QUALITY
Telemedicine
Tom’s Comments:
As the article notes below, there are many advantages in using telemedicine in health care. We are very much aware of the increased use (especially inappropriate use) of technology as one of the key drivers of health care costs. Telemedicine is one form of technology that potentially has unlimited benefits for the world of health care from a cost, quality and access perspective.
Telemedicine, especially when it is tied into Electronic Medical Records, can lay a foundation for future efficiencies in our health care system. Payers, government, managed care and employers, can all potentially reap the benefits of telemedicine if they become facilitators of its growth rather than impediments. This article identifies only a few of the obstacles that impede the growth of telemedicine, there are many other obstacles that are imbedded in payers medical policy edits that are linked to MCOs claims payment systems. The government should take a lead role in finding ways to facilitate the growth of telemedicine and managed care organizations (MCOs) will likely follow suit. If MCOs continue to be short-sighted in this regard the government may need to use its clout to “encourage” their cooperation.
Physician Care and Telemedicine
The use of information technology in diagnosing, treating and monitoring patients – known as telemedicine – is adding a new dimension to modern health care. Entrepreneurs are using the telephone, the Internet and personal computers for innovative solutions to traditional problems of health care delivery. These advances are not only making care more accessible and convenient, they are also raising quality and containing medical costs.
Telemedicine can improve adherence to protocols and increase the convenience of treatment for patients with chronic ailments. For instance, patients can use an electronic device to monitor vital signs at home and transmit the data via computer modem to self-report their health status to medical staff. A study of patients with congestive heart failure found that those who used remote monitoring required rehospitalization only half as frequently as those who depended on traditional office visits.
Additionally, transmitting data via the Internet allows U.S. health care providers to collaborate with qualified, low-cost providers in other countries who perform labor-intensive tasks that do not require the physical presence of a physician, such as interpreting ultrasounds, CT scans and MRIs. Increasingly, information technology will make distance irrelevant, and medical personnel will be able to provide medical services regardless of their location.
Obstacles to Wider Use of Telemedicine. An antiquated third-party payment system is the primary obstacle to the growth of telemedicine. Because 87% of medical costs are paid by someone other than the patient (such as insurers, employers or government), providers have little incentive to create innovative services that benefit patients directly. Additionally, state laws and regulations prevent physicians licensed in one state from practicing in other states. This impediment keeps doctors from providing crucial medical services, such as writing prescriptions or completing follow-up consultations remotely, to patients who have left the state. Similar regulations keep foreign doctors from providing telemedicine services. Telemedicine can improve the quality and increase efficiency of patient care, but these barriers must be lowered in order to realize its full potential. (“Physician Care and Telemedicine,” Devon Herrick, National Center for Policy Analysis, August 21, 2008) http://www.ncpa.org/pub/ba/ba624/ba624.pdf
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Price and Quality Transparency
Tom’s Comments:
There has been much discussion relating to health care price and quality transparency. The advocates of these initiatives hope that consumers, once armed with user-friendly price and quality data, would become prudent purchasers of health care services. This newly engaged prudent purchaser would then be the catalyst for provider (hospital, physician, ancillaries, etc.) competition. It is then hoped that providers would respond to competition by providing better value (in the form of lower costs and higher quality) in the health care market place.
On paper all of the above rationale supporting price and quality transparency makes sense. There are a number of factors that have prevented this initiative from achieving these results. The article below identifies a number of those factors that have prevented price and quality transparency from being a reality.
Ultimately to be effective, price and quality transparency data would need to be user-friendly, timely and credible. The user of this information (the consumer) must also need to be financially engaged enough to want to use the data.
Most Americans receive their health care benefits either through the employer or through the government (Medicare or Medicaid). The bulk of the health care costs are then paid for by a third party to the health care transaction that occurs between the consumer and the provider of health care services.
The real cost of health care services are then being paid by third-parties (government/employers). These payers obviously have a vested interest in addressing the overall value received based on the health care transaction.
Many believe that it will be very difficult for consumers to be able to truly evolve to prudent purchasers of health care services. The April 2007 issue of the Quarterly Health Care Report discusses this issue in detail in the article “Health Care Price Transparency and Price Competition” (http://www.bw.edu/academics/bus/programs/hcmba/nl/archives/April07.pdf).
Under my commentary related to the April 2007 article on price transparency, I discuss the potential merits of having managed care organizations act as facilitators to link cost-effective quality providers to lower co-pays, etc. Similar to drug formularies, there would be a tiering of providers based on their overall cost and quality indicators that were developed by the MCO, etc.
As one would expect, this approach to price and quality transparency would have many critics, especially the lower-tiered providers. While there are many problems with this approach relating to reliability of data, etc., it may have a greater likelihood of success vs. allowing the consumer to tread through mountains of data relating to price and quality.
Health Care Price and Quality Transparency
Responding to large employers’ interest in greater health care price and quality transparency, health plans are developing consumer tools to compare price and quality information across hospitals and physicians, but the tools’ pervasiveness and usefulness are limited, according to findings from the Center for Studying Health System Change (HSC) 2007 site visits to 12 nationally representative metropolitan communities.
Many large employers view price and quality transparency as key to a broader consumerism strategy, where employees take more responsibility for medical costs, lifestyle choices and treatment decisions. Some health plans believe providing price and quality information to enrollees is a competitive advantage, while others are skeptical about the benefits and are proceeding cautiously to avoid potential unintended consequences.
Health plans are in various stages of making price information available to enrollees. Plans generally provide some type of price information on inpatient and outpatient procedures and services from data based on their own negotiated prices or through aggregated health plan claims data obtained through a vendor; few plans provide price information on services in physician offices. However, the information provided often lacks specificity about individual providers, and its availability is often limited to enrollees in specific geographic areas.
Health plans generally rely on third-party sources to package publicly available quality information instead of using information gleaned from their own claims or other data. Health plans’ ability to advance price and quality comparison tools to the point where a critical mass of consumers trust and use the information to choose physicians and hospitals will likely have considerable influence on the ultimate success of broader health consumerism efforts. (“A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency,” Ann Tynan, Allison Liebhaber and Paul B. Ginsburg, Center for Studying Health System Change, Research Brief, No. 7, August 2008)
http://www.hschange.com/CONTENT/1008/1008.pdf
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