Telemedicine is one initiative we heartily endorse, as it would seem to have great potential to reduce the unit cost for services, ensure maximum use of capacity without regard to geography and to bring scarce medical expertise to rural and other underserved areas. Alas, this potential is often stymied by regulatory and reimbursement policies. An Altarum Institute report examines the state of this health service segment. (Altarum Report) Broadly defined, telemedicine encompasses both patient/provider and provider/provider interactions via any communication vehicle, in real-time or asynchronously. As technology has evolved so has the multiplicity of telemedicine opportunities, although regulation has failed to keep pace. The paper reviews the literature regarding telemedicine, finding that it offered generally improved patient outcomes, in areas like mortality, better self-management of disease and higher patient satisfaction. Almost all studies find the quality of care to be at least equal to that of in-person visits. In addition, there is some evidence that telemedicine can reduce inappropriate or avoidable utilization and reduce costs. The evidence is equivocal in regard to remote monitoring, but for things like physician or other clinical visits, unit cost is fairly clearly lower. And for patients, whose indirect costs are often not considered, the savings in time, transportation expense and other items can be significant.
The biggest problem telemedicine faces is our balkanized system of medical services regulation, primarily at the state level. This frequently prevents medical professionals licensed in one state from delivering services in another, or makes it burdensome and expensive to do so. Much of this regulation is aimed at protecting the turf of home-state professionals. As the research review reflects, there is no basis to regulate in regard to fears of lower quality or worse outcomes. Congress needs to man (and woman) up and pass a law stating that if a medical professional is licensed in one state, they can practice telemedicine anywhere. This would instantaneously greatly expand use of the practice, to the benefit of consumers and payers.