Today, Medicare is releasing data on in-patient hospital costs across the country to provide consumers/patients with cost comparison information. Unsurprisingly, the data are interesting and price discrepancies staggering, but the release of the data itself is also fascinating as yet another example of big government opening its vaults, so to speak, as well as adding more momentum to the power shift in healthcare from physicians/providers toward consumers/patients.
This move clearly speaks to the idea that access to information can drive behavior/decision making and that access to cost information can harness the power of the medical consumer to drive costs down.
The team at Popper and Company has focused, since the firm’s inception ten years ago, on technologies and services that improve quality and decrease cost in healthcare. We believe that three big trends at play today clearly support this:
- “Consumerification” – the rise of the power of the consumer;
- Access to information, and
- The convergence of technology from other industry segments (e.g., Telecom)
As I asked in an earlier post, is the U.S. consumer ready for so much service choice (or, in this case, so much information)? Where does the responsibility for consumer education fall? To stay on top of healthcare trends, particularly those related to the rising power of the medical consumer and the convergence of technologies, subscribe to our newsletter and follow us on Twitter. I’d also love to hear from you directly.
Tags: healthcare costs, medical consumer, medical technology, Medicare
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In a previous blog post for Popper and Co, I discussed how telehealth can be a life-saving tool in rural and urban settings. As devices get more versatile and affordable, we will start seeing additional efficiencies in health care delivery. Moreover, patients will (if they aren’t already) start demanding it. But does telehealth work in every situation? And how should telehealth systems developers adapt to an individual practice’s needs?
The Center for Telehealth and Cybermedicine Research found that while enthusiasm for telehealth was high among patients and (some) caregivers, not every clinic could perceive a benefit. It is very easy, for example, to lose the advantages of this technology without first doing some preliminary research on your particular center and patients. Telehealth must be needs-driven, filling gaps in health services that are not effectively met.
In some cases, demand for telehealth may not be very high. If patients can find care at other facilities or may be reluctant to seek care for certain diseases, then telehealth may not be helpful. Similarly, if practitioners are reluctant to use telehealth tools, this reluctance may place such a system in jeopardy.
Electronic health record (EHR) integration can be one obstacle to telehealth (at least among practitioners). Aside from data security and confidentiality issues, practitioners perceive converting records to electronic format as a burden. However, conversion is becoming easier, and improvements in remote devices are allowing us to integrate many records and data of patient vital statistics into the system, including blood pressure, weight, oxygen saturation, etc. If developed correctly, EHR adoption, remote monitoring, and health information exchange (HIE) systems can be complementary to telehealth and improve efficiencies in provision of care, improve health outcomes, and reduce costs.
Reimbursement is another issue. A project conducted by our ophthalmology division screened patients with diabetes who were at risk for retinopathy. An eye specialist looked at retinal images with a camera that didn’t require eye drops (therefore, a highly skilled caregiver wasn’t needed at the patient’s location). Two hundred patients were scanned, and approximately 40 percent of them needed referrals. Of those referrals, 5 percent were in danger of going blind without immediate treatment. Here, telehealth provided better access, improved patient health, and reduced costs of care. Yet Medicare would not cover these types of diagnostic image interpretations (called “Store and Forward”) and related referral services, because it only covers that type of Store and Forward remote services in Alaska and Hawaii. On an optimistic note: Coverage requirements can change (in fact, Medicare has already changed coverage rules for some services)!
Other obstacles to telehealth success include:
- Not thinking about sustainability. Your program may have started out with a grant, but it needs to continue operating after the grant expires. Controlling technology costs is key, as is finding out which technology is most appropriate.
- What’s the best technology? It’s always changing, making it hard to know where to turn. And often, the latest tool isn’t the best solution for a specific practice or facility. At the Center, we are always helping end-users develop the right technology mix. Often, the right mix may have to be invented.
- Telehealth may not immediately fit into a practice’s workflow. If you only have one patient using your conferencing facility, that’s a problem. Reasonable volume is key to providing adequate return on investment, as is making telehealth systems scalable to incorporate other health services. You’ll need to develop a business operating plan stating how telehealth encounters will be scheduled, how to document each encounter, what you need to build and design, how many staff you need, and what your upfront and operating costs are.
- Lack of data. Make sure you document your encounters, and analyze whether your programs are successful. How many more patients did you see? What were the outcomes? What’s the impact on costs? This data also is crucial for systems developers to create the right solutions for telehealth.
Telehealth and information technologies are needed for healthcare reform in this country. It’s going to be an interesting time, getting people connected to care. But it’s the way we do it that’s going to make the biggest difference.
Do you work for a technology company that aims to make a difference in how telehealth is practiced? Are you a health care provider who believes telehealth can make a significant impact to your practice? What, if any, are its limitations? Please tell us what you think.
Tags: cybermedicine, health technology, medical technology, telehealth system developers, telehealth systems, teleheath, telemedicine
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Wireless technology is evolving in positive ways. It’s now more affordable, more accessible (thanks to broadband capacity), and more portable (via devices such as tablets and smartphones). And it is no exaggeration to say that this technology has made a life-saving difference for many patients who otherwise would not get care.
At the Center for Telehealth and Cybermedicine Research at the University of New Mexico, we studied the ability of telehealth tools (e.g., video connections, conference calling, electronic record sharing) to improve access and outcomes of rural New Mexicans suffering from a variety of health problems. In that role, we have been the incubator for several applications of telehealth designed to integrate the technologies that address important healthcare needs and gaps in access. One example was hepatitis C. While this disease is curable, multiple treatments are required and patients must be monitored for adverse effects. Project ECHO (Extension for Community Healthcare Outcomes) was initially incubated in our Center under the leadership of Dr. Sanjeev Arora. That project was recently published in the New England Journal of Medicine demonstrating how the program provided community healthcare providers with the expertise and tools they needed to treat hundreds, if not thousands, of people who previously were receiving no care for hepatitis C. In addition, outcomes of these remote patients were as good as outcomes of patients who traveled (often hundreds of miles) to the University’s medical center in Albuquerque.
This model was successful enough that it is now being expanded into other treatment areas, such as cardiology, rheumatology, and even adolescent psychiatry. For example, adolescents on Indian reservations, who have very high rates of suicide, are benefitting from counseling. Once the patient and practitioner are familiar with the technology, online counseling sessions are very similar to face-to-face encounters.
In addition to improving patient outcomes and access to care, telehealth can reduce costs in the clinic. At the University of New Mexico, our head of neurosurgery worked with The Center to set up a system where surgeons could view patient CT scans through a secure web portal. Because of this system, 44 percent of risky patient transfers were avoided, simply by looking at the scans remotely before surgery.
In rural New Mexico, the access improvements of telehealth appear obvious (though telehealth doesn’t work in every situation, an issue I’ll discuss in a future post). But the technology can also work in urban areas, bypassing transportation and traffic congestion problems by bringing virtual care to the patient. This is health care where it’s needed, when it’s needed.
One effect of health care reform that isn’t making headlines is that increased demand for services will be placed on a limited resource: existing health care providers. But telehealth systems will help meet this new demand by providing services to nearly everyone. For example, Dr. Arora, one of the few liver specialists in New Mexico, stated as we helped start his project that he couldn’t personally treat the 30,000 New Mexicans with hepatitis C at that time. But with the help of specialists—such as Dr. Arora and his team—at the touch of a button or the click of a mouse, community practitioners can readily access experts.
What do you see as the limitations of telehealth? Is rural New Mexico a truly unique niche for this technology? In my next post, we’ll discuss the importance of setting up an operating plan, and more cost-cutting benefits of telehealth. In the mean time, if you have any questions about my telehealth study or work, please post them here.
Tags: cybermedicine, health technology, medical technology, teleheath, teleheath study in New Mexico, telemedicine
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A recent issue of The New Yorker included an interesting article by Jonah Lehrer entitled, The Truth Wears Off—Is there something wrong with the scientific method? The article focuses on the “decline effect,” which has been observed and debated in various studies in disciplines ranging from psychology to pharmacology to biomedical research. One of the observations is: As more trials were conducted with a given agent, the less efficacious that agent appeared. In many cases, the agent was no better than its predecessor, even though the initial study results were significant.
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Tags: biotech, FDA, jonah lehrer, JP Morgan Healthcare Conference, life sciences, medical technology, patti doherty, product development
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