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September/October 2007 Volume 10 Issue 5
Telehealth Systems & Services
Two recent news announcements from health information technology (IT) oriented groups emphasized the need to meet rising demand for consumer and home care services. One important initial step is to establish health IT guidelines and standards for medical devices, which is being addressed by the Continua Health Alliance, an organization with more than 130 members.[1] Many hospitals and health systems to streamline operations and improve patient care. Saint Luke's Health System of Kansas City has successfully implemented health IT, and an overview of its long-term home care services will be presented at the Collaborative Communications Summit from November 5th - 6th, 2007.[2]
The Need For Home-Based Services
A Continua spokesperson suggested that consumer and telehealth systems will be key components to meet rising demand for in-home to help elderly individuals as well as patients with chronic diseases. Current numbers of health care professionals and hospital beds are not likely to be sufficient for future needs. Two of the factors that fuel implementation of telehealth and telemedicine services are ongoing problems with the U.S. health care system and increasing numbers of individuals who require long-term disease management and support.
Lack Of Reimbursement
As highlighted in the Continua press release, insurance companies need to be convinced that reimbursement for telehealth services is justified. Continua contracted with Abt Associates (Cambridge MA) to review telehealth literature from the past five years on remote monitoring (e.g., disease management) in Europe and the United States.
Reimbursement policies and payment criteria are difficult to keep up with, even for home health agencies. In August, new rules for the Home Health Prospective Payment System were issued, which will go into effect for the new season in January 2008. As noted in an article published in the Home Care Automation Report, current payment levels can be compared with expected payments, but such estimates may be of limited value. On the surface, a reasonable assumption is that clinic parameters will remain the same from 2007 to 2008. The new rules, however, essentially double the number of Home Health Resource Groups by taking into account whether patients are new or have received services for multiple episodes. Historical data needs to be evaluated on component levels to generate meaningful projections. The HCAR is presenting a four-part series in September 2007 that discusses the details. [3]
Historical Perspectives
When the Health Care Financing Administration (HCFA) introduced its Prospective Payment System (PPS) in 2000, the change in reimbursement was implemented to support "quality efficient home health care" (Medicare News Press Release, June 2000). One very important issue for home health agencies was determining whether or not telehealth technologies would meet PPS criteria and potentially offset the significantly reduced reimbursement levels that were expected. At the time, figures attributed to the National Association for Home Care estimated that 8.0 million individuals in the United States required home care services for acute or terminal illnesses, long-term health conditions, or permanent disabilities.
In an October 2000 report published by Feedback Research Services, several industry participants and analysts offered their perspectives on the impact of PPS. One source did not expect PPS to significantly impact use of telehealth systems, while another felt that the number of reimbursed home visits would be reduced by 66% or more in 2001. A third source speculated that the number of home health agencies would decrease by 50% from 2000 to 2001 due to closures and/or consolidation.
Telehealth Equipment & Systems
A reader survey was conducted by Home Care Automation Report (HCAR) in May 2006 to provide a counterpoint to a previously published estimate that suggested "more than half" of Medicare-certified home care agencies use home telehealth systems. The findings revealed that slightly more than one-third of 368 HCAR reader-respondents identified their agencies as "home telehealth users", and 19% were considering implementation of telehealth in the future. Another article from November 2006 noted that a spokesperson for the University Of Michigan Health System indicated that its Telemedicine Resource Center served approximately twice the number of patients in 2006 than in 2004. A figure attributed to the American Telemedicine Association provided a rough estimate of 50,000 households that used home telehealth services (November 2006).[4]
A brief review of recent literature (2007) indicates there are several companies competing in the telehealth market. As reported in an article from April 2007, VNA Of Care New England has established a program that enables registered nurses to remotely monitor patients' vital signs. In May 2007, WebVMC was selected to provide web-based patient monitoring for a one-year study of 50 patients. The program is sponsored by the State of Kansas Department of Aging, the University of Kansas Medical Center Telemedicine Program, and Windsor Place At-Home Care. In July 2007, the Visiting Nurse Service of New York announced selection of Viterion TeleHealthcare's systems for use in its telehealth program serving various boroughs in New York City. A primary goal will be to eliminate the need for rehospitalization for an estimated 2,700 home health patients. In August 2007, RTX Healthcare (Denmark) received market clearance from the U.S. Food and Drug Administration for its RTX3370 wireless telehealth monitor. Desirable features include simplicity of use for elderly patients and interoperability with any clinical information system. [RTX Healthcare is a member of the Continua Health Alliance.]
[1] "U.S. Lags Globally in High-Speed Internet", Los Angeles Times (Business News), June 30th, 2007 (http://redding.com/news/2007).
[2] "Satellite Launching Fee To Come Down", Chennai Online, June 22nd, 2007 (http://in.news.yahoo.com).
[3] "Telemedicine", Outlook India, June 23rd, 2007(www.outlookindia.com).
[4] "Structured Cabling Market Poised for Huge Growth", CIOL Bureau, June 27th, 2007 (www.ciol.com).
