One of the easiest and, certainly, least controversial (i.e., non-partisan) ways to improve access to quality health care is through telemedicine and related remote care technologies. Despite its ready availability, adoption of telemedicine has been limited at best. The biggest barriers are current reimbursement models that fail to encourage adoption of such technology.
To illustrate why better and wider access to remote care is necessary, allow me to share a very personal story. My father, who lives in a small town, woke up one morning with what he thought was heartburn. After putting off going to a doctor for about an hour, he eventually sought medical care. The doctor diagnosed that he had suffered a heart attack and needed an emergency pacemaker. Unfortunately, that doctor and every other physician in town didn’t have the skills to implant the pacemaker, and the nearest facility was two hours away.
By Sanjeev Gupta, General Manager, Avaya Healthcare Solutions
Healthcare reform was the hot-button issue in the presidential election, alongside job creation, of course. While there is a great deal of debate on “Obamacare” and its worthiness and likely impact, both political parties generally agree that the current U.S. health care spend – at more than 17 percent of GDP – is far too high and isn’t delivering the expected benefits in both the quality of and patient access to care.
One of the easiest and, certainly, least controversial (i.e., non-partisan) ways to improve access to quality health care is through telemedicine and related remote care technologies. Despite its ready availability, adoption of telemedicine has been limited at best. The biggest barriers are current reimbursement models that fail to encourage adoption of such technology.
To illustrate why better and wider access to remote care is necessary, allow me to share a very personal story. My father, who lives in a small town, woke up one morning with what he thought was heartburn. After putting off going to a doctor for about an hour, he eventually sought medical care. The doctor diagnosed that he had suffered a heart attack and needed an emergency pacemaker. Unfortunately, that doctor and every other physician in town didn’t have the skills to implant the pacemaker, and the nearest facility was two hours away.
Facing no other option, he was raced by ambulance to the heart facility. On arrival, his pulse rate was alarmingly high. Despite some rather anxious moments, my father received stellar treatment and is now on the path to recovery.
Yet, my father’s experience is not typically the norm. Every year more than 600,000 Americans die from heart attacks. Most experts agree that the mortality rate from heart disease would likely decline if telemedicine solutions were more widely available.
In my father’s case, the doctor could have “called” a heart specialist at a regional center, sharing video feeds as guidance for how to best treat the patient, install an emergency pacemaker, and administer appropriate medications.
There are other conditions, such as strokes, that are often fatal without early diagnosis and treatment. Annually, more than 730,000 Americans suffer strokes, yet only a minority of the U.S. population has timely access to primary stroke care centers. In fact, a survey of facilities in the Pacific Northwest found that 88 percent lacked access, either directly or via telemedicine, to a stroke neurologist.
More than 50 million Americans today live in rural locations, with little access to cardiac or neurologic care. For them, telemedicine could mean the difference between life and death.
So what’s holding back deployment? As usual, it comes down to money. Historically, the impediment to telemedicine has been a lack of reimbursement models. While many states have legislated to pay for telemedicine, there are only 15 states that reimburse telemedicine at the same rate as face-to-face consults: California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, Maryland, Michigan, New Hampshire, Oklahoma, Oregon, Pennsylvania, Texas, and Virginia; 24 other states cover just a portion of telemedicine expense.
Paradoxically, while more than 75 percent of Medicare funds are spent on patients with five or more chronic diseases, existing reimbursement models do not support remote-patient monitoring via telemedicine.
Numerous analyses have proven the viability and reliability of remote-patient monitoring. A Veterans’ Administration study of more than 17,000 patients in a telehealth/home-based chronic disease management program showed a 25 percent reduction in number of bed-days-of-care and a 19 percent reduction in hospital admissions. The cost of this program is just $1,600 per patient annually, substantially less than nursing home care or home-based nursing.
Technologies to support remote-patient monitoring, such as Bluetooth-enabled weight scales and blood glucometers are commercially available and are easily linked to dedicated homes devices or Smartphones to collect and transmit data to health care providers. In fact, an Israeli company, Lifewatch, makes an Android-based phone with a plethora of built-in medical sensors powering seven health tests, such as lead ECG, body temperature, and blood glucose.
Insurance providers, obviously, benefit if patients are kept healthy via telemedicine and don’t need emergency care. But health care reimbursement is a much more complicated issue. Health care providers, who would have to manage the remote-patient monitoring program, choose the care plans. Yet, they would be reimbursed based on a “per-episode-of-care” model. As a result, these providers lack the incentive to make the required upfront investments in remote patient monitoring.
A shift from episodic care (i.e., pay per episode of care) to lifecycle of patient care (i.e., fixed payments per patient for yearly care) through the formation of accountable care organizations would help drive adoption. With such payment models in place, care organizations would have clear incentive to proactively manage a patient’s care instead of reacting to expensive treatment options, such as emergency room visits.
In the end, the rationale is straightforward and clear. Telemedicine technology is readily available. Its deployment could mean the difference between life and death for thousands of patients a year, while ultimately lowering the overall cost on the system. This should be a no-brainer.
