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+ Modeling Telemedicine’s Impact on Heart Failure Costs to Medicare Presented by: Elizabeth Bersin, Luke Hill, Phil Linder, Blake Roberts, Wallis Romzek, and Boramy Siek
| Date post: | 14-Jan-2017 |
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Health & Medicine |
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Modeling Telemedicine’s Impact on Heart Failure Costs to Medicare Presented by: Elizabeth Bersin, Luke Hill, Phil Linder, Blake Roberts, Wallis Romzek, and Boramy Siek
+Table of Contents
1. Overview2. The Trajectory of Telemedicine3. Current Situation for Heart Failure Patients4. Remote Monitoring5. Purpose of Analysis6. Modeling the Cost of Remote Monitoring7. Findings8. Limitations9. Scenarios10.Recommendations
+Overview
■ What is Telemedicine?
■ How is it used?
■ Types of Telemedicine
■ Telemedicine implications
Source: Mediphan.com
+The Trajectory of Telemedicine■ First signs of telemedicine
■ Current uses of telemedicine
■ Tracking ■ Specialties■ Rollouts continue
■ Future possibilities■ Expanding to include
telehealth■ More precise monitoring■ Economies of scale
Source: Apple
+Current Situation for Heart Failure Patients■ 820,720 patients admitted for heart failure in 2011
■ Cost of treatment:■ Average cost to for hospital admission: $11,000■ Average cost of Heart Stent: $30,000■ Average cost of Coronary Artery Bypass Graft: $50,000
Source: Pelizzari and Pyenson
+Remote Monitoring of Heart Failure
■ Types of RM:■ Telephone■ Electronic
■ Program costs
■ Current usage
■ Studies are mixed on effectiveness
Source: Leonard Ganz
+Purpose of Analysis
■How much would it cost Medicare?
■Why is this important?■Technology■Costs■Access■Quality of life Source: Charles Settles
+Modeling the Cost of Remote Monitoring■ Built a model to estimate
cost of implementation nationwide
■ The model estimates:■ Direct cost of monitoring■ Cost of hospital
intervention■ Cost from increased
demand■ Saving from a remote
monitoring program■ Total cost to Medicare
+How to Use the Model ■The model is comprised of two sections: parameters and detailed calculations of each cost
■Cost parameters include program costs, average cost of hospitalizations, various cost for surgical procedures, etc.
■Population parameter includes percentage of beneficiary with and without cardiovascular disease, program adoption rates, etc.
+Direct Cost of Monitoring
+Cost of Hospital Intervention
+Cost of Hospitalization w/o Intervention
+Cost Due to Increased Demand
+Cost Savings from Increasing Monitoring
+Findings■ Greatest amount of savings come from getting
increasing access to monitoring■ Early interventions are drastically cheaper and increasing
access to monitoring can save billions.
■ Over-prescription could eliminate cost savings from early intervention
+Scenarios to Consider■ Price change of remote
monitoring■ Price is likely to decrease
over time, resulting in more early interventions and savings.
■ Additional demand will increase direct cost of monitoring.
■ Utilization■ Initially likely to be low,
but will grow with time.
■ Over-prescription■ Decreased cost may
increase over prescription.
Source: Sherlock Health
Source: Sarah Marie Lammers
Source: Medchrome
+Limitations
■Data Access■Parameters can be
changed
■Assumptions■ Relationships between
variables■ Economic assumptions
■Cannot project estimates
■Repeated admissions
Source: Scott Tyler
+Recommendations
1.Implement remote monitoring programs to encourage at-risk population to get early screening
2.Expand coverage and access for Remote Monitoring.
a. Has a potential to reduce costs to Medicare for interventions and current conventional methods
b. Can potentially improve quality of life for beneficiaries.c. Factors to consider: defensive medicine
+ReferencesAmerican Telemedicine Association. "Telemedicine, telehealth, and health information technology: An ATA issue paper." May). Washington, DC: American Telemedicine Association, at http://www. americantelemed. org/files/public/policy/HIT_Paper. pdf, accessed 8 (2012).
American Telemedicine Association. “What is Telemedicine?.” Accessed February 2, 2016. http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VwHAp2NKPGI. Apple. "IOS 9 - Health." Accessed April 03, 2016. http://www.apple.com/ios/health/. "Cardiac Stent." Healthcare Bluebook. Accessed April 01, 2016. https://healthcarebluebook.com/page_ProcedureDetails.aspx?id=188.
"Coronary Artery Bypass Grafting (CABG)." Healthcare Bluebook. Accessed April 01, 2016. https://healthcarebluebook.com/page_ProcedureDetails.aspx?id=49.
Chen, Jersey, Sharon-Lise T. Normand, Yun Wang, and Harlan M. Krumholz. "National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries, 1998-2008." Jama 306, no. 15 (2011): 1669. doi:10.1001/jama.2011.1474
Children’s Health. “Telehealth.” Accessed April1, 2016. https://www.childrens.com/keeping-families-healthy/we-are-different/meet-the-patient/telehealth.
"Costs for Hospital Stays in the United States, 2010." Healthcare Costs and Utilization Project. Accessed April 01, 2016. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb146.jsp
eVisit. “Telemedicine Guide.” Accessed April 1, 2016. http://evisit.com/what-is-telemedicine/#1.
Ganz, Leonard. “Heart Failure Diagnostics and Remote Monitoring: Use Strategy or Just a Gimmick?.” Accessed March 25, 2016. http://www.medscape.org/viewarticle/567353.
Koehler, Friedrich, Sebastian Winkler, Michael Schieber, Udo Sechtem, Karl Stangl, Michael Böhm, Herbert Boll, Simone S. Kim, Kerstin Koehler, Stephanie Lücke, Marcus Honold, Peter Heinze, Thomas Schweizer, Martin Braecklein, Bridget-Anne Kirwan, Goetz Gelbrich, and Stefan D. Anker. "Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a Randomized, Controlled Intervention Trial Investigating the Impact of Telemedicine on Mortality in Ambulatory Patients with Heart Failure: Study Design." European Journal of Heart Failure 12, no. 12 (2010): 1354-362
Kulshreshtha, Ambar, Joseph Kvedar, Abhinav Goyak, Elkan Halpern, Alice Watson, “Use of Remote Monitoring to Improve Outcomes in Patients with Heart Failure: A Pilot Trial,” International Journal of Telemedicine and Applications 2010, (2010).
Lammers, Sarah Marie. “11 Types of Old People on Facebook.” Odyssey Online. February 1, 2016. http://theodysseyonline.com/rockhurst/11-types-of-old-people-on-facebook/290405.
Medchrome. "Defensive Medicine: Health Protocol of Tomorrow?." September 8, 2015. http://medchrome.com/patient/defensive-medicine-health-protocol-of-tomorrow/.
Mediphan. “Industry Overview: What is Telemedicine.” Accessed March 25, 2016. http://www.mediphan.com/solutions.php.
Pelizzari, Pamela M., and F. S. A. Bruce Pyenson. "The High Cost of Heart Failure for the Medicare Population: An Actuarial Cost Analysis." (2015). http://www.milliman.com/uploadedFiles/insight/2015/heart-failure-cost-medicare-analysis.pdf.
Settles, Charles. “Remote Patient Monitoring in Healthcare.” Technology Advice. June 15, 2015. http://technologyadvice.com/blog/healthcare/remote-patient-monitoring/
Sherlock Health. “Update on Health Insurance Prices for 2014.” Accessed April 01, 2016. http://www.sherlockhealth.com/2013/08/healthcare-reform-update-on-health-insurance-prices/.
Tyler, Scott. “Business Travel Tips: Knowing Your Limits.” Ecostyle USA. November 4, 2015. http://www.ecostyleusa.com/blog/business-travel-tips-knowing-your-limits.
Wittson, Cecil L., and Reba Benschoter. "Two-way television: helping the medical center reach out." American Journal of Psychiatry 129, no. 5 (1972): 624-627.
