Sachin J. Shah (
Lee H. Schwamm is executive vice chair of neurology and director of the Center for TeleHealth at Massachusetts General Hospital, and a professor of neurology at Harvard Medical School, both in Boston.
Health Aff (Millwood). 2018 Dec;37(12):2045-2051. doi: 10.1377/hlthaff.2018.05105.
Specialty care contributes significantly to total medical expenditures, for which accountable care organizations (ACOs) are responsible. ACOs have sought to replace costly in-person visits with lower-cost alternatives such as virtual visits (videoconferencing with physicians). In fee-for-service environments, virtual visits appear to add to in-person visits instead of replacing them. While this may be less of a problem within ACOs, whether virtual visits reduce in-person visits in an ACO is not known. Using data from over 35,000 patients in the period 2014-17 within a Massachusetts-based ACO, we found that the use of virtual visits reduced in-person visits by 33 percent but increased total visits (virtual plus in-person visits) by 80 percent over 1.5 years. While the use of virtual visits reduced in-person visits soon after registering with the program, the effect did not endure beyond a year. Whether and how virtual visits can substitute for in-person care in the long term are open questions.
专科护理对总医疗支出贡献巨大，而这正是责任医疗组织（ACO）的职责所在。ACO 试图用成本较低的替代方案（如虚拟就诊，即与医生进行视频会议）取代昂贵的当面就诊。在按服务收费的环境中，虚拟就诊似乎是增加了而不是取代了当面就诊。虽然这在 ACO 内部可能不是问题，但虚拟就诊是否会减少 ACO 中的当面就诊尚不清楚。我们使用了马萨诸塞州一家 ACO 在 2014-2017 年期间超过 35000 名患者的数据，发现虚拟就诊的使用将当面就诊减少了 33%，但在 1.5 年内将总就诊次数（虚拟就诊加当面就诊）增加了 80%。虽然在注册该项目后不久，虚拟就诊的使用确实减少了当面就诊，但这种效果在一年后就无法持续了。虚拟就诊是否以及如何能在长期替代当面护理，这些都是悬而未决的问题。
