The Effect of Telehealth on Spending: Thinking Through the Numbers
Authors: Adam M. Licurse, Ateev Mehrotra
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions15 May 2018The Effect of Telehealth on Spending: Thinking Through the NumbersAdam M. Licurse, MD, MHS and Ateev Mehrotra, MDAdam M. Licurse, MD, MHSBrigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (A.M.L.) and Ateev Mehrotra, MDHarvard Medical School, Boston, Massachusetts (A.M.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3070 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Interest is growing in how telehealth, the provision of care through virtual and remote technologies, can improve access to care. Many pieces of legislation have been proposed to expand coverage for telehealth: In 2017 alone, more than 200 bills were pending in 40 state legislatures and Congress. A central question in the debate over these expansions is what effect telehealth will have on health care spending.Media coverage and providers commonly tout reduced spending as one of telehealth's primary benefits (1). Because telehealth may be less expensive than equivalent in-person care, the argument is that substituting it for in-person care ...References1. American Hospital Association. Telehealth: Helping Hospitals Deliver Cost-Effective Care. Washington, DC: American Hospital Association; 2016. Google Scholar2. Housman L, Williams Z, Philip E. Telemedicine. Washington, DC: Congressional Budget Office; 2015. Google Scholar3. Medicare Payment Advisory Commission. Report to the Congress: Medicare and the Health Care Delivery System. Washington, DC: Medicare Payment Advisory Commission; 2016:229-60. Google Scholar4. Ashwood JS, Mehrotra A, Cowling D, Uscher-Pines L. Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Aff (Millwood). 2017;36:485-91. [PMID: 28264950] doi:10.1377/hlthaff.2016.1130 CrossrefMedlineGoogle Scholar5. Elliott AM, McAteer A, Hannaford PC. Revisiting the symptom iceberg in today's primary care: results from a UK population survey. BMC Fam Pract. 2011;12:16. [PMID: 21473756] doi:10.1186/1471-2296-12-16 CrossrefMedlineGoogle Scholar6. Borden WB. Improving care in an accountable care organization: so many choices, so little time. JAMA Cardiol. 2017;2:1023-4. [PMID: 28700775] doi:10.1001/jamacardio.2017.2207 CrossrefMedlineGoogle Scholar7. Trout KE, Rampa S, Wilson FA, Stimpson JP. Legal mapping analysis of state telehealth reimbursement policies. Telemed J E Health. 2017;23:805-14. [PMID: 28430029] doi:10.1089/tmj.2017.0016 CrossrefMedlineGoogle Scholar8. Grabowski DC, O'Malley AJ. Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for medicare. Health Aff (Millwood). 2014;33:244-50. [PMID: 24493767] doi:10.1377/hlthaff.2013.0922 CrossrefMedlineGoogle Scholar9. Comín-Colet J, Enjuanes C, Verdú-Rotellar JM, Linas A, Ruiz-Rodriguez P, González-Robledo G, et al. Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: results of a randomized controlled trial. J Telemed Telecare. 2016;22:282-95. [PMID: 26350543] doi:10.1177/1357633X15600583 CrossrefMedlineGoogle Scholar10. Hicks LL, Boles KE, Hudson ST, Madsen RW, Kling B, Tracy J, et al. Using telemedicine to avoid transfer of rural emergency department patients. J Rural Health. 2001;17:220-8. [PMID: 11765886] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (A.M.L.)Harvard Medical School, Boston, Massachusetts (A.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3070.Corresponding Author: Adam M. Licurse, MD, MHS, Department of Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Licurse: Department of Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115.Dr. Mehrotra: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.Author Contributions: Conception and design: A.M. Licurse, A. Mehrotra.Drafting of the article: A.M. Licurse.Critical revision for important intellectual content: A.M. Licurse, A. Mehrotra.Final approval of the article: A.M. Licurse, A. Mehrotra.Administrative, technical, or logistic support: A.M. Licurse, A. Mehrotra.This article was published at Annals.org on 10 April 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHealth care utilization in Alaska Native people receiving chronic disease specialty care by videoconsultation compared to propensity-matched controlsA Primary Care Telehealth Pilot Program to Improve Access: Associations with Patients' Health Care Utilization and CostsEconomic Considerations for Hospital at Home Programs: Beyond the PandemicBalancing the Tradeoffs Between Office and Video Doctor VisitsThe state of telehealth education at U.S. medical schoolsTelemedicine efficiently improves access to hepatitis C management to achieve HCV elimination in the penitentiary settingComparing telehealth to traditional office visits for patient management in the COVID-19 pandemic: A cross-sectional study in a respiratory assessment clinicTelehealth: Advances in Alternative Payment ModelsQualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical CenterMalathi Srinivasan, MD, Steven Asch, MD, MPH, Stacie Vilendrer, MD, MBA, Samuel Crandall Thomas, MD, MS, Rika Bajra, MD, Linda Barman, MD, MPH, Lauren Michelle Edwards, MD, Heather Filipowicz, MS, Lena Giang, MPH, Olivia Jee, MD, Megan Mahoney, MD, Ian Nelligan, MD, Anuradha Jayant Phadke, MD, Elise Torres, MD, and Maja Artandi, MDPatient–Provider Video Telemedicine Integrated With Clinical Care: Patient ExperiencesMary E. Reed, DrPH, Jie Huang, PhD, Rahul Parikh, MD, Andrea Millman, MA, Dustin W. Ballard, MD, MBE, Irwin Barr, MD, and Craig Wargon, DPMTelehealth Interventions Designed for Women: an Evidence MapHome Telemonitoring In Heart Failure: A Systematic Review And Meta-AnalysisVirtual Visits Partially Replaced In-Person Visits In An ACO-Based Medical Specialty Practice 15 May 2018Volume 168, Issue 10Page: 737-738KeywordsEmergency departmentHealth careHospitalsInpatientsMotivationNursing homesPopulation statisticsQuality adjusted life yearsRashesTelemedicine ePublished: 11 April 2018 Issue Published: 15 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...