- Of 254 patients responding to a survey about telemedicine visits at Massachusetts General Hospital, 80% assigned the highest rating for efficiency and communication, and 82% would recommend them to family and friends
- When rating the personal connection felt during the visit, 33% of patients and 46% of clinicians said an office visit is better, but most respondents, 59% of patients and 51% of clinicians said there was no difference
- 49% of clinicians reported no difference between virtual and office visits in the time needed for assessment and treatment
- Patients expressed willingness to pay co-payments for virtual visits
Telemedicine is being used in a number of U.S. hospitals and clinics to improve access to care, notably for people in remote areas and for underserved urban populations. Massachusetts General Hospital initiated a TeleHealth program in 2012 and now offers a range of telemedicine services in 15 clinical departments.
Lee H. Schwamm, MD, director of the Mass General Center for TeleHealth, and colleagues surveyed attending clinicians and established patients at Mass General about their experiences with two-way synchronous video conference visits during the program's first year of operation. The results, reported in the American Journal of Managed Care, show that both clinicians and patients consider virtual visits a useful option.
On a rolling basis, clinicians in five specialties (psychiatry, neurology, cardiology, oncology and primary care) were trained in how to provide a virtual visit. They offered such visits as an option to suitable established patients (e.g., able to communicate effectively in this mode, physical examination not critical at the visit).
The hospital compensated clinicians for conducting virtual visits, which were not covered by payers in Massachusetts. Before the visit, participating patients received education, instruction and phone-based support for installing the necessary software. Patients were not charged insurance co-payments for the visit.
Survey Methods and Participation
Mass General experts in health services research designed a secure web-based survey that was completed by 61 of 74 eligible clinicians (82%) and 254 of 426 eligible patients (60%). Clinicians (physicians, nurse practitioners and psychologists) were eligible if they provided at least one virtual visit during the study period. Eligible patients had at least one virtual visit during the accrual period and at least one in-person office visit during the previous six months. Most who participated were white and non-Hispanic (87%) and privately insured (77%), and 49% said it takes them at least an hour to travel to Mass General.
At least 80% of respondents answered "yes, definitely agree" to survey items about efficiency and good communication, and 82% said they would definitely recommend virtual visits to their family and friends. On a scale of 0 (worst possible visit) to 10 (best), 69% of patients rated the visit a 9 or 10.
Comparisons of Office and Virtual Visits
Most patients (63%) and clinicians (59%) reported no difference between virtual and office visits in the overall quality of the visit. When rating the personal connection felt during the visit, 33% of patients and 46% of clinicians said an office visit is better, but most respondents, 59% of patients and 51% of clinicians said there was no difference.
Most patients (75%) also reported no difference between virtual and office visits in the amount of time they spent with their clinician. High percentages of patients rated virtual visits as better than office visits in terms of travel time (95%), convenience of scheduling (80%) and waiting time (55%).
About half of clinicians (49%) reported no difference between virtual and office visits in the time required for assessment and treatment. Most also found no difference in the ability to see a physical problem (67%), ease of accessing patient records during the visit (62%), workflow before and after the visit (51%) and ease of scheduling follow-up (51%).
Willingness to Pay
Most patients (65%) said they were definitely willing to pay an insurance co-payment of $10 to $25 for a virtual visit, and 18% were somewhat willing. For a co-payment of $26 to $50, those figures were 28% and 32%. Eighteen percent of patients said they would definitely pay the full cost of a virtual visit.
Telehealth May Have Benefits Beyond Convenience
Dr. Schwamm and his co-authors believe that rather than being simple replacements for office visits, virtual visits have the potential to be used for more frequent, short encounters and for earlier intervention. They emphasize that virtual visits are inappropriate in some circumstances, such as when patients have complex issues and/or need careful physical examination or observation.
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