Not What You Think
By UNIVERSITY OF ROCHESTER MEDICAL CENTER
A new study shows that
telemedicine is effective and doesn’t reduce access to care.
A first-of-its-kind study demonstrating
telemedicine’s exceptional effectiveness comes to the conclusion that common
telemedicine concerns don’t hold up to scrutiny.
The study is one of two telemedicine studies recently published in NEJM Catalyst by researchers from the University of Rochester Medical Center (URMC). The second study demonstrates the success of URMC’s effort to provide mental health services to nursing homes via a hybrid model that includes telemedicine.
“For patients, the message is clear and
reassuring: Telemedicine is an effective and efficient way of receiving many
kinds of health care,” said Kathleen Fear, Ph.D., lead author of the first
paper, “Busting Myths about the Impact of Telemedicine Parity,” and director of
data & analytics at the UR Health Lab. “Especially for those with transportation
challenges, it is a service that really fills a gap – and, vitally, it does not
compromise the quality of the care that patients receive.”
Fear and her co-authors examined three
particular telemedicine-related concerns using data that was partly generated by
the COVID pandemic, which caused healthcare providers all around the country to
rapidly expand their telemedicine services:
- That it will reduce access to
care for the most vulnerable patients who may be unable to access digital
services.
- That reimbursing providers for
telemedicine services at the same rate as traditional services will
encourage telemedicine overuse.
- Telemedicine is not an
effective way to provide care.
“We really dug into the data, and it disproved
all three concerns, which is really quite exciting,” Fear said. “Not only did
our most vulnerable patients not get left behind—they were among those engaging
the most with, and benefit the most from, telemedicine services. We did not see
worse outcomes or increased costs, or patients needing an increased amount of
in-person follow-up. Nor did we find evidence of overuse. This is good care,
and it is equitable care for vulnerable populations.”
The paper, according to senior author and chief
digital health officer of URMC Michael Hasselberg, Ph.D., RN, is the first to
provide comprehensive data dispelling the three myths that have hindered the
widespread use of telemedicine. URMC researchers were in a unique position to
conduct the study due to the work of more than 3,000 telemedicine providers throughout
the health system and the UR Health Lab’s ability to analyze the data generated
by their work.
The researchers compared data from July to
December 2020, a period of relative normalcy after the pandemic’s first surge,
to pre-pandemic data from July to December of 2019, using data from January to
June 2021 as a follow-up period. Their analysis encompassed a review of patient
demographics, outcomes, provider use, visits completed, and more.
“For our providers, a major concern about
telemedicine has always been, ‘What might I miss if I can’t sit in the room
with the patient?’” Fear said. “But we simply didn’t find any increase in
negative outcomes. This doesn’t mean telemedicine will replace in-person care,
but it’s clear that it can help people access care more consistently and
comfortably and that it provides a highly effective complement to traditional
care.”
The second NEJM Catalyst study
looked at a program URMC physicians developed to bring psychiatric and
psychotherapeutic resources to nursing home patients through a combination of
telehealth, on-site visits, and staff education. The researchers concluded that
the program improved access to care and reduced the number of residents
requiring anti-psychotic medication.
“With a small team that we assembled here at
URMC, we’ve been able to have a huge reach, extending care to patients in parts
of the state where high-quality mental health services are scarce at best,”
said Adam Simning, M.D., Ph.D., assistant professor of Psychiatry and the
study’s lead author. “At a time when nursing homes nationwide are severely
understaffed, and the need for mental health services among their residents is
increasing, we’ve efficiently redesigned the way mental health services are
provided to the more than 50 nursing homes we work with.”
Hasselberg, who was also a senior author on the
nursing home study, believes both papers will resonate in the medical
community, encouraging payors and policymakers to continue and expand
pandemic-era policies that make the growth of telemedicine services possible.
“Hopefully, what we’ve learned here will help
the rest of the country and help shape the future of health care as
telemedicine becomes increasingly prominent,” said Hasselberg.
References: “Busting Three Myths About the
Impact of Telemedicine Parity” by
Kathleen Fear, Ph.D., Carly Hochreiter and Michael J. Hasselberg, Ph.D., RN,
PMHNP-BC, 21 September 2022, NEJM Catalyst.
DOI: 10.1056/CAT.22.0086
“Scaling Supply to Meet Behavioral Health Demand
in New York State Nursing Homes” by Adam C. Simning, MD, Ph.D., Zhi-Yang Tsun, MD, Ph.D., Nirav R. Shah, MD, MPH,
Elizabeth J. Santos, MD, MPH, Lara Press-Ellingham, MPA, OT and Michael J.
Hasselberg, Ph.D., RN, PMHNP-BC, 21 September 2022, NEJM Catalyst.
DOI: 10.1056/CAT.22.0196