Sunday, April 25, 2010

Telehealth Vital in Home Care

Speakers at the Senate Special Committee on Aging hearing on April 22nd emphasized the need to use telehealth technologies to improve patient care especially in the aging population. Speakers from the FCC, several universities, Office of the National Coordinator at HHS, and Intel, appeared to discuss aging in place by bringing healthcare technology into the home, as well as addressing the regulatory issues involved.

As Senator Herb Kohl (D-WI) Chairman of the Committee stated “there are still stumbling blocks that stand in the way of the widespread adoption of telehealth technology in the home.” The speakers agreed that connectivity gaps, misaligned economic incentives, and outdated regulations are preventing the increased usage of technologies in the home.

Richard Kuebler Department Head for Telehealth at the University of Tennessee Health Science Center (UTHSC) in Memphis explained how UTHSC research outcomes show how home-based telehealth helps at-risk populations with congestive heart failure decrease hospital admissions by 80 percent. He said, “The national implications of using telehealth in this single specialty could reduce healthcare costs by $3.8 billion. The telehealth program at the university shows that telehealth saves lives, increases the quality of life, and has successfully treated chronic diseases across the state and the entire region.”

He noted that by using telehealth technologies, the aging population prevents unnecessary hospital stays and nursing home enrollments. The significant cost of healthcare for our aging population is undeniable and UTHSC has demonstrated that in using telehealth cost savings exist with limitless potential to deliver quality medical care.

The American Telemedicine Association (ATA) presented a statement to the Committee on the changes needed by Medicare and Medicaid to bring telehealth into the home along with information on other issues affecting the use of medical technology in the home.

ATA is quick to point out that an important restriction in Medicare’s coverage of telehealth is the lack of coverage for video conferencing which is the most common telehealth method used for beneficiaries in metropolitan areas.

This means that 79 percent of Medicare’s beneficiaries are blocked from accessing these cost effective vital health services. Also in this fast evolving technology environment, it should be noted that soon mobile phone devices will be able to conduct video conferencing.

Medicare law essentially states that a beneficiary must be served at the site located in a county that is not included in a Metropolitan Statistical Area. This essentially bars reimbursement in all but the most rural parts of America.

A second restriction is that Medicare essentially does not cover remote patient monitoring, which has proven to be critical for managing chronic conditions and helps beneficiaries get care and at the same time, does not require treating patients in expensive hospitals and nursing homes.

A third restriction is that the major therapist categories such as physical and occupational therapy, speech-language pathologists, and audiologists are not covered for telehealth to the extent they are covered for other Medicare services.

As for telehealth use in the states under Medicaid, home telehealth may only be provided under waiver, but only seven states so far have established such waivers however, two more states have demonstration programs.

Home telehealth and remote monitoring both benefit both the aging and younger patients with disabilities. Although the primary focus of the Committee is on aging, the inclusion of all Medicaid recipients with disabilities to be able to obtain telehealth services yields economies of scale, efficiencies, and continuity of care.

Specifically, ATA wants to see several changes:

• Home telehealth needs to be used to monitor chronic conditions by home health agencies and physicians, but it is also important to accommodate other clinical applications as well, notably telemental health for depression and telerehabilitation for stroke care

• Since the Medicare home health benefit is very short-term focused, other service providers such as Federally-qualified Health Centers and the Indian Health Service and tribal entities should be eligible to participate

• There are health provider shortages in both rural and urban areas. Federal designations of health professional shortage areas, medically underserved areas, and medically underserved populations highlight these concerns

• Transportation problems are multiple and diverse. While federal and other public funds for special transportation services address this issue, they fall short. On an individual level, there are several reasons why travel may be difficult for many seniors, notably those with disabilities and other limitations on mobility, medical conditions and the inability to drive, or the need to reduce their driving time. Telemedicine can be an important part of this solution to their transportation problems

Mohit Kaushal M.D. Digital Health Care Director for the FCC brought up an important point as it relates to the regulatory uncertainty that exists regarding the convergence of telecommunications and medical devices.

The problem is that smart phones, video conferencing equipment, and wireless routers are regulated solely by the FCC. However, medical devices including life critical wireless devices such as remotely controlled drug release mechanisms are regulated by the FDA. To deal with this regulatory issue, the FCC and FDA are going to hold a workshop with industry at the end of the summer to propose specific solutions on how to remedy the problem.