Financial barriers still get in the way of telemedicine adoption

Providers have been slow to take up virtual care due to financial barriers, especially when they come from small practices, according to a new study published in the December edition of Health Affairs.

In general, physicians in larger practices and those in rural areas were more likely to use telemedicine, researchers found.

"Small practices and physician-owned practices have to learn and talk to other organizations that have done this before to learn what the pathway is for them," said Carol Kane, an author of the study and director of the American Medical Association's division of economic and health policy research.

Kane and Kurt Gillis, the AMA division's principal economist, examined the AMA's 2016 Physician Practice Benchmark Survey for the study. Among small practices, telemedicine use for patient interactions was just 8.2%, while it was 26.5% for large practices. Likewise, use of telemedicine for provider-provider communication and use for remote-patient monitoring were much lower in small practices than in large practices.

"Like any new technology, it's tough, and it may be something that applies only to a small portion of their patients," Kane said of small-practice physicians. "Do they really want to make that investment?"

Among specialties, usage rates also varied greatly. Because radiologists frequently use store-and-forward technology—saving an image in one place and then sending it to another place for evaluation—they were most likely to use telemedicine for patient interactions, according to the researchers. Almost 40% of radiologists surveyed used telemedicine for patient interactions, while just 6.1% of internal medicine providers specializing in allergy and immunology used telemedicine for such interactions. Radiologists also tend to work in hospitals, where telemedicine technology may be more readily available, Kane said.

Emergency medicine providers topped the list for use of telemedicine for provider-to-provider communication, at 38.8% of those surveyed. But many specialties' use of the technology for those interactions was below 10%.

Overall, remote-patient monitoring was the least frequently used type of telemedicine, with just 7.3% of providers overall using it.

Telemedicine in general has been catching on, albeit slowly. According to a recently published research letter in JAMA, telemedicine visits among a large group of privately insured people rose about 52% annually from 2005 to 2014 and about 261% annually from 2015 to 2017. According to a study by the AMA in the December issue of Health Affairs, 15% of physicians worked in practices where telemedicine was used for interacting with patients and 11% worked in practices where it was used for provider-to-provider communication.