Two thumbs down: Medicare’s AAC policy
 “It’s stupid of insurance companies to insist on an inferior device costing 10 times as much,” Roger Ebert wrote in a letter to the Editor of the New York Times last week. Ebert, the famous film critic, was responding to a feature the Times had recently published about Medicare only covering dedicated text-to-speech devices, even though those devices are typically far more expensive than multi-functional devices like the iPhone, which also offers text-to-speech applications. People who lack the ability to speak, perhaps due to ALS or Down Syndrome, often use text-to-speech devices to communicate.
At a time when everyone is debating how best to reduce costs and improve efficiencies in the U.S. healthcare system, it’s easy to sympathize with Ebert’s frustration. Why spend thousands of dollars more per patient when another device may work just as well for some patients who need text-to-speech technology?
Medicare decided to extend coverage to text-to-speech devices eight years ago, partly because they concluded that the devices were included within their definition for “durable medical equipment,” which is the over-arching category for most medical devices for home use — everything from wheel chairs to blood glucose monitors. You can bet that any reform that comes out of the focus on text-to-speech devices will have an effect on whether other medical services offered via mobile phones gain Medicare reimbursement.
The Medicare National Coverage Determinations Manual has a very specific definition for the “Speech Generating Devices” that Medicare covers: “Speech generating devices are defined as speech aids that provide an individual who has a severe speech impairment with the ability to meet his functional speaking needs,” the manual reads. Among the requirements for coverage are: “Being a dedicated speech device, used solely by the individual who has a severe speech impairment; May be software that allows a laptop computer, desktop computer or personal digital assistant (PDA) to function as a speech generating device.”
Characteristics of devices or software that result in exclusion from compensation, include:
“Devices that are not dedicated speech devices, but are devices that are capable of running software for purposes other than for speech generation, e.g., devices that can also run a word processing package, an accounting program, or perform other than non-medical function. Laptop computers, desktop computers, or PDA’s which may be programmed to perform the same function as a speech generating device, are noncovered since they are not primarily medical in nature and do not meet the definition of [durable medical equipment]. For this reason, they cannot be considered speech-generating devices for Medicare coverage purposes. A device that is useful to someone without severe speech impairment is not considered a speech-generating device for Medicare coverage purposes.”
Clearly an iPod touch, iPhone or any smartphone is useful beyond any one application. Sure, it may seem wasteful if the U.S. government offered reimbursement for mobile phones and music players that also happen to have the ability of meeting some text-to-speech patients needs. The reality is, however, it’s far more wasteful for the federal government not to offer reimbursement for these devices and/or their services, while offering reimbursement for expensive, dedicated alternatives.
Just eight years ago Medicare did not reimburse for text-to-speech devices (also known as Alternative & Augmentative Communication (AAC) devices), and it was a long road to convince Medicare that these devices were medically necessary and not just “convenience items.” Here’s what one proponent of Medicare coverage for text-to-speech devices had to say shortly after they gained reimbursement back in 2001:
“This Medicare policy change has been long in coming. For more than 10 years, the Medicare program had guidance that described AAC devices as ‘convenience items,’ effectively barring access to them by Medicare beneficiaries,” Lewis Golinker, Director, Assistive Technology Law Center explained. “Even though Medicaid programs throughout the country and most insurers recognized the value of AAC devices to individuals unable to functionally communicate by speaking or writing, Medicare persisted with this view. The long-life of this policy had more to do with the small number of people who need AAC devices than with any scientific or policy reasons. AAC devices and the people who needed them simply were invisible to Medicare decision and policy makers whose agendas always seemed to be filled with problems that were more expensive, or that affected a larger number of beneficiaries. In fact, Medicare admitted in mid 1999 that it had no records whatsoever to explain why it called AAC devices ‘convenience items,’ yet it still took nine more months before it concluded the guidance containing this conclusion should be withdrawn.”
Clearly, this type of reform will not happen overnight. Golinker’s observation is still relevant: The slow wheels of change leading up to the 2001 decision had a lot to do with the small number of people who need text-to-speech devices simply being “invisible” to Medicare. The dedicated text-to-speech device makers argue that reaching this small population requires them to charge much more for the devices — it’s not easy or cheap to market to a small segment of the population that is spread throughout it, they argue.
Of course, mass consumer products like iPods and mobile phones don’t have that problem, and, for the most part, their price tags reflect it.
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| Zander: Tracking wireless health’s inflection point
Ed Zander’s 15 years at Sun Microsystems culminated in 1999 when he became the company’s President. In 2004 Zander joined Motorola as that company’s CEO and Chairman until he stepped down early in 2008. Now, a year later, Zander has surfaced as a board member at ZigBee-enabled wireless asset tracking start-up Awarepoint, which focuses on healthcare facilities. With his attention turned to wireless healthcare, Zander recently agreed to an interview with MobiHealthNews that covered his role at Awarepoint, whether wireless healthcare is at an inflection point, how economic concerns are fueling interest in wireless healthcare, and how Awarepoint may go about pursuing federal stimulus dollars for health IT.
MobiHealthNews: Since leaving Motorola last year, you joined the board of directors at Awarepoint, a ZigBee sensor-enabled asset tracking company focused on healthcare facilities. Could you describe how you landed at AwarePoint?
 Ed Zander: Well, to be honest, when I left Moto I decided to stop with the operating roles and I took some time off. I was doing this also while I was at Sun Microsystems and also maintained my interest in start-ups while at Motorola — especially start-ups in Silicon Valley. I always stayed on little boards, dabbled with the VC guys, invested in some funds and so on. When I left [Motorola] one of the things I wanted to do in addition to working with some larger companies [like Time Warner] was to get back into small companies again with entrepreneurs and innovators to see when the next big thing was happening. It just so happens, of course, that Motorola gave me the opportunity to explore mobile, and more importantly the mobile Internet, which is something I have been very interested in even back during my experience at Sun, where we did a lot of Internet activity and believed in the network. We believed back then that eventually broadband would be everywhere.
If you combine all that with the things that Awarepoint is doing with asset tracking, you can start to see that with location-based services, everything in the world will be tagged. The idea that you could improve your asset tracking and, therefore, improve the efficiency of the overall company will eventually happen for every company. We have talked about technologies like RFID for a number of years but interest in that has started and stopped again and again. Partly because of the technology. Some of it was costs and ROI. As we explore the new technologies, like Awarepoint’s system, which uses ZigBee technology, we start to see the cost-benefit ratio that makes these tracking solutions very attractive. I love this area [of location-based services]. I think it is already affecting every human being on the planet. I think it will eventually affect every company on the planet.
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Novartis, Proteus pilot to lead to exclusive deal?
Pharmaceutical giant Novartis has tapped intelligent medicine start-up Proteus Biomedical for a small 20 patient study to track patients’ compliance with their blood pressure drug regimen. The patients are taking blood pressure drug Diovan and the study organizers track their compliance via Proteus’ “chip in the pill” technology, which reports to a receiver sensor on the patient’s shoulder when the medication has been ingested. The study has improved compliance from 30 percent to 80 percent after six months, according to Novartis.
Proteus’ Raisin technology runs on an electric charge generated by the patient’s stomach acid. The charge is detected through the patient’s body by a sensing patch on the patient’s skin. The patch records the time and date that the pill is digested and also measures some vitals like heart rate, activity and respiratory patterns. The information is then sent to the patient’s mobile phone and then onto the internet for caregivers to review and analyze.
“This industry is starting to explode,” Joe Jimenez, head of pharmaceuticals at Novartis, told the Financial Times. Jimenez is toying with the idea of hiring a “compliance tsar” to oversee the company’s partnerships and initiatives in this area. Jimenez told the newspaper that challenges to widespread adoption of Proteus’ technology for Novartis would include the obvious regulatory concerns, but, interestingly, Jimenez stressed that Novartis would also have to “negotiate an exclusive contract with Proteus in order to expand the approach,” according to the report.
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Kvedar: Change providers minds about tech
 “The time for connected health really is now,” The Center for Connected Health’s Founder and Director Dr. Joseph Kvedar told attendees during a presentation at MassMEDIC last week.
Make the case for technology
Kvedar said that connected health technology companies have to make the case to providers that their solutions work better and save more money than a medical home solution that uses little technology and requires some traveling nurses: “It’s a matter of changing provider mindsets to be thinking more [about connected health] and then marketing this solution to them,” Kvedar said, “because [providers] will come back with: ‘We just need the medical home, a couple of nurses, a pharmacist and we’ll be fine… we don’t need any tech.’ And if we don’t make the case, we will miss our opportunity for this.”
“Providers will be picking up on [connected health solutions], but I want to mention that we have to make our case. The time is now, the market is ready,” Kvedar said. “There are already people and thought leaders and organizations… trying to solve these problems… and they want to solve them without using technology. We need to get the message out” that some of these connected health solutions really are the best way to manage costs.
Payers are “breathing down providers’ necks”
Kvedar explained that the connected health market is being driven by a number of forces but two of them: care coordination and capitation are key. Care coordination has two large sub-sectors, Kvedar explained, what employers need to do to make sure their costs are met and what they need to do to make sure their employees are well cared for. For capitation, Kvedar noted that Blue Cross Blue Shield of Mass is “really breathing down care providers’ necks” to make sure they are managing costs. Capitation is where the insurance provider pays care providers a flat rate for a year to care for patients and the care provider then has to do its best to control costs within that context. Kvedar said that in the next three years maybe 50 percent of Partners revenue will be capitated.
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| Top Money-maker Health/Medical iPhone Apps
 Apple recently updated its iTunes App Store to include a list of the top 200 highest grossing applications in the entire store. While the App Store does not include a list for the biggest revenue generating apps by category, eight medical, health or fitness iPhone applications are among the top 200 highest grossing apps overall.
The only way to rank apps in the past was by popularity, which seems to rank by number of downloads within a certain period of time. Since some apps costs much more than others, the strategies that go along with service pricing do not factor into an application’s success, if you go by that metric. Ranking apps by the revenue generation, however, does.
You will note that the eight apps range in price from $1.99 to $299.99. Cheaper apps need to appeal to a mass audience to make it into the top grossing apps rankings, however, extremely expensive apps can also make the cut if their content is worth their pricetag. Take a look through this list to determine where your wireless health service’s price tag should fall — or flip through them just to see which health, medical and fitness application developers are raking it in.
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HHS: Value in mobile for reaching minorities
There has been a growing consensus that mobile phones are a key platform for reaching minorities in the U.S. when it comes to health information: Earlier this week we pointed readers to a report by the The Hispanic Institute and Mobile Future that found more than 50 percent of the U.S. Hispanic population uses the mobile Internet, while one about one third of U.S. whites do. The Pew Internet Group has published research that concluded this many times in the past. Now, a federal government official has publicly agreed:
“The fact is that minorities are more likely to look for health information on the Web,” Garth Graham, the Department of Health and Human Services’ Deputy Assistant Secretary of Minority Health, said during a keynote speech on Capitol Hill this week. “That creates an opportunity for health technologists to reduce health disparities. However, the government can be directive but cannot do it alone.”
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Methodist Healthcare: Wireless = more nurses
GE Healthcare and Sprint teamed up to update San Antonio, TX-based Methodist Healthcare’s six hospitals with a converged wireless network platform. The healthcare group’s CIO noted that the new system may result in a bigger budget to hire more healthcare provider workers, and mentioned nurses as an example.
“We have to work to make hospitals more efficient,” Eddie Cuellar, CIO of Methodist Healthcare told TelephonyOnline in a recent interview. “Our doctors and nurses need tools that are wireless so that they don’t have to be tethered to a phone or a computer. If a nurse needs to reach a doctor with a question when she is administering some medication and that doctor is walking the halls of the hospital, wireless is the only way to reach him.”
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Topol: Wireless medicine spans diseases, ages
Dr. Eric J. Topol, chief academic officer of Scripps Health, director of Scripps Translational Science Institute (STSI), and chief medical officer of the West Wireless Health Institute, penned a column about wireless healthcare over at VentureBeat this past weekend:
“This morphing of medicine centers on an unprecedented surge of technological and medical innovation. We have the tools to take full advantage of the genomics gold rush and to harness the power of the hundreds of ingenious wireless sensors in development. These non-invasive, wearable sensors, in the form of disposable bandages and pills, transform the human body into an information gateway. Vital signs and wellness information can be sent real-time to the people that need it most, whether it goes to a medical center, physician or back to the individual or their caregiver.”
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Three categories for medical body area networks
Paolo Bonato holds many titles: Director of the Motion Analysis Laboratory at Boston’s Spaulding Rehabilitation Hospital; assistant professor of physical medicine and rehabilitation at Harvard Medical School; chair of the 2008 IEEE Engineering in Medicine and Biology Society (EMBS) Technical Committee on Wearable Biomedical Sensors and Systems. Bonato’s work focuses on technology like wearable technology and robotics for the rehabilitation of disabled people.
According to an interview with Scientific American, Bonato puts medical body area networks into three groups:
“Those used to monitor a patient’s general health or ‘wellness,’ those measuring the health of the elderly, and those used to monitor patients with long-term medical conditions such as Parkinson’s disease or epilepsy,” Bonato said. “Some conditions could be monitored in the field,” he told SA. “We can’t put everyone in medical facilities.”
For more on MBANs, dedicated wireless healthcare, GE and Bonato, read this article from Scientific American.
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Survey: Connected health to cut HC costs 40%
Seventy-five percent of healthcare providers, patients, payers and technology enablers surveyed by Cambridge Consultants said that connected health preventative practice could cut healthcare expenses by 40 percent. Cambridge Consultants conducted the survey in conjunction with the Massachusetts Medical Device Industry Council (MassMEDIC).
The two groups define a “Connected Health” approach like so: “An integrated Connected Health approach advocates an end to end solution, giving patients control as well as responsibility and connecting them with a wide network of healthcare professionals and online applications. This integration can be achieved through a range of technologies, beginning with Electronic Medical Records and expanding outside clinical settings via connected devices such as glucometers and inhalers. This approach can improve medication adherence, enable early detection, reduce long-term treatment costs, and improve patient access to, and interaction with, healthcare providers.”
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Mobile health: Opportunity for reaching Hispanics
The Hispanic Institute and Mobile Future recently published a study of Hispanic Americans’ adoption of mobile technology, and the Huffington Post’s Jonathan Spalter concludes that the healthcare industry needs to reach out to the Hispanic population via the mobile platform based on the group’s staggering adoption rates of mobile technologies. To wit: More than 50 percent of the U.S. Hispanic population uses the mobile Internet, while one about one third of U.S. whites use the mobile Internet. Spalter explains:
“The report suggests ways to improve access to health care, education and economic opportunity, all through encouraging wireless innovation. Take health care. Hispanics are more likely than some other groups to suffer from diabetes, obesity and cardiovascular disease. Text messaging is an obvious and inexpensive way to expand preventive care by reminding people to check their blood sugar levels, check their blood pressure or take their medications. Wireless monitoring of a heart condition is already a reality.”
Spalter rightly points to the Pew Internet’s work on the opportunity for the healthcare industry to reach the Hispanic population in the U.S. via the mobile platform, as they have been beating that drum for a long while — more here.
Read more from the HuffPo here.
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Shorts: Continua praises Senate; FCC on "open"
FCC’s Open Internet threatens telemedicine? A PBS Nightly Business Report yesterday noted that the new FCC Chairman, Julius Genachowski’s plans for an open Internet could end up stunting growth in telemedicine or wireless health services. AT&T, Verizon and Comcast are worried that proposed FCC requirements to treat all web traffic equally will prevent them from effectively managing their networks: “For example, they might not be able to give priority to tele- medicine or smart-grid applications,” PBS reports. “Verizon’s David Young says new rules could stunt growth.” More
CellTrust launches dedicated healthcare division: CellTrust, a provider of SecureSMS for mobile phones, launched a dedicated healthcare division today called: Secure Mobile Healthcare Division. The team within the new division offers “a suite of Secure Mobile Healthcare Information Management applications designed to enhance the three core National Health IT initiatives – electronic medical data management, cost reduction and coordinated patient care,” the company said. More
Continua Health Alliance backs Senate’s health bill: The personal health devices interoperability alliance, Continua Health commended the Senate Finance Committee’s work on the America’s Health Future Act of 2009: “The Chairman’s Mark will empower patients to live independently while taking a proactive role in their own care from the comfort and convenience of their homes,” stated Chuck Parker, executive director of Continua Health Alliance in a statement. “The references in this legislation will help enable solutions that address the problems of aging, chronic disease and physical impairments through the provision of telehealth, remote monitoring and wellness and care coordination services. We look forward to supporting the committee’s work as this legislation is debated and moves forward.” More
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