Sunday, October 3, 2010

Telemedicine Needed Today

Donald M. Berwick M.D, the Administrator for CMS and Mark McClellan M.D. a past Administrator of CMS, Former Commissioner for FDA, and presently Director of the Engelberg Center for Health Care Reform at Brookings, were joint keynoters at the 2010 ATA Mid-Year Meeting luncheon. Both keynote speakers are increasingly enthusiastic about the adoption of telemedicine but also realize the important need for reimbursement for these services.

Both past administrators understand that to achieve these goals for telemedicine, the healthcare system along with CMS needs to improve medical services, reduce costs, and very importantly reach underserved populations both in rural and urban populations.

As Jonathan Linkous CEO, ATA told the meeting attendees in his introduction, “It is a pleasure to have two bipartisan leaders speaking today that are enthusiastic about the use of telemedicine to deliver care to the mainstream population.”

According to Dr. Berwick, he has a great deal of respect for telemedicine since he used telemedicine first hand in Alaska in 1997. As a pediatrician, he would fly to outlying villages to provide care and would sometimes see 40 to 50 kids when the community health worker felt that their health issues needed to be discussed and seen by a pediatrician.

In one case, a child was having hearing problems but after Dr. Berwick saw the child, he realized that the child was autistic. He was able to remotely connect the child to a child psychologist and then to the school for counseling. The psychologist and the school were able to remotely develop a plan of action, and as Dr. Berwick told the meeting attendees, the geographic barriers melted away.

Dr. Berwick recalls growing up in a small town in Connecticut where his father was the old time physician and did everything himself. He worked very hard and went out in the middle of the night. He didn’t realize it but he was actually practicing patient-centered care but that was the only way he knew to practice medicine.

As Dr. Berwick said, “Today, the system doesn’t provide the healthcare that we need but it is not out of our reach.” He is hopeful that the Accountable Care Act (ACA) passed to address healthcare reform will help to redesign, reshape, and help the system invest in different versions of integrated care such as Accountable Care Organizations (ACO) and medical homes.

According to the head of CMS, in order to redesign the system, goals have to be established to provide better care for individuals. CMS is going to begin to reward better care for five prevalent conditions, provide better healthcare for populations, and reduce per capita costs by eliminating waste and ineffectual ways that care is provided. One of the most important overall goals will be to provide better integrated care so the patient is not lost in the system.

McClellan’s remarks concentrated primarily on potential future cost savings. It is anticipated that there will be a savings resulting from the ACA with potential cost savings of $29 billion over the next ten years. As McClellan sees it, telemedicine will play an important part in this savings when telemedicine technologies used to deliver healthcare becomes the norm.

Like Dr. Berwick, McClellan looks at ACOs and sees telemedicine technologies used to create efficient delivery systems to support teams of physicians, hospitals, and other healthcare providers to collaboratively manage and coordinate care for Medicare beneficiaries. If these providers meet certain quality and efficiency benchmarks such as reducing duplicative services, improve productivity, or minimize paperwork, they may receive a share of any savings.

As McClellan reports, CMS is working to make the ACO program operational by January 1, 2012. Unlike other provisions on payment reform, ACOs will be a real part of Medicare and will not operate as a pilot, a demo, but be part of the Medicare program Proposed rules will be issued later this year plus CMS and partner organizations will continue to held public forums.

Other key cost saving provisions as a result of the ACA is the creation of the Center for Medicare and Medicaid Innovation to support the ongoing development for new models of payment and delivery. Ten million has been invested in the Center for the next 10 years to test payment and delivery innovations.

In addition, The ACA will establish the Independent Payment Advisory Board (IPAB) to monitor the fiscal health of the Medicare program and to recommend payment policy revision to contain Medicare cost growth. The IPAB begins its work in 2012 and will need to submit recommendations on an annual basis to Congress.