Telemedicine Has Mixed Influence on Costs of Asthma Care

By Scott Baltic

June 20, 2022

NEW YORK (Reuters Health) - Under the right circumstances, telemedicine can substantially reduce the costs of asthma care, especially those involving transportation and missed work, while nonetheless providing high-quality care, researchers have found.

Unfortunately, patients say telemedicine can also sometimes increase the cost of asthma care, as when their access to medication samples is reduced, Dr. Melissa B. Gilkey of the University of North Carolina at Chapel Hill and colleagues report in The Journal of Allergy and Clinical Immunology: In Practice.

Asthma costs the United States, including absenteeism, are estimated at more than $80 billion per year. Medical care alone sets the average U.S. asthma patient back nearly $3,300 per year, the researchers note, and this financial burden is worsened by the proliferation of high-deductible health plans and increasing use of branded biologics.

In their "clinical commentary review," the researchers combined a literature review with phone interviews with 42 families to explore how best to leverage telemedicine to reduce the financial burden of asthma care. The families were all affected by asthma during the COVID-19 pandemic.

Four themes emerged from the interviews. First, telemedicine offers good value in certain circumstances, with advantages seen in terms of reduced transportation costs and missed work. Some participants saw routine follow-up visits with an established provider as instances where telemedicine was especially valuable.

Second, under other circumstances, telemedicine's disadvantages could outweigh its advantages, such as at times when physical exams or acute care were needed. In addition, participants were more reluctant to use telemedicine with new healthcare providers.

Third, telemedicine could pose a barrier to material resources and to clinical-care partners. For example, participants reported that telemedicine could distance patients from asthma educators and social workers, who otherwise helped them navigate cost challenges.

And finally, telemedicine's value depends on "transparent pricing and adequate health insurance coverage, which patients found difficult to obtain consistently during the pandemic," the researchers write. Participants reported difficulties in understanding how much telemedicine visits would cost them out-of-pocket. One reported not being charged for one telemedicine visit, then paying $300 for another.

"The challenge for patients and providers is knowing when a telemedicine visit can work just as well as an in-person one," Dr. Gilkey told Reuters Health by email.

Integrating the various available telemedicine services into traditional healthcare delivery systems will require better care coordination, telemedicine reimbursement and cost-sharing policies, she and her colleagues say, but will ultimately "make asthma care more accessible, effective, and equitable."

As one way to facilitate this process, the researchers developed a structured communication approach they call "four R's":

- Raise the topic of asthma-care costs routinely.

- Reassure patients and families that conversations about cost are welcomed.

- Revise the care plan to safely reduce costs when possible.

- Refer patients to asthma educators and other care team members for support and resources.

Dr. Jay M. Portnoy, medical director of telemedicine at Children's Mercy Hospital, Kansas City, Mo., told Reuters Health by email that before COVID-19, "telemedicine was increasing in use very slowly. The pandemic accelerated that."

He added that telemedicine let patients and providers maintain their relationship during the pandemic. "In that sense, it literally was a life saver."

Although it makes sense that telemedicine's convenience and lower costs would lead to better asthma outcomes, "it has been hard to back up such assertions with hard evidence," said Dr. Portnoy, who was not involved in the new work. "I think that this paper does add to the medical literature since it confirms, with evidence, the benefits of telemedicine that we intuitively believed were there."

Dr. Tania Elliott of New York University Medical Center, who also was not involved in the research, said "the reliance on medication samples speaks to systemic issues with high drug costs that need to be addressed, versus attributing the issue to telehealth limiting accessibility to these meds."

"If they were affordable," she told Reuters Health by email, "patients wouldn't be reliant on samples."

Dr. Elliott and Dr. Portnoy were among the authors of the American College of Allergy, Asthma & Immunology's position paper on the use of telemedicine for allergists.

SOURCE: The Journal of Allergy and Clinical Immunology: In Practice, online May 26, 2022.