The recently-completed “Philips National Study on the Future of Technology and Telehealth in Home Care” was presented by lead researcher Dr. Robert Fazzi last week in a presentation at the NAHC Annual Meeting in Denver. The study was underwritten by Philips Consumer Healthcare Solutions, the division of the multi-national conglomerate that provides home telehealth systems.
The study presented valuable information regarding the number of Medicare-certified home care and hospice providers in the U.S. It also revealed interesting insights into current use of purchased vs. home-grown software systems, point-of-care systems and Electronic Medical Records. It was the telehealth section, however, that uncovered the most surprising data.
In light of the recent demise of two well-established and well-funded vendors, both due to slow sales, usage of home telehealth systems reported by Medicare agencies was much higher than anticipated. Highlights of the study, which relied on both questionaires and interviews with nearly 1,000 representative home care agencies:
- Respondents indicate an expectation that the home telehealth market will double in the next 2 years. That growth will be seen in agencies of all sizes and types, not just large, hospital-based providers.
- Use of both disease management and telehealth in tandem is the key to achieving quality Home Health Compare scores, patient outcomes and patient satisfaction.
The integration of telehealth data with Electronic Medical Records is also critical, though there is widespread confusion about EMR’s definition.
Use of point-of-care and billing/fiscal systems is currently high but little brand loyalty was detected among agencies planning another purchase.
- Patients generally embrace the use telehealth devices in the home.
- Clinicians report that telehealth systems increase referrals and decrease visits.
Representative sample implies reliable findings These results were complied from 956 agencies, carefully selected to represent a cross-section of the 8,813 registered with Medicare at the end of 2006. Their annual gross Medicare revenues ranged from as low as $.5 million to more then $6 million. They came from all 50 states and made up a representative sample of freestanding, hospital-based, for-profit, not-for-profit, rural and urban combinations.
The doubling of home telehealth deployment over the next two years, referred to in summary point #1 above, is found by adding the 17.1% reporting some currently usage to the 32.4% who say they plan to purchase a system. In addition, the study found another 16.5% of agencies that said they are not sure but considering a telehealth purchase. For the study’s purposes, definitions were standardized according to those used by the American Telemedicine Association and the U.S. Food and Drug Administration, both of which use language to be inclusive of hospital- and home-based telemedicine systems.
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. —ATA Telemedicine incorporates direct clinical, preventive, diagnostic and therapeutic services and treatment; consultative and follow-up services; remote monitoring of patients; rehabilitative services; and patient education. —FDA
As expected, large agencies use home telehealth more than small agencies. 32% of agencies with more than $6 million in Medicare revenue said they have deployed systems, while only 9% of agencies under $1 million do. Hospital-affiliated agencies reported 15% usage and not-for-profit providers 23.6%. Overall, most telehealth users have deployed within the last three years. Nearly one-quarter said their program is less than one year told; 44% are in the 1-3 year range. A small number, less than 10%, reported using telehealth for more than five years. It is one thing to transport a remote electronic monitor thousands of miles from the manufacturer to your office.
It is quite another to transport it a couple miles from your office to a patient’s home. We have previously reported the existence of a significant second-hand market, where agencies with thriving telehealth programs acquire dusty units from storage rooms of other agencies for pennies on the dollar. The Philips study discovered that it is rare for an agency to have 100% of its units installed in patient homes on any given day. Fewer than one-fifth of reporting agencies said that 90% or more of their units might be in homes on a typical day. Fully half of surveyed telehealth users said an average day would find 51% to 90% of its units in use. The remaining agencies, nearly a third, said less than half of its telehealth units would be found in use, with nearly 15% placing it at less than one-fourth. Patients: “don’t blame me!” In another significant result that may surprise everyone except HCAR readers, Fazzi announced that patients like their home telehealth units.
Nearly two-thirds reported that their patients or families rarely, if ever, refuse to accept a system into their home.
When Medicare-funded services have been completed and it is time for discharge, almost 80% of surveyed agencies say they have “many” patients and families who are dismayed that they have to give up their monitors. On the rare occasions when they did refuse a telehealth unit in their home – which only 7.1% of agencies reported happening in more than one case out of every five – patients sometimes cited fear (31.1%) and intrusiveness (24%) of the equipment itself. (Separately from the Philips study, HCAR discovered in the past that many agencies use patient dismay at losing their monitor upon Medicare discharge as an opportunity to present private pay services to the patient and family, with considerable success.)
Telehealth at the bottom line While a slight majority reports noticing little or no impact from its telehealth program on clinical caseload, productivity and overall costs, those who did report some impact overwhelmingly reported a positive one. In addition, nearly half are seeing increased referrals while less than 1% reported a referral decrease. Nearly one-third said they have seen an increase in clinical productivity while only 6% say it has decreased.
The impact on visit count is even more striking.
Half report a decrease in visits by clinical staff but only 13.6% say visits have increased. The jury may still be out regarding telehealth’s impact on clinical caseload. While nearly two-thirds say no impact has been felt, the percentages of those who report an increase or a decrease are both in the teens, not quite tied but close, with “increase” about five points (19.8% vs. 13.2%) ahead. Far more significantly, more than 70% of agencies using telehealth systems say that patient satisfaction scores go up among patients who receive telehealth services. None report that patient satisfaction decreases among those patients.
The impact of telehealth on major quality indicators is equally positive. Almost 90% of agencies using home telehealth systems say their overall quality scores improved. Roughly 80% say emergent care use has dropped and more than 75% say unplanned hospitalizations were reduced. Medicare’s holy grail for home care: patient self-care Dr. Fazzi paused his presentation dramatically on one slide to make sure all present appreciated the significance of one additional, perhaps unexpected, finding. A striking 75.9% of agencies using home telehealth system report that telehealth services have led to patients improving self-care.
The implication was clear, if unspoken, “CMS and MedPAC, are you listening?” In his concluding remarks, Fazzi offered three recommendations. If you are not providing telehealth services, now consider it. Acknowledging that his study was funded by a telehealth company, which would naturally want to see conclusions drawn in its own favor, Dr. Fazzi nevertheless emphasized that the home care industry already appears to be moving toward universal adoption. “Some say it will one day be required,”, he said, adding, “To stay current and competitive, agencies must consider making telehealth a core part of their practice.”
Focus on integrating your four major technologies.
A by-product of this study is the discovery that financial systems, point-of-care, electronic medical records and telehealth are emerging as essential home care tools. As they adopt these tools, agencies ought to ensure they talk to each other. Sharing patient data on the electronic level instead of the desktop or paper level increases efficiency and reduces costs. Look to new markets when providing telehealth. An exclusive Medicare focus is not a wise long-term strategy. Apply telehealth services to markets such as private duty, assisted living and others. Last week’s presentation of the Philips/Fazzi data was identified as “preliminary.” Dr. Fazzi announced that much more information will be shared with the industry as the analysis of the data is completed and the final report generated.