UC Davis tracks 18 years of telemedicine and finds benefits beyond the bottom line
Telehealth use is growing but the question of whether the technology reduces costs and improves outcomes remains a point of contention.
Whereas the bulk of such analysis focuses on the bottom line of health plans and employers, researchers at University of California Davis instead are looking on how it impacts patients at a more basic level: transportation costs.
Spanning nearly two decades – and undoubtedly many fluctuations in gas prices and internet connectivity capabilities – the study, which was published in the online journal Value in Health, examines 18 years of UC Davis’s own clinical records from 1996 to 2013, evaluating inpatient and outpatient interactive video visits for 19,246 patients.
Typically, the patient would still visit their primary care doctor, but they would then together consult a UC Davis specialist via video. The cost savings were measured based on patient travel to a telemedicine center near their home versus traveling to UC Davis Health in Sacramento for specialty care.
Collectively, telemedicine visits saved patients nearly nine years of travel time, five million miles and $3 million in costs. Of course, on a more granular, individual level, those numbers are a little more modest: over 20 years, one person could see a cost savings of four hours of driving time, 278 miles and $156 in direct travel costs.
The study was regional, but California is a big state, and many rural areas are underserved not just by medicine but also adequate and reliable public transportation. As such, principal investigator James Marcin pointed out, the very real costs of gas, mileage and time are all measurable savings from telemedicine to patients.
“Our findings confirm the benefits of telemedicine in terms of real savings to patients and to the environment,” Marcin, who is also chief of the UC Davis Division of Pediatric Critical Care Medicine, said in a statement. “Because telemedicine is cheaper and more convenient for patients in remote areas, they are more likely to seek medical care. Many patients do not have the time or resources to access healthcare many miles from home.”
UC Davis has been using telemedicine since 1992, and now offers services spanning more than 30 clinical specialties in over 150 locations, representing 56 out of California’s 58 counties. The technology has advanced over the years, and Marcin expects to see more cost savings to the patient as more affordable, sophisticated tools are developed to allow for telemedicine visits to take place entirely within a location of the patient’s choosing. But there is a benefit to having consultations with the primary care physician present as well, the study noted, as they can receive valuable education from the remote specialist to improve their regular care with the patient.
“I believe that telemedicine not only results in equivalent health care for patients in remote areas but better care, particularly for those with complex medical conditions,” Marcin said in a statement. “Our goal of telemedicine is not to save the health care system money but to improve patient care, and I believe it does this.”
Of course, being the earth science specialty school in the heart of California’s agricultural region, the Davis researchers also measured the environmental impact from all those saved car rides. For the record, telemedicine utilization saved the air almost 2,000 metric tons of carbon dioxide, 50 metric tons of carbon monoxide, 3.7 metric tons of nitrogen oxides and 5.5 metric tons of volatile organic compounds.
While this study clearly looked at more day-to-day impacts from telemedicine and found promising results, others haven’t been as immediately impressed with the technology. A survey conducted by the Rand Corporation and published in the journal Health Affairs called into question the true cost savings of telehealth by suggesting it may actually increase costs from over-utilization.
Many telemedicine vendors and health economists, however, pointed out a few missing key points, such as measuring which specific costs were avoided in favor of telemedicine.