TECH: Metcalfe’s law in reverse

USA Today tells us that 3,000 Patients with defibrillators are now broadcasting their signals wirelessly

Patient demand is growing as the U.S. population ages. Use of implantable defibrillators has risen from about 21,000 in 1995 to more than 250,000 last year. With such high numbers involved, some doctors worry whether they’ve got enough staff and time to process the influx of data home monitoring systems can provide. For example, what responsibility do medical staff face to respond immediately to a potential sign of trouble that turns up in a batch of downloaded data? How do they sort out real problems from the false alarms?"There are concerns about information overload," said Dr. David Martin of the Lahey Clinic in Burlington. "Physicians have less and less time, and they don’t want to have fewer patients coming to their clinics at the expense of having too much paperwork." But Martin expects remote monitoring will enable his team of five electrophysiologists to track their more than 4,600 patients more closely. "There are not enough doctors and nurses to follow these people, so it makes sense to use technology to automate some of the functions that don’t require physicians’ input," Martin said.

So as the technology races ahead, the service organizations which will do the monitoring need to be put into place. But of course this being health care they are only going to be put into place if someone pays for them. And that someone is Medicare. So the key question remains, is this a medical service that has already been granted Medicare’s blessing, or is this some type of disease management service that is still in trial? We know which end of that scale the manufacturers want this to be on, but if this technology cuts physician visits and doesn’t replace them with other funding streams, it won’t be too popular amongst doctors. Which means that it’s all very well but for now these patients are a bit like the guy with the first fax machine!

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3 replies »

  1. Physicians doing the implants are responsible for following up with patients. But of course, they’d rather do implants than followup because that’s where the money is. Device companies are competing for market share by taking the monitoring burden off docs. Uptake is therefore less dependent on Medicare reimbursement than you claim.

  2. But of course this being health care they are only going to be put into place if someone pays for them.
    As opposed to any other industry that will provide its services for free?

  3. I wonder about a couple of things. First, how many doctor visits for routine checkups to follow their condition are there per year for the 4,600 patients referred to in the article above? Second, on average, how many times a year would something unusual occur that requires physician intervention that could be detected by remote monitoring? If the bottom line is that a large number of routine doctor visits could be eliminated and safely replaced with remote monitoring, it suggests a significant opportunity for cost reduction whether doctors are happy about it or not. If the evidence leads in that direction, Medicare should be more than willing to pay for it for its eligible population. If the routine checkups would still be required, and remote monitoring would be just another added cost for an already overburdened program, that’s another matter. At the very least, it should have to demonstrate an ability to save or extend lives by catching problems in time to do something about them.