Telemedicine Utility and Barriers

Telemedicine allows health care professionals working in one location to provide services to patients in a distant geographic area.  Often these may be experts at academic medical centers in subspecialties.  A number of for-profit businesses have been established to help provide overflow or off-hours availability of certain services, such as radiology.  And there are a number of disease management providers that utilize telemedicine.  Telemedicine advocates promote its use as bringing a high level of expertise and quality, particularly to underserved rural and urban areas.  From an economic perspective, telemedicine has the potential to reduce capacity and supply constraints and increase competition, which might lead to lower prices for those who pay for health care.  Telemedicine may also lower input costs for delivering services, as there are certain economies of scale and efficiencies which can be gained by having centralized experts rendering care.

The American Heart Association and the American Stroke Association have recently issued statements encouraging the use of telemedicine to involve neurologists in suspected stroke cases.    (JAMA Abstract, full text requires registration) It is important to identify stroke victims quickly so that appropriate treatment can be started.  The JAMA report on the issue notes that there are significant barriers to use of telemedicine in this and other contexts, including lack of acceptance, Medicare and private payer reimbursement, licensure and liability concerns.  There is also opposition from some physicians, particularly the association representing emergency department physicians.  The latter barrier is likely largely turf protection, which is increasingly common among various physician specialties.

The reimbursement and licensure barriers are notable as representative of government impediments to innovations that often offer both cost and quality improvements.  At a time when there is such widespread concern over improving quality and access and limiting cost increases, telemedicine done properly can be very helpful in addressing those issues.  But the parochial nature of most state licensing, and federal refusal to insist on a solution to that problem, make remote provision of medical services difficult and more expensive.  And Medicare’s reluctance to reimburse such services, except in limited circumstances, further limits their utility.  If Medicare were more accepting, if not encouraging, private payers would likely follow its lead.  Reformers should take special care to address the many barriers that goverment has placed in the way of efforts to improve health care and lower costs.