Telemedicine: A 94% Success Rate

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Telemedicine is becoming a hugely popular health care product, and a great way to connect doctors and medical facilities with patients. Although many people are still not familiar with its application or availability, the medical community is acutely aware of the cost savings and efficacy of providing direct access between the healer and the sick.

As a matter of fact, the American Medical Association has stated that 70 percent of physician visits and 40 percent of hospital emergency room (ER) visits can be handled by a phone call. Of course, emergencies and difficult diagnoses are most readily addressed by going to a health care provider.

Telemedicine (sometimes called telehealth) has several advantages. And, the vast majority of patients like using this type of service. A survey by electronic health research firm Software Advice found that just 6 percent of patients who have used telemedicine didn’t perceive any benefits over in-person visits. The remaining patients cited the following benefits of virtual appointments:

  • 21 percent – quality of care
  • 21 percent – don’t have to travel
  • 20 percent – comfort of home
  • 11 percent – quick access to care
  • 10 percent – shorter wait time
  • 9 percent – easy to use
  • 8 percent – avoid waiting room
  • 4 percent – cost effective

So, those 6 percent would likely have complained about anything. You can’t make everyone happy. But a 94 percent success ratio is better than most options when considering ways to deliver patient care. Primarily, people said it is so much more convenient. They save time from leaving work or school and save money. The convenience dominates over all other aspects.

And employers like it as it keeps the absenteeism rate low. Benefits to employers include not having to reimburse a doctor for the expense of an office visit and not having employees spend half of a work day waiting to talk to a physician to get a prescription for a relatively simple health issue, such as a sore throat or other minor ailment.

Sometimes telemedicine is best understood in terms of the services provided and the mechanisms used to provide those services, according to the American Telemedicine Association. Here are some examples:

Primary care and specialist referral services may involve a primary care or allied health professional providing a consultation with a patient or a specialist assisting the primary care physician in rendering a diagnosis. This may involve the use of live interactive video or the use of store and forward transmission of diagnostic images, vital signs and/or video clips along with patient data for later review.

Remote patient monitoring, including home telehealth, uses devices to remotely collect and send data to a home health agency or a remote diagnostic testing facility for interpretation. Such applications might include a specific vital sign, such as blood glucose or heart electro-cardiogram (ECG) or a variety of indicators for home-bound patients. Such services can be used to supplement the use of visiting nurses.

Consumer medical and health information includes the use of the Internet and wireless devices for consumers to obtain specialized health information and on-line discussion groups to provide peer-to-peer support.

Medical education provides continuing medical education credits for health professionals and special medical education seminars for targeted groups in remote locations.

As more individuals obtain health insurance due to the Patient Protection and Affordable Care Act (PPACA), the debate about how to provide greater access to care at a reasonable cost becomes ever more relevant. Now, telemedicine is emerging as a crucial building block in the delivery of care, according to the American Academy of Family Physicians. Telemedicine also allows individuals to take greater control of their ailments, which is a way for patients to “self-manage” their condition.

However, training for telemedicine isn’t offered in medical schools; ongoing training of staff members is necessary for the programs to work. Telemedicine can transform medicine as much as electronic health records have if the commitment to quality management and consistent technical support is made. Additionally, health care professionals and policymakers need to think strategically about building a telemedicine network that can serve a large pool of patients.

According to the American Telemedicine Association (ATA), telemedicine has been growing rapidly because it offers four fundamental benefits:

Improved access. For over 40 years, telemedicine has been used to bring healthcare services to patients in distant locations. Not only does telemedicine improve access to patients but it also allows physicians and health facilities to expand their reach, beyond their own offices. Given the provider shortages throughout the world — in both rural and urban areas — telemedicine has a unique capacity to increase service to millions of new patients.

Cost efficiencies. Reducing or containing the cost of health care is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of health care and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.

Improved quality. Studies have consistently shown that the quality of health care services delivered via telemedicine are as good those given in traditional in-person consultations. In some specialties, particularly in mental health and Intensive Care Unit (ICU) care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction.

Patient demand. Consumers want telemedicine. The greatest impact of telemedicine is on the patient, their family and their community. Using telemedicine technologies reduces travel time and related stresses for the patient. Over the past 15 years study after study has documented patient satisfaction and support for telemedical services. Telemedicine offers patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances.

Smart doctors use smartphones to communicate telephonically with patients to provide value, savings, convenience, and quality of care. Not designed to replace the family physician, telemedicine is a powerful tool that can be used to augment treatment. When you need a prescription or a consultation in the middle of the night, or when you are on vacation, or on business travel, remember that your smartphone can be your best friend when you are sick.

Put The Home In A Nursing Home

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Mealtime. Naptime. Bath time. Bedtime. Everything is on a schedule for residents in a traditional nursing home, leaving little flexibility for personal decision making. But LaVrene Norton is working to make a change.

Norton is founder and president of Action Pact, a national consulting firm. It specializes in helping retirement communities and nursing homes train staff and design their facilities to feel and be more like living at home. Since beginning work on the “household model” in 1984, Norton has helped design hundreds of these communities.

The idea is that residents’ rooms are clustered around a common area, with a kitchen and living room. The size varies from four people in a private home to a bigger building with up to 20 people in “household” groups. Nursing assistants and caretakers help with the more traditional side of things, such as helping residents take their medicine and bathing. Norton says the household model is “the new nursing home” that helps focus on “person-centered care” and helps meet the wave of demand for more quality services from aging consumers.  Five percent of people over age 65 in nursing home-type facilities is more than 1.3 million.

Norton was recently interviewed:

How does your design compare to a modern day senior home?

There is no comparison. A traditional nursing home is institutional. When you move in, you in a way lose your identity. You definitely lose your uniqueness. It’s not like the staff is at fault, it’s the way the system is set-up. It’s very different when you’re in an institutionalized nursing home which most nursing homes are. The thing you’ll hear people talk about is person-centered care and that [means] teaching staff to seek the residents’ suggestions on things, do more at the residents’ timetable and attend to the residents’ needs and wishes. But the truth is, this system fights against all of those things.

What are the challenges you’ve seen with people wanting to build a household model?

There’s the need to get everybody involved without getting scared. If you say we’re going to do universal workers and all of the housekeepers are going to become CNAs [certified nursing assistants] and everybody in the kitchen is going to become CNAs and CNAs are going to do the cooking, it just freaks everybody out. We promote something that’s called a “versatile worker” instead of a “universal worker.” So we don’t expect everybody to become a CNA. We expect everybody to cross-train in something. From the CEO down, everybody cross-trains in something and that makes them more versatile.

Is this scaleable on the national level?

It is scaleable on a national level and I think it is going to be the new nursing home. My generation of people, and I’m 69 years old, who were born and raised and toughened up in the 60s are not going to tolerate bad service, shared rooms, a bath time that’s scheduled by somebody else. So the market is changing and we have to respond to that market. The neighborhood model is where you have a small group of staff, a very homey kitchen area, living room and dining room for each small group. So either neighborhoods or households are going to be in that new building once it’s built and all buildings will be rebuilt or renovated overtime.

You call it the “new nursing home.” Is this a movement?

It’s a movement because people want it. All of us want a good life for our elders and we’re frustrated by the old nursing home way. We don’t want that. Every CNA and every nurse and every cook and every housekeeper in this country, every activities person, every social worker who works in a traditional nursing home doesn’t want it for the residents they serve. They would so much rather have a good way for them to live. So you have that going for you. That’s the movement part of it. Then you’ve got the market.

Anybody who’s got a household model in their market area knows the pressure of having a decent place to showcase, to attract people to come to your home. You’ve got the customer. People my age, and 10 years older than me for that matter are not wanting the old way. They want to have a say in their life, they want to continue to contribute and give to others, they want to have a good daily life and when they look at this, and they’re much more consumer savvy, they’re not going to put up with the old way.

Is this a long-term solution?

More and more people are able to stay in their assisted-living environments. That goes for residential care as well. Residential care is a lesser life-style than assisted living and people are more able to stay there, in other words, home care keeping people at home. So, really and truthfully, whether or not in the future there are licensed nursing homes or not, there will be some kind of homey household model of community living. That allows [residents] the quality of life of home, that gives them freedom and independence and being in charge of their own life and yet has services that they need. So that’s going to be the ideal world for the future. We’ll never go back to institutionalized, long hallways filled with tons of people and warehousing people again, that’s done.

Who doesn’t this model work for?

I can’t think of a population that this concept does not work for. You use a smaller configuration which allows more interpersonal relationships with the residents to tend to them individually whether they’re severely disabled physically, whether they’re mentally ill, have severe memory loss.

People say “Well what about someone who is really sick, it won’t work for them, will it?” Well, of course it will. If I’m in bed all day I’d much rather live in a homey little space where someone could wheel my bed up to the door or help me into a lounge chair and help me into the living room area and I could just be there, whether I could talk, whether I could even be sure of where I’m at, just being around the clatter of dishes in the kitchen, and the smell of coffee pouring or bread baking, of genuine laughter in the other room. If I’m really, really sick I’m going to love it so much better. The best place to die would be at home, and this is as close to home as possible.

The Hidden Costs of Medicare

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Watch out for these unexpected Medicare costs. Certain Medicare Part D plans might require you to try similar lower-cost prescriptions before covering a more expensive medication that you are prescribed.

Some of the out-of-pocket costs Medicare beneficiaries face are fairly predictable, such as their monthly premiums, annual deductible and the copays and coinsurance associated with various Medicare services. However, there are other Medicare costs that are far more difficult to discern that could lead to surprise medical bills in retirement. Here are some Medicare costs you might unexpectedly incur in retirement:

Your free annual checkup might not be free. During the first 12 months you have Medicare Part B, you can get a free “Welcome to Medicare” preventive care doctor’s visit, and after that retirees are eligible for a free annual wellness checkup. However, depending on what tests or services your doctor orders during this visit, you may still end up with a bill. While Medicare covers a variety of preventive care services with no cost-sharing requirements, if your doctor recommends a test or procedure that isn’t considered preventive or you get a test more often than Medicare covers it, you may have to pay coinsurance and the Part B deductible may apply. If the doctor orders a test and it falls under Part B, you could very well have to pay 20 percent of those test costs. However, Medigap supplemental plans and Medicare Advantage plans may fill in some of these cost-sharing requirements.

Preventive services may trigger other costs. Medicare covers many, but not all, preventive care screenings with no out-of-pocket costs for retirees. However, if a screening test finds something concerning that requires additional tests or services, you will likely face a variety of out-of-pocket costs. The copay is reduced to zero for the preventive service, but once that part of the service is no longer preventive, now something is being treated and you are going to hit the 20 percent copay. For example, a colonoscopy is covered once every 120 months for most Medicare beneficiaries and typically costs nothing for the recipient. However, if a polyp or other suspicious tissue is discovered and removed during the colonoscopy, you may have to pay 20 percent of the Medicare-approved amount for the doctor’s services and a copayment to the medical establishment where the procedure was performed.

No annual limit on out-of-pocket costs. With original Medicare, retirees can expect to pay a Part B deductible, copays and coinsurance amounting to 20 percent of the Medicare‑approved amount for most services. There’s no annual limit on what retirees could be expected to pay out-of-pocket. There are types of situations where out-of-pocket costs can go extremely high. If you have major cardiac surgery, your 20 percent coinsurance could be thousands of dollars or possibly tens of thousands of dollars.” Supplemental insurance policies can protect retirees from these sometimes catastrophically high costs.

Penalties for late enrollment. You can sign up for Medicare Part B at any time during the seven-month period that begins three months before the month you turn 65. But if you don’t sign up during this initial enrollment period, you might have to pay a late enrollment penalty for the rest of your life. Your monthly Part B premium will increase by 10 percent for each 12-month period you were eligible for benefits but didn’t sign up for them. For example, a retiree whose initial enrollment period ended September 30, 2010, but who didn’t sign up for Medicare Part B until March 1, 2013 will pay 20 percent higher premiums due to the two full years he or she delayed signing up. People who are still working after age 65 and are covered by an employer’s group health plan can avoid this late enrollment penalty by signing up for Medicare Part B within eight months of the employment or coverage ending. COBRA coverage and retiree health plans are not considered coverage based on current employment for the purpose of avoiding the late enrollment penalty.

You could lose your right to purchase Medigap coverage. Medigap policies, which are sold by private insurance companies, generally pay for some of the health care services Medicare doesn’t cover. However, you only have a small window in which you are guaranteed the right to buy a Medigap policy. There is a one-time Medigap open enrollment period that begins the first month you’re 65 and enrolled in Part B. It lasts for six months, during which you have the right to buy any Medigap policy sold in your state regardless of your current health. After this enrollment period ends, you may no longer have the option to buy a Medigap policy, or it could cost significantly more. If you sign up in that initial period, they can’t look at your whole health history and decide to charge you more. If you don’t sign up in the initial enrollment period, then they can underwrite you. They can charge you more because of your particular health characteristics. If you delay enrolling in Part B due to group health coverage provided by an employer, your Medigap open enrollment period begins when you sign up for Medicare Part B.

Part D late enrollment penalty. Medicare Part D also has a late enrollment penalty if you don’t sign up when you are first eligible to do so or you go 63 or more days in a row without prescription drug coverage. The penalty increases the longer you go without coverage. If you become entitled to Medicare and you decide you don’t want to sign up for a Part D plan – for example, if you are not taking very many medications, if down the road you get sick and you start needing some medications, you will face a late enrollment penalty unless you have had drug coverage that was at least as good.

It makes sense to sign up for Part D when you are first eligible or when you first lose coverage so as to avoid those late enrollment penalties. The late enrollment penalty is calculated by multiplying 1 percent of the national base beneficiary premium ($.30 in 2015) by the number of months you went without Medicare Part D or other prescription drug coverage after becoming eligible for Medicare, and is then added to your monthly premiums for as long as you have Medicare Part D. For example, a retiree who was first eligible for coverage on May 1, 2011, but elected to delay signing up for a Part D plan until January 1, 2015, and didn’t have other coverage during those 43 months will be charged a monthly penalty of $12.90 in 2015 in addition to his or her plan’s monthly premium.

Drug restrictions. Medicare Part D plans have formularies that list which drugs are covered and the cost-sharing requirements. Some Part D plans also require prior authorization before you can fill certain prescriptions or might require you to try similar lower-cost drugs before a plan will cover a more expensive prescribed drug. There may also be quantity limits on how much medication you can get at a time.

Medicare Part D has a coverage gap. Most Medicare drug plans have a coverage gap that begins after a retiree incurs $2,960 in prescription drug costs and ends when drug costs reach $4,700 in 2015 and catastrophic coverage kicks in. In the coverage gap, retirees are responsible for 45 percent of the cost for brand-name drugs and 65 percent of the cost for generic medications in 2015. Part D has the famous ‘doughnut hole’ that is going to be closed, but there’s a sizable liability there for people who have substantial prescription drug costs. Some Part D plans offer additional gap coverage in exchange for higher premiums. The coverage gap is scheduled to be eliminated by 2020.

Little long-term care coverage. Don’t expect Medicare to pick up the tab for a nursing home or many other types of long-term care. Only short-term nursing home stays of up to 100 days after a three-day hospital stay are covered. If you need nursing home care for longer than that, you will be responsible for all costs. Many people who have a need for long-term care services end up spending down whatever resources are available to them and may, at that point, end up qualifying for Medicaid. While Medicare does not cover long-term care expenses, if someone is permanently living in a nursing home or some other type of assisted living facility, Medicaid does cover some of those long-term care expenses. And people can purchase private long-term care insurance that can help cover long-term care or short-term care.