Snoswell Centaine L, North John B, Caffery Liam J
Centre for Online Health, The University of Queensland, Brisbane, Australia.
Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia.
JMIR Perioper Med. 2020 May 21;3(1):e15688. doi: 10.2196/15688.
Telehealth is a disruptive modality that challenges the traditional model of having a clinician or patient physically present for an appointment. The benefit is that it offers the opportunity to redesign the way services are offered. For instance, a virtual health practitioner can provide videoconference consultations while being located anywhere in the world that has internet. A virtual health practitioner also obviates the issues of attracting a specialist medical workforce to rural areas, and allows the rural health service to control the specialist services that they offer.
The aim of this research was to evaluate the economic effects of 3 different models of care on rural and metropolitan hospital sites. The models of care examined were patient travel, telehealth using videoconferencing, and employment of a virtual health practitioner by a rural site.
Using retrospective activity data for 3 years, a return on investment (ROI) analysis was undertaken from the perspective of a rural site and metropolitan partner site using a telehealth orthopedic fracture clinic as an example. Further analysis was conducted to calculate the number of patients that would be required to attend the clinic in each model of care for the sites to break even.
The only service model that resulted in a positive ROI for the rural site over the 3-year period was the virtual health practitioner model. The breakeven analysis demonstrated that the rural site required the lowest number of patients to recoup costs in the virtual health practitioner model of care. The rural site was unable to recoup its costs within the travel model due to the lack of opportunity for reimbursement for services and the requirement to cover the cost of travel for patients.
Our model demonstrated that rural health care providers can increase their ROI by employing a virtual health practitioner.
远程医疗是一种颠覆性的模式，它挑战了临床医生或患者亲自到诊的传统模式。其好处在于提供了重新设计服务提供方式的机会。例如，虚拟健康从业者可以在世界上任何有互联网的地方提供视频会议咨询服务。虚拟健康从业者还消除了吸引专科医疗人员到农村地区的问题，并使农村卫生服务机构能够控制其所提供的专科服务。
本研究的目的是评估三种不同护理模式对农村和城市医院站点的经济影响。所研究的护理模式包括患者出行、使用视频会议的远程医疗以及农村站点雇佣虚拟健康从业者。
以一家远程医疗骨科骨折诊所为例，利用三年的回顾性活动数据，从农村站点和城市合作站点的角度进行了投资回报率（ROI）分析。进一步分析计算了每种护理模式下站点实现收支平衡所需的就诊患者数量。
在三年期间，唯一一种使农村站点获得正投资回报率的服务模式是虚拟健康从业者模式。盈亏平衡分析表明，在虚拟健康从业者护理模式下，农村站点收回成本所需的患者数量最少。由于缺乏服务报销机会以及需要承担患者的差旅费，农村站点在出行模式下无法收回成本。
我们的模型表明，农村医疗服务提供者可以通过雇佣虚拟健康从业者来提高其投资回报率。
