The advent of cheaper sensors and wireless transmitters, along with ubiquitous computing power in the form of smart phones, is making it easier and easier for patients with chronic diseases to track their conditions at home. But many health-care providers seem reluctant to adopt these technologies.
Experts say this is, in large part, because of the reimbursement system in U.S. health care, where physicians are paid for each test or office visit they provide. Outside a few specialties, doctors won’t get paid for monitoring data that’s been gathered remotely.
“It doesn’t matter how good these technologies are; if doctors can’t get reimbursed for looking at blood-pressure data that the patient records at home, they are not going to do it,” says Richard Grant, a physician at Massachusetts General Hospital and the Center for Connected Health.
This sentiment was echoed again and again at the Health 2.0 conference in San Francisco last week, where health-care innovators gathered to talk about how advances in mobile and Internet technologies can be applied to medicine. While earlier iterations of the conference focused largely on the technologies themselves, the latest gathering reflected how the field has matured. It included major players from the insurance industry, and often focused on the hurdles of incorporating these advances into health care.
“The worst problem when you buy health care piece by piece is that you can’t easily reengineer it,” said George Halverson, chief executive officer at Kaiser Permanente, a nonprofit insurer and health-care provider, at the conference. He gave the example of a program at Kaiser, which is paid an annual fee per patient, rather than per service, to reduce broken bones in older people. The program incorporated a number of steps that aren’t billable under Medicare. “We reduced the incidence of broken bones by 50 percent and saved $200 million in hospital stays,” says Halverson. “For anyone else, that would be lost revenue.”
Mark Smith, president of the nonprofit California Healthcare Foundation, agreed that the payment system discourages doctors from embracing new technologies. “My experience is that providers, when confronted with an innovation that will save money, say it will save money for insurers, not us, and essentially go on strike against it,” Smith said at the conference.
Indeed, many Health 2.0 entrepreneurs are targeting their products either directly at consumers or at insurance companies, who want to save on health-care costs. But to have a major impact on patient health, these innovations need to be embraced by physicians themselves. “It’s a lot more effective for a doctor to say, ‘I need you to upload your glucose numbers every week,’ than for a health plan to ask for that,” says Jim Hansen, executive director of the Dossia Consortium, a nonprofit organization that develops personal health records for employers.