Reducing hospitalizations through telemedicine

David C. Grabowski of Harvard Medical School and A. James O'Malley of The Dartmouth Institute for Health Policy & Clinical Practice at the Geisel School of Medicine studied a for-profit nursing home chain in Massachusetts that had contracted with a telemedicine service provider. As needed, the remote physician was able to examine residents using two-way videoconferencing technology that included a high-resolution camera.

This service extended across 11 nursing homes and provided coverage on nights and weekends when the on-call physician was not available. Because introduction of this service between October 2009 and September 2011 was staggered, the researchers were able to use five of the 11 nursing homes as a control group.

Results of the study, published in the February issue of Health Affairs, showed that even though four of the six nursing homes were responsible for most of the calls, the overall rate of hospitalization in those nursing homes with telemedicine service declined 9.7 percent as compared to 5.3 percent for the control group. The four that had the most calls, actually saw their hospitalizations decline by 11.3 percent.

But there is a caveat. "Findings from our controlled study of eleven nursing homes provide the first indications that switching from on-call to telemedicine physician coverage during off hours could reduce hospitalizations and therefore generate cost savings to Medicare in excess of the facility’s investment in the service," the researchers said. "But those savings were evident only at the study nursing homes that used the telemedicine service to a greater extent, compared to the other study facilities. Telemedicine service providers and nursing home leaders might need to take additional steps to encourage buy-in to the use of telemedicine at facilities with such services. At the same time, closer alignment of the stakeholders that bear the costs of telemedicine and those that might realize savings because of its use could offer further incentives for the adoption of telemedicine."