On April 22, 2010, U.S. Senator Bob Corker and the Senate Special Committee on Aging held a hearing entitled “Aging in Place: The National Broadband Plan and Bringing Health Care Technology Home.”

 

The agenda for this hearing was the discussion of telehealth and the use of telecommunication technologies to provide healthcare services, and its potential to enhance hospital and nursing care.

 

The committee heard from multiple witnesses from the health and technology sectors, ranging from the national coordinator for health information technologies to Memphis’ own Richard Kuebler, department head of the University of Tennessee Health Science Center (UTHSC) Telehealth Program.

 

Witnesses discussed multiple advances in technology, as well as the many barriers that stand between patient and provider adoption.

 

The UTHSC Telehealth Program has been utilizing similar technologies for 12 years serving rural areas in Tennessee and its eight bordering states to monitor diabetes and congestive heart failure.

 

To track diabetes, the program utilizes remote glucometer monitoring as well as diabetic retinopathy diagnosis. Traditional diabetic retinopathy diagnosis, used to measure and prevent blindness from diabetes, requires two visits over the span of several weeks, but with telehealth technology the whole process and diagnosis takes approximately 90 seconds.

 

In a study performed by UTHSC on ‘at risk’ patients for congestive heart failure, telehealth services reduced hospital admission by 85 percent and as a result cut medical costs from $10,000 to $2,500.

 

“Nationally, there are 5 million hospital days per year for congestive heart failure costing approximately $8 billion (based on $1,600 a year average),” said Kuebler. “The national implications of utilizing telehealth in this single specialty could reduce healthcare costs by $3.8 billion.”

 

If costs can be reduced so dramatically in one specialty area, why isn’t it happening on a wider scale? In testimony throughout the hearing, two barriers were revealed that block the national adoption of telehealth services: technology and cost.

 

Mohit Kaushal, digital healthcare director for the Federal Communications Commission, explained that a broadband connection is required for most telehealth services, but there is a shortfall of available connections for broadband.

 

One in three Americans do not have broadband services. More importantly the groups most often targeted for telehealth services consist of late adopters or those who are unlikely to adopt broadband technology at all.  

 

There is also the discrepancy of rates for broadband services between rural and urban communities. Seventy percent of remote providers do not have access to broadband services, or must pay three times as much as urban providers.

 

The Federal Communications Commission has begun combating the problem of late adopters and broadband rates by introducing the National Broadband Plan (NBP). Officials hope that creating access to broadband and fostering awareness through the NBP they will increase connectivity and awareness of innovation, as well as provide hubs for improved business, education, and healthcare.

 

On the financial side, the Medicare system reimburses providers for traditional ‘brick and mortar’ visits at a rate two to three times greater than a telehealth visit, if there is any reimbursement at all for such visits.

 

“When left to altruism alone,” spoke Kuebler, “there is little hope of a sustainable business model for telehealth.”

 

The American Recovery and Investment Act (ARIA) invested billions of dollars to encourage early adoption of health information technology but is aimed at only certain Medicare and Medicaid providers according to Farzad Mostashari, the senior advisor to the national coordinator for Health Information Technology.

 

Kaushal noted that the initial stage supported by the ARIA focuses on electronically capturing and tracking essential health information, building the foundation for later stages that are already needed. He further stated that census research results show that by 2014, twice as many Americans will be age 65 or older and the need for telehealth services will be even greater.

 

The Department of Veterans Affairs has already put many of these practices into action through their own telehealth program, My HealtheVet. By connecting 32,000 chronically ill veterans with healthcare providers and care managers, hospital use decreased 25 percent overall and 50 percent for patients in rural areas.

 

Other success stories similar to the VA are isolated across the country, but none exist on a national level. Eric Dishman, global director of health innovation and policy for Intel, testified six years ago on behalf of telehealth and urged that if America wants to see telehealth progress it needs to take initiative.

 

Senator Ron Wyden, co-chair of the hearing, mentioned in his address that currently, “2 million out of the 400 billion (dollars) in Medicare spending is used for telehealth devices and 10 percent of the population accounts for 85 percent of Medicare spending.”

 

Wyden said if telehealth were given the proper funding, it would pay for itself with all the money saved through proactive healthcare, instead of reactive hospitalization.