Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption?

Abstract

There has been rapid growth in teledermatology over the past decade, and teledermatology services are increasingly being used to support patient care across a variety of care settings. Teledermatology has the potential to increase access to high-quality dermatologic care while maintaining clinical efficacy and cost-effectiveness. Recent expansions in telemedicine reimbursement from the Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will play an increasingly prominent role in patient care. Therefore, it is important that dermatologists be well informed of both the promises of teledermatology and the potential practice challenges a continuously evolving mode of care delivery brings. In this article, we will review the evidence on the clinical and cost-effectiveness of teledermatology and we will discuss system-level and practice-level barriers to successful teledermatology implementation as well as potential implications for dermatologists.

Keywords: barriers; cost-effectiveness; health care costs; medicolegal; reimbursement; store-and-forward; teledermatology.

Figure 1:

States Providing Medicaid Reimbursement for Store-and-Forward Teledermatology^{a a} States in dark blue include: Alaska, Arizona, Connecticut, California, Georgia, Maryland, Minnesota, New Mexico, Nevada, Virginia, Washington

Figure 2:

New 2019 Medicare Communication Technology HCPCS Codes and RVU/Reimbursement Amounts^{a a} These services are not considered Medicare telehealth services and thus are not subject to geographic restrictions (patients must reside in federally designated rural areas) and originating site restrictions (patients must travel to valid originating sites such a provider office, hospital, or health facility). E/M: evaluation and management; RVUs: relative value units