Rural hospitals may not save money when they treat an emergency-room patient via tele-medicine instead of transferring them to a larger facility, but patients do, according a new report.

Previous studies haven’t reached a clear conclusion about whether avoiding transfer of an ER patient saves the hospital money. But by expanding the focus to include consumer spending related to transport, researchers found that significant savings do occur, the study says.

The study tracked not just the cost of treatment but the financial burden caused by transportation expenses, loss of work time for family and friends, and similar indirect expenses. Using tele-medicine added an average of $1,700 per patient to treatment costs. But consumers saved about $5,600 in direct and indirect expenses, the study states. The net “societal gain” is about $3,800 per patient who is not transferred.

“Our study’s primary goal was to identify the amount of money saved in situations when remote emergency medicine professionals can provide the necessary insight to help local providers avoid transfer of the patient,” said Nabil Natafgi, research associate and adjunct assistant professor of health management and policy at the University of Iowa College of Public Health and study co-author. “The cost savings is significant and should help more rural health systems recognize the financial and non-financial value of telemedicine.”

Natafgi and his collaborators used a cost-benefit model to track more than 9,000 cases over the course of 52 months at 85 small, rural hospitals in seven rural states. Of those cases, nearly 1,200 patients were able to remain in local rural hospitals because of tele-medicine technologies. This comparison of those who were able to stay in local hospitals was the basis test group for the study.

The hospitals in the study were part of the Avera health network, which provides tele-medicine resources for medical facilities. Health-care providers at a central location use interactive audio-visual technology to examine the patient remotely and ask questions. They determine whether the patient can be treated locally or should be transferred to a larger, better-equipped facility.

While use of the tele-ER services does not save the local hospital money, according to the study, the use of the technology does provide important revenues for rural hospitals otherwise struggling economically.

“The study points out that avoiding a transfer provides numerous other benefits,” said the study’s senior author, Marcia Ward, Ph.D., professor and director of the Rural Telehealth Research Center (RTRC) at the University of Iowa. “It keeps patients closer to their families and support networks, particularly elderly patients, and provides a means for which patients receive earlier diagnoses and intervention. Also, having a telehealth system increases the reputation of the rural hospital in its community.”

The paper, “Using tele-emergency to avoid patient transfers in rural emergency departments: An assessment of costs and benefits,” was published recently in the Journal of Telemedicine and Telecare. It was co-authored by Dan Shane, assistant professor of health management and policy; A. Clinton MacKinney, clinical assistant professor of health management and policy, all in the University of Iowa College of Public Health; and Amanda Bell of Avera Health, USA.

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