Telemedicine's value proposition

UPMC talks about the ROI of telemedicine

For the urban hospital – "the exact opposite of the rural hospital" – the ROI is worth noting, he said.  

Through the telemedicine program, UPMC's tertiary center captured 38 colorectal cases, Watson said. At a profit about $5,000 per case, that's $190,000 or so in revenues.

And that doesn't account for other upside, he noted, such as ancillary and consultative, avoidance of the physician's need to travel and the prevention of patients being lost to other health systems.  

Finally, for the physician there's value, too, said Watson. Given 38 cases of rural telemedicine, with an average relative value unit per case of 20, that's 760 RVUs – or roughly $34,000, he said. 

And that, he added, doesn't even account for intangibles such as positive word of mouth (there was a 94 percent satisfaction rating for telehealth).

Long story short? "Everyone" – the large hospital, the small hospital, the patient, the physician – "had a good piece of this," said Watson.

Not long ago, "This is care that would have been driven out of the rural communities into Pittsburgh and done the old-fashioned way."

Nowadays, things are changing fast. 

Doing telemedicine in a fee-for-service environment, "You can make a little money, like I showed," said Watson. "The real horsepower and juice is when you enter the virtual world. You cannot have a hospital system without virtual."

In this new era of shared risk, he said, "You'll see nursing homes (where) you'll pull up an iPad or video device to make sure the nurse can actually see the patient before they get transferred. Handoffs will be done with a combination of video and EHRs. Codes will be done with video. The OR will be surgical telemetry networks. All of these are going to be payer gain-share models.

"You will see insurers creating, to some degree, narrow networks through portals, benefit designs, incentives to get people to the right level of care," said Watson. "It's not just accessing care, it's accessing the right care. And video – or virtual, is a better way to say that – is the way it's going to be done. We're certainly seeing it on the ground. It is absolutely fascinating to watch."