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Wednesday, December 29, 2010

Telemedicine VS. The Growing Tsunami of Health Care Costs

With 2011 approaching, we find ourselves immersed in many political debates that will determine which direction our country takes for decades to come. With our national deficit at record highs and facing the aftermath of the financial meltdown, one of our most pressing issues is how do we balance cost with good healthcare. Currently there are 53 million Americans without any form of healthcare coverage, a staggering number for the world’s only superpower. However, the debate continues: is healthcare coverage a right of citizenship or a privilege? Outside of this political debate is the undeniable fact that our healthcare costs are spiraling out of control, reaching $2.5 trillion in 2009. This accounts for 17.3 percent of GDP, after rising a record 5.7 percent in the previous year. Where are these dollars going and what is to show for it? Certainly a majority of the spending goes towards the treatment of chronic disease such as COPD (chronic obstructive pulmonary diseases like asthma and emphysema), diabetes, and heart failure. The most costly form of treatment is extended hospital stays.

So with our country facing a ballooning healthcare bill, what are the solutions when our aging population is steadily increasing our overall incidence of chronic disease? Combine this likely rise in hospital stays with a growing shortage of physicians and the addition of 32 million Americans to the healthcare system due to healthcare reform and you are faced with a daunting task of balancing budget with providing good healthcare.

Inherent in the answer is providing appropriate treatment with the most cost effective method. Telemedicine is proving to be one such answer: it’s a cheaper way to deliver quality treatment and it can be done without travel instantly through videoconferencing technology. Hospitals like UC Davis in California are adopting telemedicine as a way to extend specialist reach to patients without needing a doctor at every facility. Take a look at this video highlighting an emergency room scenario where a young comatose patient received the appropriate treatment for his diabetic coma through a consultation between his ER doctor and a specialist over a videoconference. Not only was his life saved as a result of the technology but tremendous cost savings were revealed by enabling immediate access to the appropriate care in the ER as well as for follow-up visits with his specialist.

If telemedicine can both save lives and save money then hopefully more hospitals will be following the example of UC Davis in the near future.

~Dr. Kevin Friedman



Wednesday, December 22, 2010

Prescribing in the Technological Age: Defining Legal and Ethical Guidelines


We’ve all been to the doctor and received medication. You know the drill, where based on his questions, your answers, and typically a physical exam, he determines whether or not you’re in need of medication. If that medication requires a written prescription he writes you a script and you take it to the pharmacy. This is basically the way you and I are accustomed to seeing a doctor and receiving treatment. It wasn’t long ago that similar personal experiences, like banking and dating, were based solely on this type of face to face interaction. Technology, however, has changed the way we communicate with each other and now we can conduct much of our daily lives without ever leaving the comforts of our home by using telecommunications equipment.

Monday, December 13, 2010

Obama Signs 4.5 Billion Child Nutrition Bill: Protecting Children or Infringing on Choice?

One out of every three? Now that’s hard to believe. That’s one out of every three children in America is overweight or obese. A staggering statistic for a country that prides itself on athletic excellence, Olympic dominance, and a general ethic of competitiveness. But that’s what the statistics are telling us, and what became the motivation behind a sweeping overhaul bill of child nutrition standards signed by President Obama today.

As with any government action these days, there are voices of opposition from both the right and left, but I believe this health reform is right down the middle and completely common sense. To give you the brief overview, the measure gives the government more power to set nutritional standards for public school cafeterias and vending machines, and a financial boost to help make this a reality. The bill also provides funding to subsidize healthy meals for lower income children.

For those concerned (and we all should be) about the exploding costs of our country’s healthcare system, this move targets the root of the problem, where poor nutrition in children leads to chronic diseases in adults, like diabetes and heart disease. These diseases are reaching statistically epidemic levels in lower income and minority families, who often lack affordable access to healthy eating choices. America’s public school system is the only institution with the scope and reach to effectively address the issue. Having spent nearly three years working to reform New York City’s school system, I know firsthand that school-subsidized breakfasts and lunches are often the only chance for students from financially challenged families to get the regular nutrition they need. Healthy food is far more expensive, and sadly harder to find in underserved areas, such as Harlem or the South Bronx for instance, where I spent much of my time.

Detractors will say this is yet another example of the government overreaching and infringing on our choices to eat what we want. However, this smart policy actually increases choice in my view, and finally provides a new option so many kids lack today. A healthy option.

~Alex Price

Wednesday, December 8, 2010

Great Barrier Reefs, Kangaroos, Fosters...And Now Telemedicine?

As telemedicine picks up momentum in the USA it is important to recognize that as a Nation we are not always the first adopters of new technology, and telemedicine is no exception. Certainly we are a world leader in healthcare however as the 38th ranked country in average lifespan at 78 years, Japan being the leader with an average lifespan of 82 years, we don’t own the market when it comes to an ideal healthcare system. Certainly there are recognizable issues with respect to healthcare access across different demographic groups, geographic locations, and time barriers to attaining adequate care that require an overhaul of the current system. The movement of telemedicine offers many possible solutions to these inadequacies as we combine technology with medical professionals and offer the combination to the patient. Many countries in Europe, China and recently Australia have recognized the benefits of telemedicine and are making great strides to bring it to their respective populations.

At this link is a great publication by the Australian government outlining the potential benefits, pitfalls, and possible solutions to connecting patient and physician over videoconferencing technology. Unique to this discussion is the Australian government’s outreach to health professionals and key interest groups to contribute their opinions to policy making strategies prior to implementation of such policies.

Among the topics addressed by the Australian paper is the general consensus that telemedicine offers a great solution to expanding healthcare to a country that has a widespread population over vast amounts of territory where many specialties are concentrated in cities. Of the concerns outlined are reasons telemedicine has not been widely accepted as of yet including lack of reimbursement for such services and technological barriers to delivering standardized care over such a medium. The Australian government’s Department of Health and Aging, responsible for delivering their form of Medicare, is in charge of coming up with some potential solutions to the problem. These solutions include financial reimbursement of physicians on both ends of the teleconference, an additional technology implementation incentive and expanding their broadband nationally through a National Broadband Network.

Telemedicine is a huge undertaking for our national government, hospital systems, physicians and patients alike, but will have a tremendous upside if implemented correctly. Certainly we should be aware of how other progressive countries, such as Australia, are planning to deliver this type of service to its citizens.

~ Dr. Kevin Friedman

Thursday, December 2, 2010

Show Me The Money! Quantifying Cost Savings The Key For Telemedicine

With the enactment of the 2009 American Recovery and Reinvestment Act, also known as the “stimulus bill”, many initiatives have been launched that will affect healthcare delivery in the future. One such initiative is spending hundreds of millions of dollars to expand broadband for the widespread use of telecommunication in hospitals and clinics. Additionally monetary incentives will be distributed to medical practitioners to convert from paper based tracking of their patient interviews and records to a completely electronic form. The big question is: will these programs to expand the utilization of telemedicine be enough to convince hospitals, doctors groups, and individual physicians to adopt a radical change in the way they have delivered healthcare, a system that has never undergone such transformation in so short a period of time?

It is my assertion that in order for the movement to gain traction and become a permanent fixture in our healthcare system, we will need conclusive evidence that telemedicine is a cost saver for the system and patient, and results in improved patient care and disease outcomes. Certainly the VA system, which has been an early proponent and adopter of telemedicine, is a perfect clinical environment for such data gathering, some of which is already being done as outlined in this article from the Gerson Lehrman Group. According to a recent report released by the Veterans Health Administration, telemedicine resulted in a “25% reduction in the number of bed days of care and a 19% drop in hospital admissions.” This significant improvement in patient care was seen among the VHA’s 32,000 veteran patients with chronic conditions being monitored and treated through a national program called Care Coordination/Home Tele-Health (CCHIT) .

Certainly objective criteria such as these, that have a direct correlation with cost savings, will be a major factor in the future widespread adoption of telemedicine, including remote patient monitoring and patient-physician consultations. The other highlighted and commonly accepted benefits of receiving coordinated care at home versus a traditional medical setting include saved transportation costs, reduced costly visits to the ER, decreased hospital admissions due to early detection of disease onset, and improved quality of care with patients given access to more specialists.

~Dr. Kevin Friedman