Decisions About Being Old and Single
INTERESTING STUFF – 27 June 2015

House Calls, Telemedicine and Medicare

Medicare is in the third year of testing its Independent at Home demonstration project to see if it can improve care and cut costs for some of its more frail patients with house calls. The idea is to test

”...how well a house call approach really works and how to pay for it. About 8,400 frail seniors with multiple chronic conditions — Medicare's most expensive type of patient — are receiving customized home-based primary care from 17 programs around the country,” according to a story at Yahoo! News.

The study was created by The Affordable Care Act and legislation is pending in Congress to extend the project another two years. Meanwhile, Medicare has released an analysis of the project's first year. Results so far?

”...it saved an average of $3,070 per participating beneficiary.”

Meanwhile, in Cincinnati,

”Donna Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor,” reports Kaiser Health News.

“So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.

“'This was so easy,' Miles said.

These two developments, small as the trials are so far, are crucial to the future of elder healthcare and here's why. The 65-plus population the United States has grown dramatically since President Lyndon B. Johnson signed Medicare into law 50 years ago.

In 1965, there were approximately 18 million people age 65 and older in the United States. Today, there are about 41 million and in 2050, there will be more than 88 million.

This is a problem. There are few enough doctors to go around now and it is becoming well known that remaining in our homes, where nearly 90 percent of elders want to be as they age, is less expensive than living in care residences but for some, getting out and around becomes problematic.

Telemedicine and house calls will make remaining home more feasible and can save time (for physicians and patients) and save money too. Not to mention that it makes getting care for people with mobility problems a whole lot easier.

And, house calls these days are a far cry from what I remember as a kid 65 years ago. According to the Yahoo! News report:

”Forget the little black bag of yore. Today's house calls can result in an EKG in the living room, and on-the-spot tests for infections. Providers can use portable X-rays, check medicine bottles to tell if patients are taking their pills, spot tripping hazards, and peek in the kitchen to see if healthy food is on hand.

"'It helps you avoid the emergency situations,' said Naomi Rasmussen, whose 83-year-old father in Portland, Oregon, is part of Medicare's Independence at Home study.”

Videoconference technology has been available for 20 years and I've read dozens of reports over the years of how it will revolutionize healthcare but it has been incredibly slow to get going. Hardly anyone can use it yet.

”...fewer than 1 percent of Medicare beneficiaries use it,” reports Kaiser. “Anthem and a University of Pittsburgh Medical Center 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.”

Nevertheless, the innovation is moving forward, if slowly. Many more younger, non-Medicare, patients have access to telemedicine, the number of insurance providers that offer the service is increasing and Medicare is tiptoeing toward change too:

”Medicare Advantage plans have the option to offer telemedicine without the tight restrictions in the traditional Medicare program because they are paid a fixed amount by the federal government to care for seniors. As a result, Medicare is not directly paying for the telemedicine services; instead, the services are paid for through plan revenue.

“Republicans and Democrats in Congress are also considering broadening the use of telemedicine; some of them tried unsuccessfully to add such provisions to the recent law that revamped Medicare doctor payment rules and to the House bill that seeks to streamline drug approvals,” reports Yahoo! News.

To me, telemedicine and house calls are such a no brainer – for patients of all ages - that it is frustrating to see how slowly they are developing. It's not like there is any doubt; they ARE going to happen.

Comments

Yes, they will happen, but I'd say not without an increase in our Medicare premium while stopping all COLA raises to SS incomes.

And will you have to have an advantage plan which costs more than other plans offered? Will my medical insurance begin to overtake the income I have for food, medicine, housing?

The communications between doctors is still
a problem as far as patient records are concerned
because no one has coordinated the process, can
we expect more from a home/telemedicine set up?

Education needs to be happening before putting in place such a program. Are med schools preparing students? Are tech schools and medical
training meshing at a point for this to develop?

One problem I see in the med/tech revolution is that people whose specialty is medicine/health care are now thrown a laptop and expected to be automatons.

Until they implant a computer chip or 2 that takes the information directly from the dr or nurses brain as it is spoken, they can't have an effective practitioner and recorder/transmitter all in one package.


I'm not American, so I'm wondering... why would it cost extra? Don't these pilot projects show that it actually saves the system money to treat seniors in their homes?

In fact the teleconference became a practical reality in the early 80s - Xerox (where I worked) developed it.
The foreseable future (as we used say) brought challenges we often faced with all our futuristic products. We figured it would at least 6 years for Consumers to catch on. (The fax machine is a good example).
Teleconferencing is easily viable and applicable to thousands of common routines. But the common gound needs to catch up with the future.
We have talked for as long about a simple phone call to a Nurse Triage to expedite treatment, get help where it is needed now, and to futher reduce costs. The concept hasn't traveled very far since the invention of the telephone.
Why?
Manucaturers and marketing have said the costs of innovation have to absorbed into the life cycle of the product. The lifecycle months/years contain the most productive years and pay back the costs of innovation and creation. (For example; it took Xerox 60 months to fully develope a consumer ready product. Often never introduced!) Teleconferencing was one of those products.
Why now do we forgo easy, accessible, cheaper, faster medicare?
If you currently live in Florida - you know why. Our Gov is an x-HCA CEO (https://en.wikipedia.org/wiki/Rick_Scott) and is opposed to it . . .

I have high hopes for the changes and progress that technology is bringing. Given a choice, I wouldn't be so aware, but having been suddenly thrust into cancer care at a major university medical center, I'm in awe of the advances I'm seeing in treatment, diagnosis, care, and communication. I've no doubt this is the way of the future and that it will eventually reach most doctors and patients. It's better care, and that's what we all want.

A patient who wants to be seen in the office should be seen in the office (i.e., telemedicine should not be used as an excuse to avoid seeing a patient).

Other than that, it sounds like a great idea. One of the huge unspoken problems for older people is finding transportation to and from the doctor's appointment--that becomes more of a stress than the appointment itself!

Any improvement that allows elders to stay in their homes is welcome to me.

Great subject today Ronni! I wish I could get this now! I have so much trouble getting to and from doctor appts. I usually use an ambulette. It takes 3 days to get a ride. If I have a problem that can't wait three days - then I must go to an urgent care. Ambulettes do not transport patients to urgent care. So I wait or decide to call an ambulance to be seen for some things that could easily be taken care of in the Telemedicine or Housecall format instead. I am happy that we may have these options. Additionally, I have to cancel tests that could easily be performed at home (such as blood work) and all other apointments right now while I wait another 3 to 4 weeks for a repair on my wheelchair. First repair did not work out. I love the idea of being able to eliminate as many medical trips as possible. Jessie...

Telemedicine makes good sense for conditions that can be diagnosed by visual examination or perhaps clearly described by the patient.

I can also see advantages of home visits when the nurse or doctor needs to bring equipment to measure blood pressure, blood glucose, or other indicators.

However, I don't see what the doctor would do, if she observes that a person is not taking his meds regularly or doesn't have healthful food in the house.

I currently travel 30 miles one way to see my doctor every three months just to get my prescriptions renewed. The trips are generally in rush-hour traffic for a 1:30pm appointment since that is the first appointment after lunch (otherwise I spend two hours in the waiting room because my doctor's office is overly-optimistic in scheduling appointments). Needless to say, the trip raises my blood-pressure.

My doctor sees me for a total of ten minutes. An aide spends about five minutes taking my vital signs prior to the doctor's entry. I seldom need additional tests, although I am subject to random drug testing due to some of the meds I am taking.

So I spend two hours getting to and from the doctor's office to spend about 15 minutes... not to mention gasoline and wear and tear on our car and polluting the air.

However, I doubt that this service will be available during my lifetime....

I second Darlene.

Related story with a twist:

Yesterday, a woman at the senior residence where I volunteer, leaned across a lunch table and flat out told the woman across from her to "eff off."

The other woman made a face like she just saw Santa get his balls kicked by an elf.

Don't know how it all started.

The things I overhear in that dining room could make a lively sitcom.

As entertaining or shocking as this scenario might be to some people, I am continuously asking myself this question:

Where you want to be living when you reach a certain age?

My first choice would be safe at home with my husband and one eyed cat.

So, yes we would welcome and choose any new telemedical discoveries that would help us age in place.

Things can get a little testy in the ILF.

Recently a couple quality placemats were stolen.

Oh, and leftover party cake was pilfered from the cook's fridge.

Someone wanted cake.

But there is a ceiling camera in the dining room.

Gee, even there you are watched like
you might start partying like it's your second grad.

The place mat culprit was seen on the camera footage. She was called into the office and told to hand back the mats.

The cake thief is still at large.

I saw a BOLO strip across the entrance last time I walked by.

It's just like high school, without homework.

I once traveled with a doctor from Australia who routinely saw patients who lived in the outback by teleconference. That was in 2005. It ought to be possible to do more of this here. The Kaiser plan I'm on might be a pioneer, though Kaiser has a lot of sunk costs in buildings and facilities. Wonder if they would fear underutilization of all that plant?

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