Communications and medical technologies have the ability to keep more seniors healthier at a lower cost, particularly those who live in remote rural areas, Sen. Herb Kohl (D-Wis.), who chairs the Senate Special Committee on Aging, told the panel at a hearing on Friday.
The hearing, "Aging in Place: The National Broadband Plan and Bringing Health Care Technology Home" focused on the spread of broadband, how information technology might change the way patients and their doctors relate, the potential for cost savings and some of the barriers to "aging in place."
One study claims that remote monitoring could generate net savings of approximately $200 billion over 25 years from just four chronic conditions, Mohit Kaushal, digital healthcare director, Federal Communications Commission, noted in his presentation.
"Although economic studies like these are open to criticism due to the difficulty in quantifying savings," Kaushal said, "the Veterans Hospital System has implemented its Care Coordination / Home Telehealth Program (CCHT) for 32,000 veteran patients with chronic conditions. The program has resulted in a 19 percent reduction in hospital admissions and a 25 percent reduction in bed days for those veterans who are admitted."
"There is also a significant cost saving associated with these improved clinical outcomes," Kaushal added. "The CCHT Program, at $1,600 per patient per year, costs far less than the VHA's home-based primary care services, at $13,121 per patient per year, and nursing home care rates, at $77,745 per patient per year."
"Delivery of critical healthcare services in patients' communities and homes can reduce costs borne by patients, providers and health insurers and increase patient satisfaction," said Farzad Mostashari, MD, senior advisor, Office of the National Coordinator for Health IT.
While opportunities abound for employing telehealth and home monitoring to improve care and provide greater access to care, barriers remain, Mostashari told the panel.
"Several issues that could potentially hamper broad adoption will need to be addressed in the near term including: privacy and security concerns, licensing and credentialing, and questions about the regulatory approach for these evolving technologies," he said. "Patient safety issues will be carefully considered by the Food and Drug Administration, to address the challenges and safety risks of using medical devices - that were not designed for use in this setting or by lay users - in the home."
Robin A. Felder, professor of pathology and associate director of clinical chemistry at The University of Virginia School of Medicine, told the panel that his organization conducted a case-controlled study comparing monitored vs. non-monitored elders in a senior living facility in the Midwest over a three-month period.
"Our results demonstrated a 36 percent reduction in billable medical procedures, a 78 percent reduction in hospital days, and a 68 percent reduction in the cost of care," Felder said. "Despite the reduced cost of care, the efficiency of the caregivers increased by over 50 percent."
Eric Dishman told the panel his message was urgent: "We need a 2020 vision and implementation plan for preparing fot the 'Age Wave' that uses technology and workforce retraining to bring healthcare home," he said.
Dishman, an Intel Fellow with Intel Corp. and the global director of health innovation and policy for the Intel Digital Health Group, is also senior policy advisor with Continua Health Alliance and senior fellow with CAST, the Center for Aging Services Technologies.
"Simply put," Dishman said, "we do not have enough physicians, nurses and other healthcare providers to meet the needs of an aging population. This is why looking at ways to cost-effectively deploy HIT is, and will be, of growing importance for our national healthcare strategy."
Yet tough barriers remain, those who testified acknowledged. The FCC's Kaushal put them into three categories:
- The connectivity gap. Broadband is either missing or too expensive.
- Misaligned economic incentives. The prevailing fee-for-service reimbursement system pays for volume rather than outcomes, and hence prevents many of these technologies from being paid for.
- Outdated regulations, created back when our only interactions with physicians were in their offices - not via remote monitoring and videoconferencing.