Tuesday, August 4, 2015

“Online doctor visits can be easy, but Congress thinks they increase costs” | mHealth Insight: the blog of 3G Doctor

In this  followup article for Why Medicare has been so slow to adopt Telemedicine, from August 1, 2015) the assessment that telemedicine could increase costs for  CMS

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it. Anthem and a health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient

Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers

I think this is nothing more than a lack of acceptance that the world has changed and a defence of the outdated approach that’s being taken to maintain the status quo. The 2000 year old office visit model is dead thanks to the successes of modern medicine and we now need to serve Patients with chronic conditions in between office visits.

In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services — barely a blip compared with the program’s total spending of $466 billion, according to a study in the journal Telemedicine
Can you imagine any other service industry spending just 0.001% of their budgets serving customers remotely? Is it any wonder the US healthcare system wastes so much money on extended hospital stays and avoidable readmissions when you realise insurers are investing so little in supporting Patients the moment they leave the building?
“The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel,” Ateev Mehrotra, a Rand Corp. analyst, told a House Energy and Commerce subcommittee last year. “Telehealth may be ‘too convenient.’ 
Ateev hasn’t yet realised that the new definition of quality in healthcare is convenience. Arguing against making care convenient while the US spends $3.8 Trillion a year on healthcare is nonsensical, you might as well start building Hospitals on top of very steep hills and build steep staircases in front of the doors of Primary Care Clinics.
But the telemedicine industry says letting more beneficiaries get care online would reduce doctor visits and emergency care. Industry officials, as well as the American Medical Association, the American Hospital Association and other health experts, say it’s time for Congress to expand use of telemedicine in Medicare
It’s not just the “telemedicine industry” (a term I see being used in the USA to refer to vendors trying to flog expensive outdated bespoke equipment to Doctors when they could for the large part make do with the mobile devices they already have in their pockets) eg. check out the evidence published by John Bachman MD, Professor of Primary Care at the Mayo Clinic, that shows how remote interaction using nothing more than the tools of our time can reduce the need for GP visits by 40%.
Popular outside Medicare. “There is no question that telemedicine is going to be an increasingly important portal for doctors and other providers to stay connected with patients,” former Surgeon General Richard Carmona said in an interview

Telemedicine offers all these features.

There are many devices akin to telehealth that offer improvement and significant leverage in bringing technology to patients in their homes.

Microsoft XBOX, Sony Playstation 

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