A telehealth program for diabetes self-management doesn't just shorten the wait to talk to a physician specialist compared to an in-person visit; it also results in patients with type 2 diabetes having comparable improvements in blood glucose control to patients receiving traditional care, a study conducted among military veterans has found.
The "telediabetes" program at the Veterans Affairs Pittsburgh Healthcare System, where the study took place, merges an electronic consultation, or e-consult, from an endocrinologist specializing in diabetes with ongoing telephone-based care. Unlike a typical e-consult meant to be a one-time recommendation, this program provides team-based care with follow-up.
The approach represents the potential for better clinical quality in the treatment of veterans, but also could help curb costs for both patients and providers. Telemedicine is becoming increasingly popular as the financial benefits for providers who offer it come to light. And new policy changes in Washington and around the country are poised to reshape the reimbursement landscape and open big opportunities for hospitals and health systems to drive more revenue from virtual care.
A September study from Nemours Children's Health System examined the use of telemedicine to treat sports injuries, for instance, and found that each visit saves health systems an average of $24 per patient. Then, in November, three significant policy developments took shape.
First came changes to MACRA and MIPS payment models. The Centers for Medicare and Medicaid Services published the final rule on November 2, 2017 and it includes new billing codes for virtual visits that involve care planning and risk assessments as part of CMS's chronic care management program.
Then Congress signaled a new direction of its own for telemedicine when the U.S. House of Representatives Veterans Affairs Committee passed The VETS Act, HR 2123, supporting the VA's Anywhere-to-Anywhere program. The initiative is designed to enable VA providers to offer virtual consults to patients regardless of geographical location -- including across state lines, which is widely viewed as one of the biggest regulatory impediments for hospitals looking to institute telehealth services.
In the study, the research team compared results for 442 patients who participated in the e-consult program, and another 407 patients who had a traditional face-to-face visit and follow-up care. All patients were veterans with type 2 diabetes who were referred from remote VA facilities between 2010 and 2015 for a consultation about improving their blood sugar control.
Veterans in the e-consult group, compared with the face-to-face group, were several years younger on average (64 as opposed to 68), slightly more likely to be male (98 versus 95 percent) and more often lived in a rural area (16 versus 4 percent). At the initial consult, both groups reportedly had a hemoglobin A1c -- a measure of average blood glucose level over the past few months - -of 10 percent.
The time to get a face-to-face consultation took 37 days, compared with only 10 days for an e-consult, according to the research. Within three to six months of the consultation, patients in both groups significantly improved their A1c, which was just under 9 percent for the e-consult group and 8.75 percent for the face-to-face group. One year after the consult, A1c improved further in each group, to 8.8 percent in the e-consult group and 8.6 percent in the face-to-face group.
In the e-consult group, the decline in A1c differed by the level of the veterans' engagement in self-care of their diabetes, with the patients who fully engaged in adhering to the recommended treatment having the lowest A1c at one year (8.6 percent).
According to a 2017 report from Grand View Research, the telemedicine market is expected to top $113 billion by 2025, with a growth rate of 18 percent.