Medicare, Telehealth and congress

Medicare annual spending on Telehealth is around $5M. Compare that number with $505B annual spend for covering about 60 million Americans and you get the idea that Telehealth is not a prevalent service. CMS stipulates allowable originating sites of care  to be where the patient physically is. Like the home which is where most patients end up recovering. It is arguably their preferred place to be. Care can and should be provided where the patient is and it should be cost effective and clinically approved.

At the moment Telehealth is only available to Health Professional Shortage Areas and not in larger metropolitan areas where population is more dense. By eliminating this restriction there will most probably be an overflow of service requests where medical services and consultation could be conducted from the comfort of one’s home.

Currently Telehealth is restricted to voice and video. Congress can aid by expanding and adding other modalities to active monitoring with the use of wearables and sensors. This will require an expansion of CPT and HCPCS codes to actually cover these real time and on going services.

Lastly congress can consolidate states and federal offices in normalizing the licensing process to allow physicians to care for patients beyond their state’s borders. This will elevate demand from physicians in larger and more dense populations and also provide patients with choices.

There are 6 acts under way which are relevant to Telehealth:

Interstate Telehealth licensing

The Federation of State Medical Board (FSMB ) will enable physicians to practice across state lines. This compact was adopted by legislators in Alabama which is the 7th state required to enact it. 11 other states have the act pending approval.

Medicare Telehealth parity act 2015 – H.R.2948

This act discusses the expansion of Telehealth in 3 phases:

Phase 1

Expands what sites qualify as “originating site” to include federal health centers, rural health clinics, and counties in Metropolitan areas with populations less than 50,000.

Include services provided by diabetes educators, respiratory therapists, audiologists, occupational therapists, speech language therapists, and physical therapists.

Phase 1 also provides Medicare coverage of asynchronous (store & forward) Telehealth services across the country (beyond Alaska and Hawaii).

Phase 2

Expands qualifying originating sites to include a “Home Telehealth Site”, to include counties in Metropolitan Areas with populations of 50,000-100,000.

Phase 3

Originating locations definition expanded to include counties in Metropolitan areas with populations above 100,000. CMS is also authorized to develop and implement new payment methods for these services.

ACO improvement act – H.R.5558

An act to improve the ACO model by providing additional incentives based on quality of care and increasing collaboration between patients and physicians. Among the financial incentives for performance, this act includes patient’s option to choose their primary care provider, a nurse practitioner or physician assistant in rural and underserved areas.

Telehealth enhancement act – H.R.3306

This bill and it’s revised 2014 version, will add Medicare home health payments to remote monitoring services and is aim to expand coverage to all critical access and sole community hospitals. It would also cover home-based video services for hospice care, home dialysis and homebound beneficiaries and allows states to set up high-risk pregnancy networks.

The next step in the evolution of Yoga in the west

DFAyurveda is the traditional Indian system of medicine that arose out of the philosophy and practice of Yoga. It helps us to bring a greater vitality and awareness into our lives on all levels.

In the west Yoga was been brought to us mostly as a new form of physical therapy, and grew into a big business, mainly advocating a specific life style.

It may applied mechanically, en mas, as a system of techniques or asanas rather than a complete system for well being. It is not uncommon to walk into a class with 30 students mat to mat.

Moreover, Yoga studios predominantly operate in a gym mentality – unlimited access to Yoga classes for a set fee. There is less guidance provided to the student once they commit to a practice with no individual customization of the practice to meet the individual where they are at.

Exploring the link between the two system it is clear how some postures are beneficial for one person while they will aggravate another. The context of the individual is critical, in other words.

You may have experienced this yourself. A hot yoga classes upsets you. A Bikram teacher yelling at you boot camp style had make you not go back to class again. It may have got you back on the mat full of anticipation. You intuitively desire more restorative practice during the warm seasons. Warrior I held for a long time makes you question the integrity of the teacher, but Warrior II feels really good… so what is going on here?

In the tradition, Yoga has been taught in the context of  the individual, designed to meet their body, mind and consciousness where they are at. For example, if on the mental one experiences insomnia, anger or anxiety, while on the physical they suffer from constipation, lower back or join pain – Ayurveda observes the cause as excessive air (vata dosha) and prescribe specific asana and pranayama routines which will directly treat the cause at root to eliminate the effect. Ayurveda also observes how some Yoga postures may aggravate a condition.

What I would like to suggest is that is high time for Ayurveda to ride the coattail of Yoga, and help studios evolve into an important next stage of their evolution. Yoga teachers by gaining knowledge of Ayurveda can help their students on a deeper level to balance the body and mind, eliminate and prevent the disease process and maintain a state of harmony. It will be possible to create a vision for students with a clear trajectory for their progress and desired outcome. I believe that the integration of both systems will bring out the complete healing potential of yoga and the complete spiritual potential of the ayurveda.

So imagine with me a Studio which is a healing center, that knows their students on an intimate level, offers collective and private classes which directly impact the well being of the individuals, while providing lifestyle consultation, dietary, food and nutrition services, and serving as a true learning center for greater integration and deeper studying.

what google brillo means for healthcare IT

today google announced brillo, their IoT operating system based on android and it’s matching communicating protocol. brillo will be  live later this year and so will weave, the communication protocol. google is now making moves to join apple and microsoft, a timely move.

brillo and weave will work well on light weight devices, like cameras, door locks, etc. essentially home devices. in the growing market of health related devices and monitors, this announcement means another stride in that direction, in the shape of affordable scales, wearables, remote monitoring, telehealth and other means to collect specific and relevant information from patients where they are.

with small computers scaling up, a low memory foot print we should expect a wave of innovation when it comes to healthcare related products.

eating food for your type

ayurveda teaches us how to eat the foods which suit our body and mind for optimal health and balance. primarily the goal is to balance our digestive fire (agni), helps to achieve peace of mind (satva) and supports our immune system (ojas).

in ayurveda we recognize the 20 attributes which manifest in 10 pairs and they are the negative/positive of all forces in nature, specifically our mental and physical. a balanced digestive fire is warm, light and slightly oily. those qualities we seek in the food and drink we consume and also in the energy we absorb from the environment we are in, either through our skin, our eyes, ears and nose. to support a healthy digestive fire we should refrain from consuming that which contains the opposite energy. being mindful of the quantity of these opposing qualities to sustain a healthy digestive fire.

for example, avoiding iced drinks and having a warm tea rather before/during your meal will help sustain that fire. on the flip side, what is too hot or too heavy will diminish our digestive fire, for example strong spices or fried food. something to develop a keen awareness to as we eat, drink and interact with our environment.

it so happens to be that we tend to desire that which will put us further out of balance and with the notion of “like increases like” in ayurveda, this state of balance is an active state we need to be mindful to sustain. for example, someone who is pitta by nature, i.e. tend to hold excess heat, will keep seeking that which is hot or spicy, therefore it will throw them further out of balance rather than pacifying/cooling the excess of heat.

it is a good idea to pursue eating habits which incorporate the 3 doshas and the 6 tastes, being mindful of what we need more of and what we need less of. it starts with mindful eating noticing how what you consume affects your body and mind and refine the process over time. the body will let you know what works well and what does not.

stress will kill you. ayurveda can help!

by now it is clear that stress will corrodes our ability to maintain a healthy body and mind. those are well documented considerations at this point. we drive ourselves over the top in our career, sometimes in our relationships, either personal or professional and may end up living in a constant state of stress. i include myself here. the last 5 years have been challenging in so many ways it got more and more difficult to maintain balance.

ayurveda’s approach to the heart is that it is our source of vitality. propelled by the nervous system and influences the rhythms of the range of systems of the body and mind. the heart circulate prana, what is referred to as energy, both energy we take in and energy we expel, and works synchronistically with the breath, therefore.

the heart is governed by the following 3 sub doshas:

  • sadhaka pitta: the fire which determines truth. located in the heart and brain, by which we achieve our goals.
  • avalambaka kapha: the form of water that provides support and is located at the heart and lunge and lubricates the chest. in turn it connects to rasa which is distributed by the heart and lunges.
  • vyana vayu (vata): the pervasive air located at the heart and governs circulation.

a healthy heart means a balance of diet, emotions and mind. stress is a major contributor to imbalances of the heart which leads to cardiovascular disease. the number one killer of men in the continental US.

stress propagates through the body and overwhelms the body with cortisol. in term our heart rate elevates and so does our blood pressure which in turn account for accumulation of fat tissue in the blood transportation system.

ayurveda teaches us that most of heart related diseases stem from an emotional factor: anger, fear or repressed emotions. it is how we respond to stress which affects our bodies the most. effects of hostility and anger will affect our being dramatically. what tools and approaches are available to us to deal and address stress as it manifests in our body and mind?

as with yoga we focus on cultivating and familiarizing (what is named bhavana in sanskrit) awareness and be in the moment so we can pause this cycle rather than automatically responding to a feeling. the gita talks about this and if you read the aditya hridayam it talks about the inner enemies for us to conquer. we learn to relax our mind and therefore our nervous system to increase our inner power.

four approaches to consider:

  1. dharama: if you consult with an ayurvedic MD one of the questions you will be asked is “are you engaged in the work you most want to do?”. in other words what is your dharama and are you walking the right path? because if you are not, any “fix” will be temporary and superficial. at root we find fulfillment in being in service for other people and creatively expressing ourselves. though this path (marga in sanskrit) may be a longer ranging one, it is vital start asking this question in order to find the path and long term healing.
  2. pranayama: take the time to stop and withdraw your senses and connect with your inner self by simply breathing fully. find peace in that given moment, letting go. notice how your breath changes when you are stressed and notice, make that impression, of your breath when you are relaxed. go back to that moment to relax your body and mind. bring yourself actively to balance by changing your breathing practice.
  3. tapas: generate heat by taking a yoga class which is designed to break a sweat. other forms of sweating are wonderful as well if you yoga is not your thing. from a steam to running, playing soccer – whatever works for you. cleansing your body through the sweat glans will balance your mind and nervous system and affect your overall happiness.
  4. eat a fine meal: based on your constitution, location and season, treat yourself to a healthy meal and nourish your body.