Increased use of telemedicine may create opportunities for clinical laboratories to deliver increased value to both physicians and nurses

Recent data shows widespread employer adoption of telehealth services may soon become a reality. However, studies also show virtual provider visits and other telemedicine technologies are unlikely to diminish the role of clinical laboratories in providing the data required for diagnosis and treatment decisions. Instead, laboratories and anatomic pathology groups will likely see changes in how samples are collected from patients using telemedicine and how medical laboratory test results are reported, as access to telemedicine grows.

A recent National Business Group on Health (NBGH) survey indicates that in 2018 “virtually all [large] employers (96%) will make telehealth services available in states where it is allowed.” The survey was conducted between May and June 2017, with 148 large employers participating.

Christine Smalley, Managing Director with consulting firm Claremont Hudson, divides telemedicine technology into three distinct segments:

1.     Provider-to-provider;

2.     Remote patient monitoring; and,

3.     Patient-to-provider.

In an article she penned for MedCityNews, Smalley calls provider-to-provider telemedicine the “most evolved to-date” segment of the telehealth trend. She highlights ICU stroke care with remote consults and monitoring as an example of its “success,” and notes a large potential for growth in remote patient monitoring (RPM). Smalley cites a Berg Insight report that estimates 50-million patients will use remote monitored devices by 2021. However, Smalley also notes consumer acceptance of patient-to-provider telemedicine has fallen short of industry expectations.

While virtual office visits—where patients have access to physicians via telephone or videoconferencing—grab headlines, Smalley argues that “several factors” are hindering adoption.

“Reimbursement is not yet universal,” she notes. “But consumers are growing used to paying more out-of-pocket with high-deductible plans. Physicians have long resisted change in how they practice, and many remain lukewarm at best about telemedicine. It’s no coincidence that many of the innovations and pioneering models have come from outside of healthcare delivery … The barriers that loom the largest may likely be consumer awareness and trial.”

The Center for Connected Health Policy (CCHP) reports that 35 states have laws governing private payer reimbursement of telehealth, a number that has not changed since 2016. According to a CCHP press release, some state laws require reimbursement be equal to in-person visits, though not all laws mandate reimbursement.

Adopting Existing Retail Models to Promote Telemedicine to Patients

Smalley contends “smart marketing” will be needed to get consumers to leverage the telemedicine options that are becoming available to them. She says simply offering video or telephone visits is not enough. She encourages integrated delivery systems to take a page out of retailers’ playbooks.

“Look at how retailers, like Walmart, integrate online shopping and the store experience by offering side-by-side options supporting product delivery and in-store pickup. Telemedicine options ultimately need to be offered in a way that feels integrated and seamless to the health consumer,” she suggested, in her MedCityNews article. One example, she notes, would be providing an easy-to-navigate link to a virtual visit on a healthcare network’s urgent care webpage.

Telemedicine isn’t just about the office visit. Pathologists such as J.B. Askew, MD, PA (above), have embraced telepathology technology to bring pathology interpretation services to remote and resource strapped areas worldwide. (Click on image above to watch a video of Askew demonstrating the use of a telepathology imaging system.) (Image/video copyright: J.B. Askew, MD, PA, North Houston Pathology Associates/Meyer Instruments.)

Click image above to see YouTube video

Healthcare Spending Could Increase Due to Telehealth

While health plans have zeroed in on telehealth as a way to drive down healthcare costs, a 2017 RAND Corp. study published in Health Affairs found virtual visits to physicians might not decrease spending, though access to care is improved.

“Instead of saving money by substitution [replacing more expensive visits to physician offices or EDs], direct-to-consumer telehealth may increase spending by new utilization [increasing the total number of patient visits],” a MedCityNews article suggests.

The RAND study examined commercial claims data of workers enrolled in the California Public Employees’ Retirement System (CalPERS) Blue Shield of California HMO (Health Maintenance Organization) from 2011-2013. Researchers focused on care received for acute respiratory infections. According to a RAND press release, net annual spending for acute respiratory infections increased by $45 per telehealth user.

“Given that direct-to-consumer telehealth is even more convenient than traveling to retail clinics, it may not be surprising that an even greater share of telehealth services represents new medical use,” noted Lori Uscher-Pines, PhD, a RAND Policy Researcher. “There may be a dose response with respect to convenience and use: the more convenient the location, the lower the threshold for seeking care and the greater the use of medical services.”

Telehealth in Clinical Laboratories

Will telehealth services offered by hospital networks and healthcare providers impact clinical laboratories? While a physical visit is still required for drawing blood, collecting urine, or performing pathology testing, interpretive digital pathology, such as Whole Slide Imaging (AKA, Virtual Slide), does enable pathologists to provided distance interpretation services of blood tests to remote and/or resource deficient areas of the world, as Dark Daily reported in past e-briefings. This could become a substantial revenue stream in the future if telepathology’s global popularity continues to rise.

—Andrea Downing Peck

Related Information:

Telemedicine Is on the Rise, Including for Labs

Large U.S. Employers Project Health Care Benefit Costs to Surpass $14,000 per Employee in 2018, National Business Group on Health Survey Finds

Large Employers’ 2018 Health Care Strategy and Plan Design Survey

Take a Lesson from Retail to Improve Patient Adoption

mHealth and Home Monitoring

Direct-to-Consumer Telehealth Prompts New Use of Medical Services; Not Likely to Decrease Health Spending

State Telehealth Laws and Reimbursement Policies, April 2017

CCHP Releases Fifth Edition of 50 State Telehealth Lawns and Reimbursement Policies Report

Almost All Large Employers Plan to Offer Telehealth in 2018, but Will Employees Use It?

Direct-to-Consumer Telehealth May Increase Access to Care but Does Not Decrease Spending

International Telemedicine Gains Momentum, Opening New Markets for Pathologists and Other Specialists

‘Nighthawk’ Radiology Services Expand to Hospital Pharmacies: Could Pathology Laboratories Be Next?

From Micro-hospitals to Mobile ERs: New Models of Healthcare Create Challenges and Opportunities for Pathologists and Medical Laboratories