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Journal of ASPR - Winter 2014


A care model that could reduce physician shortage

By Crystal Peterson, Director, Physician Recruiting and Retention, Specialists On Call, Inc., Reston, VA

We’ve all been warned of the looming physician shortage, which is expected to crest by the year 2025. According to the Association of American Medical Colleges (AAMC), there will be a physician deficit of nearly 130,600, equally distributed amongst all general specialties. The Affordable Care Act, once fully implemented, will create a patient surge as the newly insured enter the healthcare market, making the situation even worse. However, despite what we read and may likely experience in our roles as physician recruiters, a November 2013 RAND Corp study indicates that the shortage projected by 2025 could be cut by as much as 50 percent or even eliminated altogether. How can such a discrepancy exist amongst healthcare experts?

It appears both cases could be true. While the projected shortage is accurate based on the data collected by the AAMC, the RAND study goes on to explain that data fueling the shortage is based on static, unchanged care delivery models. The study continues to say, "The projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on new models, even without increases in the supply of physicians.” Many of the models showcased by reform initiatives - like telemedicine - have actually been in place for decades.

The Centers for Medicare & Medicaid Service’s Hospital Readmissions Reduction Program, the Medicare Shared Savings Program, and Comprehensive Primary Care Initiative are creating renewed interest in remote monitoring and virtual visits post-discharge to better manage patients and prevent unnecessary hospitalizations. These programs highlight the use of telemedicine technologies as tools for achieving higher quality and better coordinated care.

Many researchers support the idea that telemedicine and telehealth can reduce health care costs through more efficient care, better patient outcomes, and/or more timely care. This holds true, even if they have not yet agreed that taken as a whole, telemedicine saves money. The overall consensus, however, is that telemedicine works well with the system to improve efficiency and effectiveness, but it does not replace the system.

Efficiency Outcomes
Telemedicine can lower health care costs by delivering the same level of care more efficiently. Let’s take consultation times, for example. Telemedicine uses "store-and-forward,” a process where digital images, video, audio, observations of daily living and clinical data are captured and "stored” on the client computer or mobile device; then at a convenient time they are transmitted securely ("forwarded”) to a clinic at another location where they are studied by relevant specialists. The opinion of the specialist is then transmitted back. A physician’s review of "store-and-forward” information takes less time than an in-person consultation.

The largest efficiency gains, however, may come from a reduction in unnecessary patient transports. Studies on telemedicine interventions in pediatric cardiology, trauma, stroke and burn care show that, "Telehealth interventions in acute care settings like emergency rooms can remove the need to have some patients transferred to receive specialty care in other hospitals.” In addition, remote visits to patients in skilled nursing facilities, for wound care for example, can result in avoided transportation costs.

Effectiveness Outcomes
Another way in which telemedicine can produce cost savings is through the provision of better care, which reduces the frequency and/or cost of subsequent health care services. Ideally, telehealth provides care that decreases the need for services such as hospitalizations, emergency room visits and outpatient visits.
Home monitoring and acute care telemedicine

Two areas that have emerged with the strongest evidence of overall cost savings utilizing telemedicine include: home monitoring and acute care telemedicine. Home monitoring can reduce costly hospital visits and readmissions, while saving transportation costs and missed work income for patients who would otherwise need to commute or be transported from a facility to receive follow up care.

The lack of specialist physicians at local emergency rooms requires certain acute care patients, such as stroke or head trauma victims, to be transferred to hospitals with the necessary specialists on staff. In a 2009 University of Arizona study, researchers found that the around-the-clock trauma and emergency management telemedicine network prevented 17 unnecessary transfers and saved an estimated $104,852 in transfer costs.

For many, telemedicine means greater access to quality care, better management of chronic disease, and a solution to critical physician shortages in both urban and rural areas. At the same time, virtual care and remote monitoring have the potential to dramatically lower costs over more expensive inpatient alternatives and increase the efficiency of care delivery.
While technology continues to advance, and the efficacy of telemedicine continues to be demonstrated across the spectrum of care, legal and regulatory barriers hinder the pace at which widespread adoption of telemedicine in the United States can occur. Updating licensure requirements, introducing and expanding reimbursement for telehealth services, and creating a foundation of evidence based protocols for telehealth and telemedicine deployment are gaining momentum at both the state and national level. 2013 saw a positive change across all healthcare sectors as state legislators, patient groups, provider organizations, healthcare CEOs, and payers joined advocacy groups in the campaign for change. 2014 stands to be a busy year as these organizations continue to rally for telehealth and telemedicine.

Dávalos ME, French MT, Burdick AE, Simmons SC (2009, December 15). Economic evaluation of telemedicine: review of the literature and research guidelines for benefit-cost analysis. Telemed J E Health.


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