JAMIA: Lower implementation costs are key to telemedicine adoption
In order for telemedicine case management to be more widely adopted, less expensive technology is needed to lower implementation costs,  according to a recent study from The Journal of Medical Informatics Association.

Walter Palmas, MD, from the department of medicine at Columbia University College of Physicians & Surgeons in New York, and colleagues sought to determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention.

“In the U.S., people with diabetes incur more than twice the amount of medical expenditures as those without diabetes; approximately 50 percent of these expenditures correspond to inpatient care, whereas physician office visit represent less than 10 percent,” wrote Palmas. “Thus, there is a great interest in interventions that may reduce preventable hospital admissions in people with diabetes.”

The authors studied 1,665 participants aged 55 or older who resided in federally designated medically underserved areas of New York State from a randomized controlled trial comparing telemedicine case management of diabetes to usual care, the Informatics for Diabetes Education and Telemedicine (IDEATel).

According to the authors, Medicare claims payments were analyzed for each participant for up to 60 study months from date of randomization, until their death or until Dec. 31, 2006 (whichever happened first), as well as study expenditures for the telemedicine intervention over six budget years (Feb. 28, 2000– Feb. 27, 2006).

“Mean annual payments [with adjusted standard errors] were estimated as $9,040 ($386) and $9,669 ($443) for the usual care and telemedicine groups, respectively,” the study found. “The comparisons between telemedicine and usual care were similar over different lengths of participation. This was also the case for all subclasses of services other than durable medical equipment, where payments in the telemedicine group were larger than those in the control group.”

“Project intervention costs [over six budget years] were estimated as U.S. $622 per participant per month of intervention delivered,” the authors wrote.

Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population,” the report concluded. “Cost savings were not realized through lower expectation in inpatient care or substitution of electronically delivered case management services for in-person services. Expenditures in durable medical equipment were higher for telemedicine participants, but that did not significantly affect overall expenditures, of which they represented less than 5 percent. Overall, Medicare claims payments were similar to those described for similar elderly populations with diabetes.”