PHYSICIANS/TECH/POLICY/POLITICS: Hard to generate savings when you spend more, eh?

The real medical story of the day is of course Michael Owen’s torn ACL, which leaves the idiot Swede’s decision to take only one fully fit striker plus a kid he won’t play to Germany as dumb as they come. But you lot don’t care about that. Instead let me tell you about my conversation with a consulting firm looking into home monitoring. The people interviewing me, once they’d got past my somewhat cynical notions about how technologies get reimbursed by Medicare and whether private insurers actually give a rats arse about saving money, kept harping on about reimbursement and how to get home monitoring reimbursed.

I made a point that will be all too familiar to THCB readers that if (and it’s not a tiny “if”) remote monitoring of the chronically ill, and all the DM processes that go along with it, is to be done routinely, then someone somewhere will have to give up some of their income to pay for it. In other words, if catching bad things happening to patients before they crash is the end result of home monitoring, there’ll be less money spent on the ones who crash. The optimists among us believe that the amount of that money not spent will exceed the amount spent on the home monitoring and DM, but that’s a subsidiary point. Instead the key issue is that under our current diversified system the people not getting the money for the patients (e.g. doctors and hospitals) who no longer crash are going to be different from the people who get the money for the monitoring (e.g. tech companies and DM service providers).

So if DM programs based around tech use, like the Medicare Health Support pilots or BeWell Mobile’s asthma DM program, are to be successful then they’ll either need additional funding from payors, or redirected funding from payors. When you have a global budget, like the VA, then it may well make sense to bring in this type of program, which is why Health Hero Network is having success with the VA, but struggled to get wide adoption outside it before. But, and you all know this, the VA, Kaiser et al are exceptions.

While leads me to the second part of the equation; how willing is the rest of the system (those doctors and hospitals) to accept less money for any reason—let alone subsidizing the adoption of new technology that will benefit someone else? Well you know the answer to that one, and yesterday came more proof, as apparently the AMA has beaten the Republicans to a bloody pulp and will not have to deal with the draconian fee cuts that were coming their way.

So I remain a skeptic that we’re going to spend more to spend less; I just think that we’re going to (slowly) just spend more.

1 reply »

  1. I’m not sure that your underlying premise here makes sense. Maybe I just don’t understand you. But the postulate seems to be that:
    a) doctors and hospitals and other stakeholders will percieve this as a threat to their revenue stream
    b) the stakeholders somehow have the ability to block this sort of technology/care delivery.
    I can’t agree with either of these. For one, *if* implemented and successful, remote monitoring may reduce office visits, procedures, and acute hospitalizations, but this will likely be more than offset by the demographic changes underway. Americans living longer, with more chronic diseases, not to mention the obesity epidemic, will keep the office waiting rooms and hospital beds full. And it’s not clear that monitoring will decrease office visits, etc. Lord knows, we see a lot of folks in the ER who present solely due to an aberrant blood pressure or glucose reading. So I don’t think there will be a revenue-driven backlash against remote monitoring, and it’s such an obvious increase in quality of care, that it will be hard to oppose, even by foot-dragging.
    And as to b), well, doctors have a hard time acting in concert to direct threats to their revenue, let alone vague and tenuous threats.
    So yes, funding will have to be found for remote monitoring if it is to happen. But I doubt there will be a petty squabble over resource allocation, at least in this case.