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Telemedicine's Explosive Growth Rate Belies its Penetration

By John Commins  
   May 18, 2016

Telemedicine has grown tremendously in the past five years in some rural areas. Yet barriers remain, and only a fraction of the population has access.

"Soccer is America's sport of the future," so that old joke goes, "and it always will be."

I am reminded that of that chestnut every four years as I follow the World Cup misfortunes of the U.S. men's team, and whenever the subject turns to telemedicine.

For so many years we've been talking about the potential of telemedicine, how it can improve population health and access and contain costs, particularly in rural America. Still, we've yet to achieve the sort of widespread utilization and population health benefits that many advocates have envisioned.

For example, a new study in JAMA examined claims data and found that telemedicine visits among Medicare beneficiaries increased by 28% each year from 2004 to 2013, and that 107,000 telemedicine visits were provided in 2013.

More than 40,000 rural Medicare beneficiaries received one telemedicine visit that year, with a mean of 2.6 visits each. That's pretty impressive growth.

Still, 107,000 telemedicine visits represent a fraction of 1% of the nation's 55 million or so Medicare beneficiaries.

There is a human face behind each of those 107,000 visits in 2013. The study found that the most likely users of telemedicine services were disabled beneficiaries with mental illness who were generally sicker and poorer than the average Medicare beneficiary.

Related: Forcing the Conversation on Behavioral Health

It also found that that the "vast majority" of these visits were for behavioral health services. The numbers aren't overwhelming, but for many of these vulnerable people telemedicine is a lifeline.

In tribal communities, such as the Fort Peck Indian Reservation in Montana, "initial internal reviews and anecdotal evidence suggest that the physical distance [of psychiatric consultations by videoconference] helps patients open up about difficult experiences more quickly than if they received therapy in-person, potentially speeding up treatment progress," according to the Billings Gazette.

Is the Glass Half Empty?  Or Half Full?

JAMA study lead researcher Ateev Mehrotra, MD, an internist, pediatrician, and associate professor of Medicine and Health Policy at Harvard Medical School, takes the half-empty/half-full approach to telemedicine.

"The glass half full perspective is that after all these years of conversation and interest in telemedicine, we see very steady and fast growth in the number of telemedicine visits that are provided for Medicare beneficiaries, despite all the restrictions and complaints about how the Medicare rules are outdated." Mehrotra says.

"The fact that there have been more than 100,000 of these telemedicine visits provided in the Medicare population is a big number if you compare it to things like bypass operations and other things in the Medicare population. From that perspective it is relatively big numbers."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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