Change is hard, but COVID-19 doesn’t care. Significant changes in the organization and practices of major institutions typically require years and even decades. Prior to the COVID-19 outbreak, telemedicine was available but adoption was slow. Mental health services and opioid addiction treatment via telemedicine were often cited as examples of appropriate special cases. Conventional wisdom among professionals in healthcare administration fields, however, according to researchers from the Stanford Institute for Economic Policy Research (SIEPR), was that telemedicine cost too much and resulted in lower-quality care than traditional in-person meetings with physicians and patients. But when the pandemic lockdowns hit, overwhelmed medical facilities prompted telemedicine adoption on a much broader scale.
The Stanford researchers published a working paper that dispels the myths of telemedicine cost and quality of care. The Impact of Increased Access to Telemedicine report suggests that telemedicine neither raises costs nor compromises care quality. The study analyzed 12 million remote and in-person primary care evaluations and 30-day follow-up care in Israel from January 2019 to June 2020. The data included 10.4 million visits prior to a nationwide lockdown and 560,000 initial primary care visits after the lockdown.
Prior to the lockdown, only 5% of primary care visits were by phone or video. After the lockdown, the incidence of telemedical primary care visits quickly rose to 40% of all visits. The research data analysis included costs of lab tests, prescriptions, referrals to specialists, and other treatments.
The data showed that, while primary care visits rose by 3.5% as telemedicine access increased, the 30-day follow-up costs dropped 5%. Doctors of patients who had telemedicine care visits prescribed 5% fewer medications, 4.5% fewer referrals to specialists, and 9.5% fewer referrals to radiology. It is interesting to note that referrals for lab tests were unchanged.
To assess the relative diagnosis accuracy of in-person versus telemedicine visits, the researchers tracked patients with symptoms of urinary tract infections (UTIs), heart attacks, and bone fractures. They chose those three common conditions because misdiagnosis would require additional care. Analysis of patient diagnosis and treatment data found no significant differences in accuracy between in-person and telemedicine visits for the three conditions monitored in the study.
The final conclusion of the Stanford research is that, contrary to common opinion, telemedicine saved costs without compromising quality of care. There are additional questions to follow and mixtures of in-person and telemedicine modes to study, but the current research is promising.
