Robotic surgery, gene therapy, and deep brain stimulation are so-called "frontiers" of medicine. Now there's a new frontier--telemedicine. "Research firm IHS Markit estimates that telemedicine visits will soar from 23 million in 2017 to 105 million by 2022" (Associated Press, 2/6/19). By then, one in ten doctors' visits could be via telemedicine. This could be an understatement if practitioners, health systems, and investors keep discovering new ways to expand telemedicine's reach.
Telemedicine's original intent was to provide virtual doctor visits for patients living in remote rural locations. Today, there's an ever-growing list of telemedicine applications: specialty consults, dermatology, urgent care, telepsychiatry, house calls, prenatal and postpartum visits, pathology, radiology, neurology, post-surgery visits...to name a few. Many of telemedicine's more recent applications are for "consumer convenience" and lowering costs, targeting younger generations, working adults, and large retailers.
"Walmart workers can now see a doctor for only $4. The catch? It has to be a virtual visit" (Associated Press, 2/6/19). "The retail giant recently rolled back the $40 price on telemedicine, becoming the latest big company to nudge employees toward a high-tech way to get diagnosed and treated remotely."
Despite the rapid growth of these more recent applications, rural patients remain the biggest beneficiaries of telemedicine, especially when it comes to need rather than convenience. According to the Centers for Disease Control and Prevention, poor access to healthcare services contributes to the high prevalence of poor health in rural populations when compared to those living in urban and less remote settings. With the closing of many small rural hospitals, the demand for telemedicine has continued to grow for this segment of the population.
Telemedicine for the elderly is also in high demand, as more senior care facilities and home healthcare agencies become aware of its benefits. Psychiatrist Terry Rabinowitz of the University of Vermont found that in his study of 278 telepsychiatry visits, "online therapy was cost-effective and a medically acceptable alternative to face-to-face care for nursing-home residents in rural areas" (The Wall Street Journal, 2/7/19). "To be sure, providing online therapy for the elderly comes with challenges. For starters, it takes technical knowledge and time to set up the equipment and connections for a virtual therapy session." Plus, to qualify for Medicare reimbursement, patients must reside in an area designated as rural and must be treated at an "authorized site, such as a nursing-home or physician's office."
Despite the apparent benefits of telemedicine, providers face a few barriers to implementation. Licensing of telemedicine providers is state-specific and, as noted, federal laws determine reimbursement rules, not just for Medicare but also for Medicaid recipients. Practicing telemedicine across state lines is also an issue. Plus, some states require an initial face-to-face visit between doctor and patient before starting any telemedicine visits. And, of course, malpractice insurance carriers also have certain limitations and rules that must be followed to practice telemedicine.