Article on Bloomberg.com By Alex Wayne & Alex Nussbaum – Sep 24, 2013
Enrollment in the Affordable Care Act’s public health exchanges, a key effort to reach people without health insurance, will start slowly, a senior Obama administration official said.
While the U.S. exchanges begin selling insurance plans on Oct. 1, the medical coverage doesn’t take effect until Jan. 1, a gap that may lead some Americans to hold off on purchases until the last minute, said the official, who asked not to be identified because the person wasn’t authorized to speak on the record. The biggest portion of sign-ups will occur closer to January, the officials told Bloomberg News today.
Such a scenario would mimic patterns surrounding the initial enrollment periods for Medicare Part D prescription drug plans in late 2005 and Massachusetts’s health-care law in 2006. The Obama administration has said it’s seeking at least 7 million people to enroll through the Affordable Care Act by April.
“A majority of individuals would say, ‘If I’m not going to get my insurance until Jan. 1, then I’m certainly not going to pay my premium on Oct. 1,’” Dan Schuyler, a director at the consulting firm Leavitt Partners in Salt Lake City, said in a telephone interview. “Realistically, a lot of people will not actually buy the product until the end of November at the earliest.”
Lawmakers and proponents of telemedicine have begun exploring how technology can improve the health care system in the wake of Obamacare
The University of Virginia Health System is home to a program that may be essential to solving the health-care-access problem in the U.S. The program is centered around telemedicine, or the use of electronic communication to exchange medical information either from patient to physician or between doctors.
Through the UVA system’s Center for Telehealth, physicians from 40 specialties partner with 108 community hospitals, free clinics, schools and more to provide nearly 33,000 people with care they otherwise wouldn’t be able to acquire.
“It saves lives, it saves functions, and it reduces cost,” David C. Gordon, the director of the office of telemedicine and rural network development at UVA Center for Telehealth, says about the program.
According to Gordon, the University of Virginia Health System has reduced preterm deliveries during high-risk pregnancies by 25% via telemedical services that maintain communication between patients and physicians through technology as simple as Skype and as complicated as robotics, even when those in need are hundreds of miles away from care.
Since its inception, Gordon says, they have saved Virginians over 7.9 million miles in travel for health care.
The UVA system, however, is not alone in providing a once unavailable service to patients; every state has a telemedicine program, ranging from stroke diagnosis to psychiatric evaluations to prenatal care. And now, with the expanding insurance coverage provided by the Affordable Care Act — and the doctor shortage predicted to come with it — proponents of telehealth believe its widespread implementation can have a positive impact on the future of the health care system.
“There is this perfect storm of increased demand with the newly insured, a shortage of primary-care physicians and specialists, and a need to keep costs in control,” Mario Gutierrez, the executive director of the Center for Connected Health Policy, a leading telehealth policy center, tells TIME. “I think telehealth provides a real vehicle for doing that.”
If members of health care communities with and without specialists and highly skilled practitioners are able to work together using technology, Gutierrez says, the issue of access to care can be met head-on. “What the system will encourage is for the greatest efficiency and improvements in quality that are going to be measured by the outcomes of the patient population,” he says.
Some outcomes have already begun to prove there is some benefit in adopting telemedicine: the Partners HealthCare system in Boston was able to reduce readmission of 1,200 heart-failure patients by 50% through a home telemonitoring program. Under the Affordable Care Act, Medicare is required to reduce payments to hospitals that have excessive readmissions rates by as much as 2% in 2014. New advancements in telemedicine such as in-home care products, proponents say, allow doctors to follow up with patients from outside the hospital via a computer or mobile device, which can help hospitals reduce readmission rates and avoid penalties.
Other technologies, like WellPoint’s LiveHealth Online, cut out the initial visit altogether, letting patients visit the doctor from home or work via live video and instant-messaging services with doctors. That is something that could be of great use in the coming years, with the Association of American Medical Colleges estimating that the U.S. will be doctor-deficient by as many as 91,500 by 2020.
The benefits of telemedicine were also the topic of discussion at a briefing on Capitol Hill on Friday, where panelists from both the private and public sectors declared everyone is a winner when telemedicine is implemented. “It’s a win-win,” said Neal Neuberger, the executive director of the Institute for e-Health Policy, on Friday. “I’ve never met a member of Congress on either side of the aisle, in either house, that didn’t think this was a good idea.”
Though Congressman Gregg Harper, a Republican from Mississippi, is presenting a bipartisan bill to Congress this week that tackles the cost of telemedicine and expands the role of Medicare and Medicaid, telehealth still faces huge barriers to widespread implementation, largely because of the fact that there is no comprehensive standard policy surrounding it. “The march of technology for health care far exceeds our ability to adopt, diffuse, incorporate and govern … in a public- and private-sector setting, any of these technologies,” says Neuberger.
Because of licensing rules, physicians are generally unable to practice outside their states. If a patient they’re seeking to provide virtual care for is out of state, they will need a license in both places, restricting access for those in need. Medical boards have also placed higher regulatory standards on telehealth practices, like a requirement that a patient mush have an in-person, established relationship with the provider before receiving care.
Doctors are also limited in the services they are reimbursed for under Medicare, which only encompasses telehealth services that are provided in narrow scope of rural areas, by physicians and nurse practitioners in specific offices. According to the American Telemedicine Association, 80% of Medicare beneficiaries are not covered because they live in counties federally designated as metropolitan areas. Despite that, 42 states cover telehealth through the Medicaid program, and 15 states have laws that mandate coverage for telehealth services.
24-hour device offers better blood pressure test, Twin Cities doctors say
By: Jeremy Olson , Twin Cities Star Tribune September 8, 2013
Twin Cities doctors say the cuffs at the clinic may misdiagnose thousands. They are touting a 24-hour monitor.
A blood pressure check may be one of the most tried and true routines of a visit to the doctor’s office. But a group of Allina Health doctors in Edina is challenging the reliability of the conventional test and is trying a new method they believe could provide a more accurate diagnosis for thousands of patients who suffer from hypertension.
While few doubt that routine checks help millions of Americans control their high blood pressure, there is growing evidence that these point-in-time readings overdiagnose some patients — people whose numbers go up at the doctors’ office simply because of nerves — while underdiagnosing others whose hidden hypertension puts them at greater risk for stroke and heart disease.
“The reality is [that] your blood pressure fluctuates day to day, hour to hour, minute to minute,” said Dr. David Ingham, who practices at Allina’s Center for Outpatient Care in Edina. “And those fluctuations are important.”
Over the past year, Ingham and his colleagues have been testing a new device on more than 1,000 Twin Cities patients to see whether 24-hour blood pressure monitoring can provide a more accurate diagnosis.
One of those patients is 37-year-old Jeff Zoss of Minnetonka, who agreed to wear the wireless monitor. It was strapped to his left arm and took his blood pressure every 20 minutes, then tracked his scores so they could be uploaded to the doctors.
Technology is the primary cause of our skyrocketing health-care costs. It could also be the cure.
Article on TechnologyReview.com by Antonio Regalado, September 3, 2013
Moore’s Law predicts that every two years the cost of computing will fall by half. That is why we can be sure that tomorrow’s gadgets will be better, and cheaper, too. But in American hospitals and doctors’ offices, a very different law seems to hold sway: every 13 years, spending on U.S. health care doubles.
Health care accounts for one in five dollars spent in the United States. It’s 17.9 percent of the gross domestic product, up from 4 percent in 1950. And technology has been the main driver of this spending: new drugs that cost more, new tests that find more diseases to treat, new surgical implants and techniques. “Computers make things better and cheaper. In health care, new technology makes things better, but more expensive,” says Jonathan Gruber, an economist at MIT who leads a heath-care group at the National Bureau of Economic Research.
Much of the spending has been worth it. While the U.S. spends the most of any country by far, health care is becoming a larger part of nearly every economy. That makes sense. Better medicine is buying longer lives. Yet medical spending is so high in the U.S. that the White House now projects that if it keeps growing, it could, in 25 years, reach a third of the economy and devour 30 percent of the federal budget. That will mean higher taxes. If we can’t accept that, says Gruber, we’re going to need different technology. “Essentially, it’s how do we move from cost-increasing to cost-reducing technology? That is the challenge of the 21st century,” he says.
Still using audio tapes to dictate?
Thinking about switching to a digital recorder or call-in system?
Top 10 reasons why you should make the switch:
- Tapes easily become lost or misplaced, resulting in wasted time and productivity. When a digital audio file is sent for transcription, a copy can be sent and a copy kept for a period of time (for redundancy purposes).
- Tapes wear out and recording quality degrades over time, resulting in wasted time and additional costs. Digital audio files do not contain any actual moving parts and cannot be “eaten” by a recorder.
- Tapes are normally recorded with multiple reports on them, which means the transcriptionist receives these jobs all at once. The moment a digital audio file has been dictated, it can be sent–thus the MT receives the dictation more quickly and turnaround time improves. Stat dictation can be transcribed immediately.
- It is only possible to record onto tapes using “overwrite” mode. This means that if you need to add additional audio to a file, you have to append the additional audio. With most digital systems, it is possible to insert audio mid-file, which means if you need to add an extra paragraph, you can.
- Tapes are physical, meaning that a tape recorded in Timbuktu cannot be transcribed in Topeka within the same hour. Digital audio files are not geographically constrained. A digital file recorded in Timbuktu can therefore be transcribed in Topeka or any other location within the hour, thus improving turnaround and providing the opportunity to reduce office space and cut expenses via out-sourcing. Read more
Washington Post article by Sarah Kliff and Sandhya Somashekhar, August 24, 2013
With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays.
Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces — online sites where uninsured people will be able to shop for coverage, sometimes using a government subsidy to purchase a plan. An estimated 7 million people are expected to use these portals to purchase health coverage in 2014.
The task is unprecedented in its complexity, requiring state and federal data systems to transmit reams of information between one another. Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready.
“There’s a certain level of panic about how much needs to be accomplished but a general sense that the bare minimum to get the system functional will be done,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It will by no means be as smooth and as seamless as people expected.”
Oregon announced this month that it will delay consumers’ direct access to its marketplace, opening the Web site only to brokers and consumer-assistance agents in order to shield consumers from opening-day glitches.
“Even though we’re testing now, once you actually have the system up, you don’t know what the bugs will be,” said Amy Fauver, spokeswoman for Cover Oregon, the state agency implementing the law there.
From article on InformationWeek by Ken Terry – August 19, 2013
The Food and Drug Administration (FDA) has released final guidelines on the design, testing and use of radio-frequency (RF) wireless medical devices. Although it doesn’t promulgate legally enforceable responsibilities, the document is intended to guide both device manufacturers and healthcare providers toward the safe and secure use of wireless medical devices. Covered are devices “that are implanted, worn on the body or other external wireless medical devices intended for use in hospitals, homes, clinics, clinical laboratories, and blood establishments.”
The FDA document has no relation to the impending guidance from the agency about how it will regulate apps that turn smartphones and tablets into medical devices. In fact, the draft guidance on RF wireless devices was issued in 2007, before smartphones and tablets became a factor in the industry. The FDA is focusing on the safety aspects of medical devices in hospitals, homes and other fixed-care settings.
For example, the guidance states, “Because there are risks associated with RF wireless systems, we recommend that you carefully consider which device functions should be made wireless and which device functions should employ wired connectivity.” Among the issues that could compromise transmissions from wireless devices and potentially endanger patient safety, the FDA guidance says, are:
– Poorly used wireless networks.
– Lost, corrupted, or time-delayed transmissions.
— Degradations in wireless transmissions that might be caused by competing wireless signals or electromagnetic interference.
– Lack or compromise of wireless security.
– Potential misuse of wireless devices because of lack of or inadequate instructions for use.
The document cautions that although a cellular phone network might be adequate for voice communication, “it might not be sufficient for certain medical functions. Connections lost without warning, failure to establish connections, or degradation of service can have serious consequences, especially when the medical device relies heavily on the wireless connection. Such situations can compromise the wireless transmission of high-priority medical device alarms, time-sensitive continuous physiological waveform data, and real-time control of therapeutic medical devices (such as wireless foot switches).”
The FDA document also addresses the security of wireless signals and data from medical devices. Wireless transmissions should be encrypted to safeguard not only the data but also hospital information systems, it says. Among the areas of vulnerability, it warns, are Bluetooth communications between devices and wireless networks.
The guidelines don’t discuss the issue of hackers trying to take control of implanted devices such as pacemakers and defibrillators. Fears of that kind of cybercrime –which, so far, have proved baseless — were sparked by a letter that the Information Security and Privacy Advisory Board, which advises the National Institute of Standards and Technology (NIST), sent to government agencies last year. The board suggested that FDA take this kind of threat into account in its regulation of monitoring devices.
The FDA statement also makes several “recommendations for pre-market submissions for devices that incorporate RF wireless technology.” The agency suggests how manufacturers should describe wireless devices in submissions to the FDA and directs them to provide information about any “risks and potential performance issues” associated with a device’s wireless functions. In addition, the FDA wants device makers to describe the testing of their products for the range of risks described in the guidance.
The FDA notes that the Federal Communications Commission (FCC) also regulates wireless technology, so jumping through the FDA’s hoops might not be sufficient to obtain approval for wireless medical devices.
Last September, for example, the FCC released its final rule for medical body-area networks (MBANs), which include wearable monitors that send data to wireless hubs in hospitals. The FCC allocated certain portions of the radio frequency band to MBANs, one for indoor and another for outdoor use.
Story by Dan Gunderson, Minnesota Public Radio August 8, 2013
FERGUS FALLS, Minn. — Martha Hitzeman is legally blind, and at 87, needs medication for pain and to prevent strokes.
But sometimes she forgets to take her pills.
“She was starting to miss doses, sometimes maybe four or five doses in 10 days,” said her daughter, Marie Fuchs. “So I knew she wasn’t getting the medication she needed.”
Fuchs, who manages her mother’s medication, enrolled Hitzeman last August in MedSmart, a pilot project run by PioneerCare a long-term-care facility in Fergus Falls.
Her mother now has a small device on her kitchen table that holds two weeks’ worth of medication. The automated dispenser beeps twice a day — and keeps beeping until Hitzeman tips it over and the pills are dispensed.
“When I hear it ringing, I do what I need to do and take my time getting out here ’cause it will ring till I get here,” Hitzeman said. “It’s really a wonderful convenience.”
By ensuring that elderly people take medications, the simple device could allow them to stay healthy and out of the hospital or nursing home. After a year, it has proved so successful that other communities plan to start using the program.
MedSmart was created in response to a state Minnesota Department of Human Services request for ideas that could help elderly patients stay at home. It is funded in part by a $117,000 DHS matching grant.
The device is connected to a phone line, and if it isn’t tipped over within an hour, Marie Fuchs will receive an automated text message.
“I was able to take a week’s vacation last fall and not worry about her taking her meds every day,” Fuchs said. “It gives her the independence and gives me the peace of mind that she’s getting what she needs.”
The MedSmart program costs patients $39 a month. Data collected during the project found the device reduced medication errors for most participants.
In Fergus Falls, there are 73 people using the MedSmart program, 40 of whom are monitored each day. On a recent week, 39 took their medication as directed 100 percent of the time.
The device won’t help everyone. For some, it won’t provide the level of help they need. However, the project is filling a need in the community, said Todd Johnson, a pharmacist at Lake Region Healthcare in Fergus Falls.
“I know there’s a case or two where family members have said, ‘you pretty much allowed my family member to maintain independent living, when they weren’t able to do that before,’ ” he said. “Non compliance, especially with chronic disease medications, or just not taking them properly or running out of them is a major cause of re-admissions, clinic visits.”
There are a number of devices on the market that dispense medication, but what makes the Fergus Falls project unique is that it’s not just about technology, said Karen Wulfekuhle, director of home and community services for PioneerCare. It provides a local team of health professionals who decide on the best solution for individual patients, she said.
Wulfekuhle is trying to convince insurance providers to pay for the medication reminder. She said it’s not unusual for insurance to pay hundreds of dollars a month for drugs a patient needs.
“The argument is, how valuable is that medication if they’re not taking it? A $39 a month charge for a machine that helps support their health – [it] makes sense to cover that expense if in turn it’s going to keep them out of the hospital,” she said.
Since 2003, DHS officials have awarded 400 grants to organizations that help fix health care gaps for the elderly according, Jean Woods, director of the department’s aging and adult services division.
The grants cover a variety of community based projects. An earlier grant helped establish an electronic monitoring program for seniors in Fergus Falls. Another grant trained Somali volunteers in the Twin Cities to check on elders and perform basic home chores. In Aitkin County, a grant funds a volunteer program to add safety equipment to the homes of senior citizens to reduce falls.
“Minnesota has been very intent and very purposeful about wanting to make sure people, wherever they live in the state, can stay home and be served through home and community-based services,” Wood said.
DHS officials awarded $2.3 million in grants during the 2012 fiscal year. The funding is appropriated each year by the legislature. The department tracks grant projects for five years. More than 90 percent become self sustaining, Wood said.
From Kaiser Health News article by Kelsey Miller – August 5th, 2013
The Physician Payments Sunshine Act, an Affordable Care Act provision requiring doctors and medical companies to disclose their financial relationships, went into effect Aug. 1. Physicians say they are now working to find a balance between necessary transparency and what some perceive to be burdensome filing.
“We want to spend our time seeing patients, not doing paperwork,” said Dr. Jason Mitchell the director of the Center for Health IT at the American Academy for Family Physicians.
The Sunshine Act requires drug companies and medical device makers to report payments, gifts and investments to Centers for Medicare and Medicaid Services. Though the act is now in effect, a complete set of records are not due until March 2014 and will not be made public until September 2014.
Consumer advocates and other stakeholders favor openness when it comes to the large amounts of money medical and pharmaceutical companies spend to influence a doctor’s choices, according to a Pew Health Center statement from 2012. Holding both parties accountable with a clear reporting system would allow consumers to spot potential bias.
Mitchell, who is also a practicing family physician in Missouri, does not anticipate many immediate changes for doctors – aside from fewer lunches with pharmaceutical representatives.
He predicts that because of the increased attention placed on these small meetings that make up a majority of the reportable interactions, doctors will likely shy away from them – which could be problematic. If doctors minimize their working relationships with pharmaceutical and medical representatives, their knowledge could be “less of a resource,” Mitchell said. It’s important for doctors to keep up with drug and product information in other ways, he added.
In an effort to simplify the reporting of these payments, a number of iPad and iPhone Apps have been developed. Doctors and industry professionals can enter data by hand or scan documents which are filed into easy lists and spreadsheets.
The Centers for Medicare and Medicaid Services created different Apps designed specifically for doctors and others for medical companies, both of which have to remain accountable for these transactions.
Though it’s up to the companies to do the reporting, doctors are encouraged to keep their information up to date and to follow up on what transactions are being reported.
“There’s no reason to believe it will be erroneously reported,” Mitchell said. “We don’t have anything to hide. We certainly are very conscious of conflicts of interest.”
“Transparency is a good thing,” Mitchell said. “But we certainly don’t want an increased burden.”
From July 26, 2013 Indianapolis News article
A Marion County Indiana jury Friday awarded a woman $1.44 million after finding Walgreens and a pharmacist violated her privacy when the pharmacist looked up and shared the woman’s prescription history.
The lawsuit filed in Marion Superior Court spun out of a tangled relationship between the pharmacist, her husband and the man’s ex-girlfriend.
The verdict and seven-figure award came at the conclusion of a four-day jury trial.
The lawsuit alleged Audra Peterson, a pharmacist at the Walgreens store at 6269 W. 38th St., improperly reviewed the prescription history of Abigail Hinchy, Crown Point, and divulged that confidential information.
“As a provider of pharmaceutical service, defendant Walgreens Co. owes a non-delegable duty to its customers to protect their privacy and confidentiality of its customers’ pharmaceutical information and prescription histories,” Hinchy claimed in the lawsuit.
Walgreens was negligent in training and supervising Peterson, the suit said, while Peterson breached her statutory and common law duties of confidentiality and privacy to Hinchy.
The six-member jury found for Hinchy, ruling the pharmacist and Walgreens violated privacy rules when Peterson looked up records on Hinchy, her husband’s ex-girlfriend, according to attorney Neal F. Eggeson, who represented Hinchy.
He said testimony indicated Peterson then shared that information with her husband, Davion Peterson, who has a child with Hinchy.
“We believe it is a misapplication of the law to hold an employer liable for the actions of one employee who knowingly violates company policy. We intend to appeal the ruling.”