Hottest -- and Coolest -- Trends That Will Change Your Practice in 2013

Neil Chesanow

Disclosures

March 13, 2013

In This Article

An Explosion of Mobile Medical Devices

The miniaturization of medical devices continues to astound. Among those recently approved by the FDA is iHealth's Wireless Blood Pressure Monitor, which measures systolic and diastolic numbers, heart rate, pulse, and measurement time. It mates with your iPhone® or iPad® to let you test, record, track, and share your results. Another, iBGStar, is an iPhone-enabled glucometer. AliveCor's smartphone case turns an iPhone into a 2-lead electrocardiography device. Studies are currently in progress to test its effectiveness for postablation follow-up, long-term remote monitoring of atrial fibrillation, monitoring QT duration in response to medication, and other uses. Each device can wirelessly send current and trending data to the cloud for review by providers monitoring a patient's health.

Patients are embracing this technology. In 2011, 5% of the world's smartphone users were using mobile health products; in 2015, the number will leap to 30%, predicts research2guidance, a mobile market consulting firm.[1] But whether doctors will follow remains to be seen.

Reimbursement along every step of using wireless medical devices is still a great unknown. Say you want your patients with type 2 diabetes to use the FDA-approved iBGStar Glucose Monitoring System, which sells for $49.99 at Walgreens. Who pays for that? To have patients upload trending data on blood glucose to the cloud to be monitored, the provider doing the monitoring must subscribe to a service to make connectivity possible. Who pays for that? Once the data are uploaded, they must be reviewed. Will you be paid for that? "To be honest with you," Scher admits, "that whole model hasn't even been developed yet."

"Clinicians do what they're incentivized to do," says Daniel Kraft, MD, a hematologist/oncologist and executive director of FutureMed, a program that explores the future of medicine through technological advancement. But it may still make sense for hospitals, clinics, and Accountable Care Organizations (ACOs) to invest in mobile monitoring technology even if it isn't reimbursed. "Maybe a clinic should buy 10 connected blood pressure cuffs -- they're only $60 -- and lend them to patients," Kraft suggests. "Physicians are starting to be rewarded for outcome-based care. Hospitals want to lower readmission rates. If your patients' blood pressure is well controlled, your bonus may justify the expense."

Telemedicine Spreads to the Burbs

For some 40 years, telemedicine has been largely limited to underserved rural areas. Almost every state Medicaid plan covers at least some telemedicine services. In some circumstances, Medicare patients may be covered too. Fifteen states require private insurers to cover telemedicine the same as they do in-person services. Many other insurers cover at least some telemedicine services.

According to the American Telemedicine Association, approximately 200 telemedicine networks exist in the United States, with 3500 service sites. Over one half of US hospitals use some form of telemedicine today.

However, telemedicine is rapidly expanding to the suburbs and cities. Take health kiosks. SoloHealth is one company that operates kiosks in the pharmacy departments of nearly 300 retail outlets across the country. The firm expects to have 2500 kiosks in the market by mid-2013. The kiosks can provide screening for vision, blood pressure, weight, and body mass index; include a symptom checker; and offer an overall health assessment at no charge. SoloHealth's Website has a directory of local providers if a personal visit is recommended.

Telemedicine is also getting a boost from insurers. The latest is Anthem Blue Cross. Early in 2013, the California-based insurer will launch a new online care service for fully insured customers and self-funded national employers. The service will be accessible by computer. Members can choose a doctor and address their health issues via 2-way video. Some firms that offer telemedicine charge as little as $40 for a remote visit. For patients in high-deductible health plans or those who are elderly, frail, or disabled, it could mean the difference between getting care and doing without.

The Telehealth Promotion Act of 2012, proposed last December, would enable more doctors across the United States to remotely treat patients. If passed, the House bill would increase federal support and payments for telemedicine services within Medicare, Medicaid, the Children's Health Insurance Program, TRICARE, federal employee health plans, and the Department of Veterans Affairs.

"The obstacles with telehealth have been reimbursement and physician licensure," says Scher. "If you live in the greater New York area, for instance, you may deal with patients who live in 3 different states. You may not have a license in 2 of those states. This legislation addresses that. It will establish federal standards for medical licensure and offer incentives to hospitals to use telehealth in a cost-sharing mode. It also allows ACOs to use telehealth instead of face-to-face interactions on a fee-for-service basis."

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