Blog | Thursday, March 21, 2013

New technology, same old reimbursement


One of my tennis friends asked me about new innovative smart phone technology and why it hasn't been embraced in health care. She had just watched a video about Dr. Eric Topol, Chief Academic Officer at Scripps Health in San Diego, and his demonstrations of how a smart phone could monitor blood sugar, take EKGs and cardiac ultrasounds and really deliver health care to the patient at home.

My friend's question; "If this technology is here, why isn't it being used?"

According to Dr. Topol, new apps for the smart phones could eliminate 80% of echocardiograms that are done in facilities, at costs of $300 to $1,500 each. Having patients come into the office when they experience symptoms or for diabetics to get their blood sugar regulated could be eliminated. New technology could be data driven and personalized and save millions of wasted dollars in health care. So why is medicine so far behind the innovation curve?

The answer: No-one pays for it.

Why aren't all physicians using e-mail to communicate with patients and save them an office visit? The politically correct answer is "Remote medicine is not as good as seeing the patient in person and making sure the diagnosis is correct." The real answer is: No-one pays for it.

U.S. health care has complicated payment systems for work done. The payor for health care services is either Medicare/Medicaid (CMS) or hundreds of different (for-profit) insurance companies. CMS sets the payment rules that everyone follows. Medicare and all insurers will only pay for face to face visits. Reimbursement is for doing more and the more you do the more you get.

The doctor that tries to save a patient time and travel by covering a number of problems in one office visit will not be rewarded and, in fact, will be reimbursed less. If you do a skin biopsy on the same day you do a visit for arthritis flare, CMS and insurance companies will not pay for both things. Do them on separate face to face visit days and voila, better reimbursement for your time and skill.

E-mail, remote monitoring, remote echocardiograms, discussing tests via a smart phone are freebies. No patient visit means no reimbursement. The cost of putting in high technology is borne by the physician too.

Most physicians and hospitals and surgery centers and labs and pharmacies are happy with this status quo. There is great fear of change and so we continue to spend more on health care than any nation in the world. We do wasteful mass screenings and one-third of all prescriptions are a waste. People who need care are not getting it and others are getting too much that they don't need.

ObamaCare is trying to make some gradual changes by supporting pilot programs to change the way health care is delivered. But it is slow going and innovative answers are out there. If we could just figure out how to pay for services, while using new cost-saving technology we would all be following Dr. Topol's future dream.

This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.