Mobile health devices and applications hold great promise for improving the cost and quality of care, but an outmoded system of reimbursement for physicians considering the technologies thwarts their adoption, both public and private health IT experts said.
Consumers already use mobile applications for tracking their personal health, but it will take major changes in healthcare's financial system for physicians to include email, texts and devices into patient care, according to a panel discussion May 5 sponsored by the Institute for e-Health Policy.
The institute is part of the HIMSS Foundation, which provides research and education for public and private organizations and individuals involved in e-health policy. HIMSS publishes Government Health IT magazine.
Mobile health devices can expand access to healthcare, said Dr. Mohit Kaushal, digital healthcare director of the Federal Communications Commission's Omnibus Broadband Initiative told the group.
"In order to enable that, there has to be a lot of innovation and new technologies but also changes in reimbursement policy," he said. The FCC promoted the use of wireless devices and applications in healthcare as part of its national broadband plan released in March.
Medical devices, health sensors and their applications rely on wireless broadband networks to transmit raw data for tracking chronic illnesses, diagnostic health information through telemedicine services, and personalized services, such as health reminder texts via cell phones.
Consumers already obtain applications cheaply, "to manage health and wellness, measure and track blood glucose levels and help people feel more engaged and empowered," said Jane Sarasohn-Kahn, an economist with Think-Health Management Consulting. "When citizens are more engaged in health, they impact their health outcomes and ultimately reduce costs for chronic care," she said.
The U.S. now spends $2.3 trillion annually on health, three quarters of which goes to care for chronic conditions, Sarasohn-Kahn said. "Mobile health can really help us bend that cost curve," she said.
For example, Dr. Dale Alverson, medical director of the Center for Telehealth at the University of New Mexico Health Sciences, said telehealth has been used in the state's rural areas to do retina testing related to diabetes in order to help prevent blindness. Providers receive no reimbursement for the early detection screening, yet the patient would be eligible for disability benefits if he or she became blind.
"Reimbursement should be based on the data," said Alverson, who is also president-elect of the American Telemedicine Association.
Mobile health applications and devices, such as for measuring blood glucose and oxygen, are ways for physicians to get data in real time about chronic care and aging populations and save money at the same time, said Sen. Ron Wyden (D-Ore.).
The Centers for Medicare and Medicaid Services spends $400 billion on Medicare, with just $2 million of that reimbursed for telehealth products, he said. The recently enacted health reform law calls for payment pilots and demonstration projects based on quality data. Wyden said comprehensive, long-term payment reform is needed.
"We need to move the reimbursement iceberg to one based on quality not volume," he said. That will open up opportunities for products and services that bring more value to improving healthcare.
The National Institutes for Health (NIH) is vested significantly in mobile health research, said Audie Atienza, NIH's scientific advisor for technology partnerships. In 2009, NIH awarded 100 grants that dealt with mobile phones. More are expected in other wireless technologies and monitors. "That research has broad appeal across disease categories," he said.
