Patients Like It and Physicians are Interested – Why Isn’t Telehealth Flourishing?

Most people don’t really like going to the doctor. But at least some studies are showing people are more comfortable when the “going to” part of seeing a doctor is taken out of the equation.

Telehealth is defined as the use of medical information exchanged from one location to another via electronic communications to improve a patient’s health.

So how do patients view telehealth? In a recent study of patient experiences following video visits with their primary care physicians, all 19 patients interviewed reported overall satisfaction with the video visits. Most reported being interested in continuing use of video visits as an alternative to in-person visits.

Convenience and decreased costs were the main benefits cited. Some of the patients reported feeling more comfortable with video visits and preferred to receive serious news via video visits, as they could be “in their own supportive environment.”

But are physicians routinely offering telehealth visits to their patients?

In family practice, the answer is no; only 15% of family physicians had used telehealth services during 2014, according to a recent study published in the Journal of the American Board of Family Medicine.

Physician telehealth users differed from nonusers in many ways. They were more likely to be located in a rural setting (26 percent vs. 15 percent), to use an electronic health record (97 percent vs. 92 percent), and to work in a practice with at least 6 family physicians (40 percent vs. 29 percent). In addition, telehealth users were less likely to work in a privately owned practice and to provide general primary care to their patients.

Physician telehealth users were also less likely to report at least one barrier to providing telehealth services in their office than nonusers. Lack of training and reimbursement were the most common barriers identified by both users and nonusers.

“If telehealth services are to have a major impact in the primary care setting, more physicians will need to become experienced in the use of these services,” the authors conclude, noting that many of the barriers to wider adoption “are amenable to policy modifications.”

“One suggestion for overcoming the training barrier is for family medicine residency programs to ensure that graduating residents are offered opportunities to use telehealth services. To address issues of reimbursement, governmental and private payers could engage in outreach efforts to increase awareness of their current allowed payments for telehealth and either expand the types of telehealth services currently eligible for payment or develop new ways to reimburse telehealth services,” the authors say.

The bottom line is that “uptake in the United States has occurred most rapidly where reimbursement is favorable,” according to the authors of recent study in The Annals of Family Medicine. Notably, Medicare reimburses for telehealth specifically in areas where there are health care professional shortages and for specific approved services, the study says.

As far as patient preferences, the study participants “repeatedly cited reduced costs as an important benefit of video visits,” the authors note.

As part of a pilot program evaluated in this study, patients were not required to pay a co-pay for their video visits. “While this likely contributed to participants’ opinions of the cost benefits, patients also noted that they saved transportation costs and were absent from work for less time,” the authors say.

“Further work is needed to identify the full range of patient cost considerations related to telehealth, they state. “Cost issues have important implications for practices and health systems incorporating telehealth into care models, as they are likely to impact patient satisfaction and uptake of virtual services.”

If it is cheaper to the patient, and it provides high-quality care that the patient is satisfied with, why wouldn’t we reimburse for it?