According to Pediatrics® magazine, the official journal of the American Academy of Pediatrics, the availability of telemedicine in child care centers and schools reduces children’s Emergency Department (ED) visits for non-emergency problems, reducing costs to insurance companies and other payers. Supporting the telemedicine/telehealth industry’s contention that investing in remote monitoring results in net cost savings, the report† describes research conducted by the University of Rochester (NY) last spring.
When telemedicine is available in these two types of locations, ED use decreases dramatically for urban children who develop acute illnesses, in turn reducing overall health care costs by helping to keep non-emergency cases away from the emergency room. This finding is based on the experience of Health-e-Access, a telemedicine service that provides pediatric care for acute illnesses through 10 primary care practices in Rochester, New York.
In the University of Rochester study, which was partly supported by a grant from the Agency for Healthcare Research and Quality (HS15165), researchers examined telemedicine, office and ED visits at 22 child care and school sites. When telemedicine was available, children had 22.2% fewer visits to EDs as compared to children in similar locations without telemedicine.
However, researchers also noted that children in telemedicine sites had 23.5% more illness visits overall. With telemedicine seeming to generate more inexpensive office and telemedicine visits and to decrease the number of expensive ED visits, researchers calculated health costs will break even in areas where the ED to telemedicine cost ratio is five to one. In the Rochester community, where the research was conducted, ED costs were found to be seven times the cost of a telemedicine visit. In other urban areas, it can be much higher.
Thus, the study’s findings support reimbursing telemedicine providers for services with an expected financial gain for insurance companies and payers. Pediatrics® described the research project’s methods and results in greater detail:
OBJECTIVE. Health-e-Access, a telemedicine service providing care for acute illnesses in children, has delivered >6500 telemedicine visits from 10 primary care practices in Rochester, New York, by using telemedicine access at 22 child care and school sites. The goal was to assess the hypotheses that children served by Health-e-Access received health care more often for acute illnesses but had fewer emergency department (ED) visits and lower health care expenditures than did children without access through this service.
METHODS. By using insurance claims, this case study compared utilization (starting in May 2001) of telemedicine, office, or ED care for children with versus without telemedicine access. Children included in analyses had six consecutive insurance-covered months through July 2007. Claims data captured all utilization. A total of 19,652 child-months from 1,216 children with telemedicine access were matched with respect to age, gender, socioeconomic status, and season with child-months for children without telemedicine availability.
RESULTS. The mean age at utilization was 6.71 years, with 79% of all child-months being covered by Medicaid managed care. The overall utilization rate was 305.1 visits per 100 child-years. In multivariate analyses with adjustment for potential confounders, overall illness-related utilization rates (in-person or telemedicine visits per 100 child-years) for all sites were 23.5% greater for children with telemedicine access than for control children, but ED utilization was 22.2% less.
CONCLUSION. The Health-e-Access telemedicine model holds potential to reduce health care costs, mostly through replacement of ED visits for non-emergency problems.
†See “Acute illness care patterns change with use of telemedicine,” by Kenneth M. McConnochie, M.D., M.P.H., Nancy E. Wood, B.A., C.C.R.A., Neil E. Herendeen, M.D., and others, in the June 2009 Pediatrics 123(6), pp. e989-e995.
