost Driver?

Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls this cost savings into question. Increased convenience can increase utilization, which may improve access, but not reduce costs.

The study has some obvious limitations. First of all, it followed patients who used one particular telehealth service for one specific cluster of disease (“respiratory illness”) and narrowed the cost measure to spending on that condition only. Strep throat, coughs, and sinusitis are not drivers of potentially expensive care to begin with, so major cost savings (by avoiding the ER or hospitalization) would not be expected with the use of telehealth services for most of these concerns.

Secondly, the patients whose data were scrutinized had commercial insurance (i.e. a generally healthier and younger population than Medicare beneficiaries, for example), and it is possible that the use of telehealth would differ among people with government insurance, high-deductible plans or no insurance at all.

Thirdly, the study did not look at different ways that virtual doctor visits are currently being incorporated into healthcare delivery systems. For example, I was part of a direct primary care practice in Virginia (DocTalker Family Medicine) that offered virtual visits for those patients who had previously been examined in-person by their physician. The familiarity significantly reduced liability concerns and the tendency for over-testing. Since the doctor on the other side of the phone or video knew the patient, the differential diagnosis shrank dramatically, allowing for personalized real-time treatment options.

I’ve also been answering questions for eDocAmerica for over 10 years. This service offers employers a very low cost “per member per month” rate to provide access to board-certified physicians who answer patient questions 24/7 via email. eDocs do not treat patients (no ordering of tests or writing prescriptions), but can provide sound suggestions for next steps, second opinions, clarifying guidance on test results, and identify “red flag” symptoms that likely require urgent attention.

For telehealth applications outside the direct influence of health insurance (such as DocTalker and eDocAmerica), cost savings are being reaped directly by patients and employers. The average DocTalker patient saves thousands a year on health insurance premiums (purchasing high deductible, catastrophic plans) and using health savings account (HSA) funds for their primary care needs. They might spend $300/year on office or virtual visits and low-cost lab and radiology testing (pre-negotiated by DocTalker with local vendors). As for eDocAmerica, employers pay less than a dollar per month for their employees to have unlimited access to physician-driven information.

The universe of telehealth applications is larger than we think (including mobile health, remote patient monitoring, and asynchronous data sharing), and already extends outside of the traditional commercial health insurance model. Technology and market demand are fueling a revolution in how we access outpatient healthcare (which represents ~40% of total healthcare costs), making it more convenient and affordable. As these solutions become more commonplace, I have hope that we can indeed dramatically reduce costs and improve access to basic care.

Keeping people well and out of the hospital should be healthcare’s prime directive. When those efforts fail, safety net strategies are necessary to protect patients from devastating costs. How best to provide that medical safety net is one of the greatest dilemmas of our time. For now, we may have to settle for solving the “lower hanging fruit” of outpatient medicine, beginning with expanding innovative uses of telehealth services.

Message To The IRS: “Leave Medicine To The Experts”

I saw this via a friend’s Facebook post:

Really, IRS?

Believe it or not, the folks at the IRS think they know more about breastfeeding than doctors and medical researchers.

According to an article in the New York Times, the Internal Revenue Service has determined that breastfeeding “does not have enough health benefits to qualify as a form of medical care.”  Therefore, women cannot count expenses for breastfeeding supplies in their tax-sheltered healthcare spending accounts.

In doing so, the IRS has ignored the guidance of experts at the Department of Health & Human Services and World Health Organization who are actively promoting breastfeeding because of its significant health benefits for mothers and children.

Sign our petition reminding the IRS to leave medicine to the experts!

Oh get real, people!

First of all, you will never — by which I mean not EVER — find someone more supportive of breastfeeding than I am. I nursed my last kid for two whole years, and the only reason I gave up the first time was because there were two of them (kids, that is). So don’t go trying to lump me in with those terrible, mean, unsupportive doctors who are sucking at the teat (pardon the choice of idiom) of the amoral, soulless baby formula manufacturers.

The IRS may have worded the decision poorly, but they are not making medical decisions. They’re not even expressing a medical opinion. They are drawing a line that needs to be drawn between what constitutes “medical care” and “being healthy.” Read more »

*This blog post was originally published at Musings of a Dinosaur*

Real Reform In Healthcare

“We want our employees to spend their time on real issues,” said Charlie Salter, VP of Benefits at ConAgra. He means it. Charlie and ConAgra have built their healthcare benefits around some simple concepts that are yielding impressive results. How impressive? Close to flat healthcare cost trend since 2007.

Charlie’s work is part of a growing trend among America’s most innovative companies: Designing healthcare benefits in ways that have a real impact on quality and cost. It’s why I [recently] asked Charlie to share the podium with me in Boca Raton. ConAgra is showing it’s possible to control healthcare costs by helping people do the right thing.

The vision behind ConAgra’s programs is simple: Employees have to be responsible for managing their own care. But, says Charlie, this is easy to say, harder to do. “So we do as much as we can to make it as easy for people to do the right thing.” ConAgra gives its employees a significant financial stake in their well-being, through a health plan that has a $1,500 deductible. ConAgra supplements the plan with a health savings account (HSA) that lets workers use pre-tax dollars to pay for the deductible. Like other HSAs, any money the employee doesn’t spend is theirs to keep. It means employees are more engaged in healthcare decisions. Read more »

*This blog post was originally published at See First Blog*

Healthcare Reform: What We Should Learn From Massachusetts And Indiana

Obamacare is fashioned after the Massachusetts healthcare reform plan. It leaves the administrative services in the hands of the healthcare insurance industry.

Indiana empowers consumers to control their healthcare dollars.

Therein lies the difference between ineffective and effective healthcare reform.

President Obama has even given the State of Massachusetts $8 billion dollars in bailout money to support the failed healthcare reform plan. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Pay More, Get Less – The Certain Future Of Healthcare

Even with healthcare reform, Americans will increasingly be burdened with high deductibles, more financial responsibility, and less satisfaction with their health insurance for the foreseeable future. Why? Because the healthcare system is unable to transform its services in a manner that other industries have done to improve quality and service while decreasing costs. The two biggest culprits are the mentality of healthcare providers and the fee for service reimbursement system.

Doctors and patients haven’t altered the way they communicate over the past hundred years. Except for the invention of the telephone, an office visit is unchanged. A doctor and patient converse as the physician scribbles notes in a paper chart. Despite the innovations of cell phones, laptop computers, and other time saving devices, patients still get care through face to face contact even though banking, travel, and business collaboration can be done via the internet, webcams, and sharing of documentation. As Dr. Pauline Chen noted in a recent article, doctors are not willing to use technology to collaborate and to deliver medical care better, more quickly and efficiently. Mostly it is due to culture resistant to change. Partly it is due to lack of reimbursement. Both are unlikely to be addressed or fixed anytime soon. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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