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News Roundup: December 16, 2013

Boomers Enjoying Longer Life at Home Thanks to Tech Innovations

Published by HealthTech Zone
Karen Veazey
December 12, 2013

As our longevity grows and geriatric health improves, quality of life in our elder years is an important topic. There are 10 million seniors living alone, and, according to a study published in the Journal of American Medicine, they’re not the healthiest generation. Boomers clock in with higher rates of hypertension, diabetes, obesity and cholesterol than previous generations. So how do we care for an aging generation without stepping on their toes?
Some elders don’t mind downsizing and moving into a retirement community flush with amenities and people their own age, but the vast majority of Americans want to stay in the home they’ve come to love, without becoming a burden on caregivers.

Visual Monitoring

Those caregivers are often adult children for whom technology is playing a key role in elder care. Video chat options like Skype and FaceTime let you see your loved ones, allow you to pick up those all-important non-verbal cues about their health and welfare. These platforms also let grandparents stay connected to friends and family they otherwise wouldn’t see very often, an important contributor to overall mental health.

Apps

We all remember the LifeCall medic alert commercials where poor Mrs. Fletcher has fallen and she can’t get up. Emergency medic alert systems are now abound and are even integrated into some cell phones targeted to older users, like the Jitterbug. Apple’s Caring in Place app serves caregivers by keeping responsibilities organized in checklists.

Home Monitoring

Personal care can be the vulnerable spot in many parent-child relationships, as adult children try to monitor whether mom and dad are taking medication and eating regular meals. Here, role reversal, control issues and deception get tangled up with good intentions, and relationships can be ruined. Creations like MedMinder and TabSafe smart pillboxes can be a lifesaver for families, providing locked or unlocked dispensers with integrated reminders for the parent and cellular notification for the caregiver. These systems can be pricey, however, so less expensive options like GlowCaps – lids that attach to pill bottles and provide visual and audio reminders – are also available.

When more comprehensive care or monitoring is required, whole house systems like SafeinHome and BeClose are allowing elders to stay in their homes while giving caregivers the ability to unobtrusively check in. Sensors placed around the home can monitor how long the refrigerator has been open, how long someone has sat in a chair or stayed in bed, and even if the faucet was left running. Many of these systems operate through cellular or Wifi so setup is simple and elders don’t feel like they’re burdening someone with complex installation. A side benefit comes when caregivers can talk to elders without the conversation focusing on well-being.
Health Monitoring

For elders with specific health issues, there are even tools like Microsoft’s Health Vault or HomMed’s Teleheath Monitor, which integrate with home health gadgets like scales, blood pressure cuffs and glucose monitors and provide instant readings to the caregiver.

The most important aspect of home health monitoring is agreement between the caregiver and user. If an elder is deceived or tricked into being monitored, or feels forced, not only can relationships be ruined but they will eventually find ways to stop using the system. But, thanks to advances like these, providing ongoing quality of life in the home of their choice is more possible than ever for our elders.

CMS Data Show Hospital Readmissions Fell 18% in 2013

Published by Home Health Care News
Jason Olivia
December 10, 2013

The Affordable Care Act appears to be having an impact on lowering the number of costly hospital readmissions, as reforms under the law have helped drive down the 30-day readmission rate by as much as 18% in 2013, according to data released this week by the Centers for Medicare & Medicaid Services (CMS).

During the first eight months of 2013, the 30-day Medicare readmission rate for all causes and conditions averaged less than 18%, translating into an estimated 130,000 fewer hospital readmissions between January 2012 and August 2013, according to the CMS data.

Prior to the regulations taking effect, the 30-day hospital readmission rate for all conditions held steady at 19% from 2007 to 2011.

The declining trend is widespread across the country. Comparing readmission rates over the first eight months of 2013 to the average rates for 2007 to 2011 in local health care markets, CMS found that 2013′s readmission rates were at least a half of a percentage lower in 76% of local markets—or 232 of the 306 recorded by CMS.

Improvements in the Medicare readmission rate on a national scale were further emphasized as fewer than 10% of local markets had higher rates. Using the same comparison, readmission rates also dropped in 49 states and the District of Columbia.

The only state that did not see a decrease was Utah, which already had one of the lowest rates in the country, as noted by CMS.

“We can see that the decline in all-cause readmission rates that began in 2012 is continuing this year on a widespread basis,” wrote CMS in a statement. “While we continue to monitor and study these encouraging reductions, what is fleas is that intense focus on reducing hospital re-admissions through improved process of care and new tools in the Affordable Care Act are having a demonstrably positive impact.”

Use of telehealth network can boost care, study says

Published by USA Today
Kelly Kennedy
December 6, 2013

Using a remote expert to oversee intensive-care units decreases mortality and decreases the amount of time people spend in hospitals, according to a study released Thursday.

And that, in turn, saves money.

Researchers at the University of Massachusetts Medical School looked at how using telehealth to help doctors develop treatment that use proven best practices, as well as to respond to patient alerts and alarms. They compared the units with telehealth with control groups in 56 ICUs in 32 hospitals and more than 110,000 patients. The research was released in CHEST Journal.

"Telehealth gives us the capability of managing health with much greater productivity," said Brian Rosenfeld, chief medical officer at Philips Hospital to Home, which provides hospital transition technology including telehealth.

Because of provisions in the Affordable Care Act that require hospitals to pay fines if Medicare patients are readmitted to hospitals too soon, telehealth networks can play a bigger role in reducing costs, researchers said. In some pilot programs, doctors are paid a fixed amount per patient rather than for every test.

Medicare reimburses telehealth only for patients located outside city limits or in areas with a provider shortage, and then only if the services mimic a face-to-face interaction between a doctor and a patient. However, the Centers for Medicare and Medicaid Services just last week changed its 2014 fee schedule so more people in rural areas would qualify for telehealth services, and so that those services could include home-based telehealth services.

"This is the crux of how we have to deal with the ACA, because it's not fee-for-volume anymore, but fee-for-quality," Rosenfeld said.

In an ICU, telemedicine involves a physician specializing in intensive care medicine working from a remote site and coordinating care with the ICUs of several hospitals. He or she double-checks care plans to ensure they use the correct methods, answers nurses' questions in the middle of the night while the attending doctor sleeps and monitors patients' vital signs from a remote location to detect signs of trouble.

This can be a boon for rural hospitals with fewer specialists, large hospitals with staff shortages or any facility where a second opinion can be helpful.

The remote intensive care specialist "goes out to, not only his own academic medical center, but to community hospitals 200 miles away," Rosenfeld said. The attending physician at the hospital could specialize in a different filed, and the intensive care specialist can provide outside advice.

The system, researchers found, led physicians to manage problems earlier, use data better, follow best practices more closely and respond to medical alarms more quickly.

They also found that a higher percentage of patients that lacked the telehealth system died at a slightly higher percentage — 11% — than those in the control group — 10%. ICU patients with telehealth died at a lower rate than the control group, too.

The length of stay in the ICU for telemedicine patients was 20% lower than for the control group. Overall, the telehealth patients spent half a day less in the hospital for a seven-day stay for non-telehealth patients; one day less in a two-week stay; and 3.6 days less in a 30-day stay.

"Telehealth is one way to make sure quality care occurs more frequently," said Craig Lilly of the University of Massachusetts Medical Center, the study's lead author. "We can have high-end, high-fidelity clinical services at dramatically lower costs."

Remote help can save as much as $10,000 per patient, while allowing specialists to help in hundreds of cases a week instead of a few in one hospital.

"It's less about the video capacity, and more about catching problems before people get sick," he said. "In this paradigm, the offsite person is part of the team."

They can help monitor who might be getting sick, as well as catch gaps in care, he said.

About 9,000 ICU beds nationwide are monitored this way now, Rosenfeld said. That's about 12% of all adult ICU beds.

The new system, Lilly said, means a nurse who spots a problem at 2 a.m. and is reluctant to call a doctor has someone to ask for help.

They can also leave an "electronic signature" of what they want done, and the remote doctor can ensure that happens, Lilly said.

"When I practiced at Johns Hopkins, there were many mornings when I'd come in and think, 'What the heck went on here last night?'" Rosenfeld said. "Either someone missed [a problem], or they thought it was something else, or they didn't want to call me, but they have that expertise now."

Opportunity Knocks at Home: How Home-Based Primary Care Offers a Win-Win for U.S. Health Care

Published by Brookings Institute
Jonathan Rauch
December 5, 2013

For far too many Americans, growing old and frail today means confronting repeated cycles of crisis, hospitalization, and expensive but ineffective or even counterproductive treatment—leading to still more of the same. Instead of reliably providing high-value treatment aiming to maximize quality of life in our declining years, the health-care system often provides high-cost treatment that seemingly aims to maximize treatment itself. The result is bad for the federal budget and in many cases, alas, even worse for patients. “There’s a lot of spending, but also a lot of suffering,” as Dr. Steven Landers, the president and CEO of the Visiting Nurse Association Group of New Jersey, said in a recent discussion with the author.

At a time when so many of the country’s health-care and fiscal problems seem intractable, this paper surfaces some good news. A win-win alternative, one that can reduce both cost and suffering, is at hand. With some nudging, it could move fairly rapidly into the mainstream of health care. Home-based primary care, as this alternative approach is called, is “one of the big opportunities in health care,” Landers said. Specifically:

Medicare beneficiaries who are in their declining years and have multiple chronic conditions can be provided with better care at lower cost, thanks to the use of multidisciplinary teams that treat them primarily at home.

Because this population is the most expensive group of patients in the medical system, even fractional savings can make a significant dent in health-care costs. More important, the result is likely to be more humane and effective from the patient’s point of view.

The multidisciplinary, home-based approach is not “vaporware,” an untried concept. To the contrary, it has a distinguished pedigree and has shown during more than a decade of clinical use and development that it can work in a variety of contexts.

To bring home-based care to a national market, much will need to happen. Demonstrations will need to show that home-based care can scale affordably; Medicare payment structures will need to change; medical culture will need to adjust. But many of those changes are under way already, and all are within reach.
In short, multidisciplinary, home-based primary care is low-hanging fruit in the search for a higher-value health-care system.