Research Activities, December 2009: Emergency Medicine: Telemedicine reduces children's emergency department visits for nonemergency problems

Emergency Medicine
Telemedicine reduces children's emergency department visits for nonemergency problems

When telemedicine is available in child care centers and schools for urban children with acute illnesses, the use of emergency departments (EDs) decreases substantially, according to a new study. In turn, the decline in ED use for nonemergency problems reduces health care costs. 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 their study, researchers from the University of Rochester examined use of telemedicine access at 22 child care and school sites, office visits, and ED care. Children at telemedicine access sites had 22.2 percent fewer visits to EDs than those without access. However, they had 23.5 percent greater illness visits overall (i.e., visits to any site). Based on observed differences in use rates among children at telemedicine access sites, the researchers calculated a break-even ratio, where the payment for ED visits would be sufficiently greater than the payment for telemedicine visits so that the cost decrease due to fewer ED visits would equal the cost increase due to more overall visits.

Based on this calculation, if the mean payment for ED visits is at least fivefold greater than the mean payment for telemedicine visits, then the health care system will at least break even with the introduction of telemedicine. The 5 to 1 break-even ratio was exceeded by current reimbursement rates in the Rochester study community, where the ED to telemedicine payment ratio was 7 to 1. Thus, the study's findings support reimbursing telemedicine providers for services with an expected financial gain for insurance companies and payers. The study was supported in part by the Agency for Healthcare Research and Quality (HS15165).

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.

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Research Activities, December 2009: Emergency Medicine: Telemedicine reduces children's emergency department visits for nonemergency problems