Case Study: Teledermatology
“Well, this analysis does not suggest to me that it makes sense to push ahead with fancy telemedi-cine equipment for our practice. As I read the data, it costs us $280 to provide a consult to a patient via telemedicine and $320 to do it face-to-face. Telemedicine might boost our profits a little, but I can’t imag-ine too many patients will want to give up meeting their dermatologist in person. So,” Reese, the practice’s CFO, summed up, “I recommend against this project.”“If that were the whole story,” said Carroll, the director of market-ing, “I would agree with you. But this looks only at our costs. We need to think about the costs patients bear. Many of our patients are children, so they have to be driven across town by a parent. By the time you figure in the travel costs and time costs parents incur to bring their children here, a face-to-face visit could easily cost $100 more than a telemedicine visit. And that back-of-the-envelope calculation just looks at people in the local area. We know children in the western half of the state are not get-ting the care they should. There are very few dermatologists out there, and there are no dermatologists who specialize in treating pediatric skin cancer. The time and travel costs for those patients could easily be $200 per visit. We can’t just look at our own costs.”“I hadn’t thought of that,” said Reese. “I was focusing on these cost estimates, not taking into account the opportunity to do group visits—which our patients have been asking about—very inexpen-sively. This technology will let one of our doctors or nurses talk to eight patients at once in their homes. It’s mostly teaching and coaching, so the patients do not need ultra-high-resolution monitors on their home computers. We could even do some follow-up visits that way, so I think there are options this analysis of $280 per visit does not consider.”
Discussion questions:
• Does Shea’s point about patients’ costs make sense?
• Which perspective on costs looks more like a societal perspective to you?
• Would using telemedicine equipment mean giving up face-to-face dermatologist visits?
• What would be the advantage, if any, of being able to serve patients in the western half of the state?
• What would be the advantage, if any, of being able to offer telemedicine group visits?
• What is your assessment of the promise of telemedicine for this practice?
