Mobile adoption just keeps marching forward, but someone had best solve the payment issue sooner rather than later.
The move toward accountable care organizations and Medicare's denial of reimbursements for certain preventable readmissions certainly will put some of the onus on hospitals and integrated delivery networks to keep post-discharge patients and those with chronic diseases healthy. It is starting to make economic sense for health systems to invest in remote monitoring for managing complex cases in patients' homes rather than in costly hospital settings.
Grants and government subsidies can help, too, up to a point. This week, Flagstaff Medical Center in Flagstaff, Ariz., announced that it was collaborating with Qualcomm, Verizon Wireless, Zephyr Technology and the National Institutes of Health to monitor patients with congestive heart failure via 3G broadband connections across much of Northern Arizona.
The program, dubbed Care Beyond Walls and Wires, will employ Zephyr home medical devices such as weight scales and blood-pressure monitors to capture patient data, then send readings to the hospital daily via Motorola Droid X2 smartphones on Verizon's network. Flagstaff Medical Center will choose 50 participants who had been hospitalized with CHF or a related heart condition and are at high risk of readmission.
A hospital spokeswoman indicated that many of the potential patients are on far-flung parts of Indian reservations that never had landlines and heretofore have not have much in the way of cellular coverage, either. Nor have they had regular access to ongoing care for their chronic diseases.
This is all great, but let's look across the pond for some longer-term perspective.
We've also just learned that the UK's Department of Health is pleased enough with the reduction in emergency visits, hospital admissions and mortality rates in a demonstration of home telehealth among more than 3,000 people with diabetes, heart failure or chronic obstructive pulmonary disease that British government wants to expand remote monitoring to 3 million people nationwide. The Department of Health calls this the largest randomized trial of telehealth and telecare in the world.
That's right, the National Health Service wants 3 million people, or nearly 5 percent of the entire population of the UK, to have access to home-based telehealth services for chronic conditions. To illustrate the potentially massive scope of the nascent Three Million Lives campaign, a similar percentage of the population in the United States would involve 15.5 million people. (The name sure seems like a tip of the hat to unceremoniously deposed CMS Administrator Dr. Donald Berwick, creator of the 5 Million Lives campaign for hospital safety in the U.S., and a well-known admirer of the NHS.)
A newly published preliminary report found that properly employed telehealth technology can cut emergency visits by 15 percent, emergency admissions by 20 percent, elective hospital admissions by 14 percent and inpatient bed days by 14 percent, while saving the NHS about 8 percent of expenditures. "More strikingly they also demonstrate a 45 percent reduction in mortality rates," the report says.
This all sounds wonderful, except for one ominous question: Who will pay?
Last week at the mHealth Summit in National Harbor, Md., I heard representatives from British telecommunincations giant Vodafone discuss a pilot the company recently ran in conjunction with medical supplier Baxter Healthcare. Working with NHS health trusts in Manchester, England, and Cardiff, Wales, Vodafone provided smartphones to patients who needed semiannual immunoglobin infusions.
The phones allowed the patients to self-administer the infusions at home, while remaining in constant text, voice or video contact with hospital-based nurses. Dr. Axel Nemetz, head of Vodafone mHealth Solutions, reported that the setup cost the NHS £1,500 ($2,320) per home infusion, far less than the £4,000 ($6,200) price tag the same service would carry in the hospital. Plus, patients got treated in their own homes, not in a sterile, discomfiting hospital environment.
Sounds like a win-win, right? Well, not to everyone. "The problem we had was with the hospital administrator," Nemetz said. That £2,500 ($3,880) savings per infusion came right out of each institution's revenue stream, and the two NHS trusts that pay the participating hospitals so far have not been willing to change the reimbursement model, according to Vodafone.
"We would like to roll it out in a broader way," Nemetz said, "but you need to optimize the incentives first."
As the British say, someone is being penny-wise but pound-foolish. On both sides of the Atlantic.
