Frustrated with lengthy wait times to see a dermatologist, a group of community health centers in Massachusetts has negotiated their own telemedicine reimbursement with four health plans to implement a teledermatology program in order to improve access. Backed by a Partnership for Community Health grant, in its first year the platform has expedited more than 112 cases and referred 60 percent back to the primary care physician without a need for an in-person dermatology visit, saving an estimated 30 percent in annual costs by eliminating unnecessary specialist consults. Teledermatology has previously been shown to be just as effective as in-person visits for identifying skin cancer.
The program offers teledermatology at 22 remote sites, where a handheld scanner captures various views of the lesion. The images and patient information are sent to a specialist for evaluation via store-and-forward technology; a reply is returned within 48 hours, along with a recommendation for follow-up care if needed. Compared to the typical delay of weeks or even months for the initial visit with the dermatologist, this time difference can mean life or death to a patient with undiagnosed melanoma.
Traditionally, studies estimate that only about 20 percent of “new issue” dermatology appointments actually necessitate an in-person visit with a dermatologist; less than 1 percent are diagnosed as skin cancer. By screening the referred cases, the teledermatology program cuts the caseload of new patients by half, saving time, cost, and effort for both patients and physicians. This, in turn, helps PCPs become more efficient and effective.
With the grant’s two-year window coming to an end, the health centers are uncertain whether the program can continue without Medicare reimbursements. Rather than wait, some experts advise forming partnerships with individual health plans on coverage and reimbursement for the sake of savings, efficiencies, and—most of all—the patients.
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