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Will telemedicine improve acute care management?

November 23, 2020

Topics: Quote of the Day

Momentum is gathering for telemedicine, which could alleviate a longstanding problem: wait times.

By Austin Frakt
The New York Times, November 23, 2020

The pandemic may present an opportunity to reshape the future of emergency medicine.

The coronavirus has already prompted health care leaders to rethink how to deliver care to make the most of available resources, both physical and digital. If the shift to greater use of telemedicine continues after the pandemic, it could reduce reliance on the emergency room, where crowding has long been a problem.

This could happen if telemedicine increases the ability for doctors to see more patients more quickly.

Of course, telemedicine isn’t a solution for every health problem. And patients with limited digital fluency and access may get left behind as reliance on telemedicine grows. But the potential payoff is large: A review of medical records of older patients found that 27 percent of emergency room visits could have been replaced with telemedicine.

On average, a patient visiting an emergency room will wait about 40 minutes. Although that’s down from about an hour a decade ago, 17 percent of patients visiting an emergency department in 2017 waited over an hour. About 2.5 percent waited more than two and a half hours.

As many studies have documented, longer wait times can be harmful. Longer waits can also increase costs.

Additionally, many people end up waiting in the emergency department on the advice of other medical providers, though they may not need to. Their problems could be handled elsewhere.

Once the pandemic fades, the momentum from telemedicine may continue, with the possibility of making progress on a problem that shouldn’t wait.

NYT Reader Comment:

By Don McCanne, M.D.

How should an acute problem be managed? By telephone? By telemedicine? By an urgent primary care office visit? By an urgent care center? By an emergency department? Should a private insurance company be dictating the approach? Should a less appropriate approach be dictated by the source of payment whether due to a lack of insurance or through very high deductibles, or due to restrictions of provider networks established by private insurers?

Sorting these approaches through triage based on clinical circumstances can improve the efficiency of our health care system, but it would be far more effective if we remove one important stumbling block: disrupting entrance into the health care system based on our dysfunctional, fragmented system of financing health care.

If we had a well designed, single payer improved Medicare for All system that removed the dictates of private insurance bureaucrats, with their provider networks and prior authorization requirements, then we could improve the flow within our health care delivery system, obtaining the appropriate care at the appropriate place at the appropriate time for the appropriate patient. Addition of the option of telemedicine can only improve this flow when it is appropriate for the clinical circumstances.


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About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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