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Telehealth can improve the experience of patients with cancer by facilitating access and reducing cost.
The burning question prior to Yuri Gagarin’s (the first human to travel to space) maiden space voyage was, “Can the human body function in space?” At the time, physicians were concerned about the effect zero gravity would have on blood circulation and respiration. Further, the National Aeronautics and Space Administration (NASA) sought to understand what other physiological and psychological effects space travel would have on the human body. The research conducted in the 1960s to answer these questions gave way to telehealth as we know it today.
The inclusion of telehealth as a Medicare service in 2002 was the next major advancement in this care delivery model. At the time, it was limited to Medicare beneficiaries who were in rural areas that had a shortage of healthcare professionals. Telehealth eventually made it into conventional clinical practice, but it wasn't until the COVID-19 public health emergency that it was widely embraced in almost every area of patient care; as temporary regulatory changes reduced some of the constraints surrounding it. For example, the need for specific clinical licenses to deliver healthcare services via telehealth was waived in many states and D.C.
Cancer programs and practices around the country experienced a rise in telehealth use during the COVID-19 pandemic. At the University of Texas at San Antonio Mays Cancer Center, telehealth visits accounted for 40 percent of its patient visits as of August 2020. Between March and July 2020, nearly 7,000 patients at the Sidney Kimmel Comprehensive Cancer Center at the Thomas Jefferson Health System received telemedicine care, compared to roughly 150 patients during the same time span in 2019.
To help make some of these COVID-19-related reforms permanent, legislation is currently making its way through Congress. The Telehealth Extension and Evaluation Act, for example, will eliminate the geographical limits that were previously tied to telehealth, thus allowing Medicare recipients to receive care via telehealth wherever they live. Healthcare providers nationwide have been anticipating Congress’ involvement in the future of telehealth, as new studies suggest that telehealth saves patients with cancer time and money.
A 2023 study published in JAMA Network Open sampled 11,688 patients, who were 65 years old and younger and who had 25,496 telehealth visits from April 1, 2020, to June 30, 2021. Using two measures for trip reimbursement rates ($0.56 or $0.82 per mile) and census tract-level medial hourly wages, the researchers calculated the savings patients with cancer experienced when using telehealth. They found that telehealth saved the patients about $1.2 million in lost income due to the time spent driving to access cancer care and about $467,000 in lost income due the time spent at a medical visit. The average total cost savings per patient ranged from $147.4 to $186.1 per medical appointment, depending on the type of visit and other factors. These financial benefits of telehealth extend beyond cancer care. One study found that patients who use telehealth spend considerably less on healthcare services. Further, the average telehealth patient's monthly medical costs decreased by 61 percent, from $1,099 to $425, between January 2020 and February 2021.
According to a 2019 report from the American Society of Clinical Oncology, 12 percent to 15 percent of oncologists practice in rural areas. However, 20 percent of the oncology population resides in even more rural areas—at least 60 miles from the closest oncologist. More than one million rural households do not have access to a vehicle, and this, coupled with the lack of effective public transportation in rural communities, makes travel to medical appointments difficult for patients with cancer. However, telehealth can play a key role in improving access to care in rural and urban settings. It can be a foundation for delivering next generation, equitable, and comprehensive cancer care—centered on saving patients time and money.