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.

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.

what i’d like to see in the iphone5 (and probably won’t)

Good chance of getting:

4G LTE: 100Mbit up, 50Mbit down (peak). this will be huge for everyone. streaming made easy, uploading live videos and pretty much change the rules of the game when it comes to utilizing the phone. the big question is – can the carrier(s) handle the demand?

HD front and 8MP rear camera with a dual flash system. HD facetime – thank you very much. better photos at low light condition? yes please. no doubt apple will introduce major improvements to the camera, both hardare and software. by now the iphone is the most popular camera on flickr and it’s growing fast. we want to be able to take better photos easily, at different conditions and share them quickly. as the pixel count rises so the demand for bandwidth (see 4G LTE) and a quick turn around for large file sharing. we can ex (cpect something unique with this feature’s new offering. the inherit problem is the small chip for the camera and it’s ability to shoot in lower light conditions.

wider screen: has been rumored for a while with some fake prototypes etc. can’t wrap my head around a wider screen unless it’s up to full HD, which will be, no doubt, incredible (i’ll rate this as 1% chance of happening). if i’ll have to guess it will be retina 2.0 with a slightly higher pixel density and a more crisp display than the current 960 x 640 at 326 ppi.

better battery life: with iCloud and push across the board, there is no doubt apple is pouring tremendous effort behind making their devices stay up and running longer. expect something unexpected.

built in noise cancelation mic: a la jawbone, it’s time for the iphone to become a better phone. and please let’s take care of the proximity sensor issue. please.

NFC with eWallet OR BLE (4.0) + APIs: this will be very exciting to have. finally. eWallet patents are around for a while and android is a head of the curb. if we look east to japan we see clearly how mobile is used and credit cards are gone. yes – gone. the phone will be THE payment system in the very near future. it’s the credit companies that should be on their toes with this one. it is really all a matter of timing no? can’t enter too soon and definitely not too late.

there has been much discussion over Bluetooth Low Energy, otherwise known as BLE, which is the 4th version of bluetooth, now available in the just released macbook airs. what the new standard means is low energy consumption and wider range (50m) which means awesome apps and peripheral devices are heading our way. this is an interesting strategic call by apple, do they go with NFC and RFID or do they bet on BLE? based on the this recent move of incorporating BLE chips within the new line of macbook air… well… let’s see what happens 🙂

Little chance of getting:
solar charging: apple has been working on this for a while now. heck, there is a prototype out in the wild that is solar enabled (link). this is a game changer and the reason why there’s little chance of getting this one is because it’s probably required to perform much more tests and phase out gradually. maybe a device which combines both battery and solar charging a la hybrid first.

haptic display + APIs: probably the advancement i would like to experience the most. haptic displays will revolutionize the way we interact with smart devices and their touch screen as they provide feedback to our touch sensory system. imagine that each button you click on a touch screen feels real. this is huge for UX across the board and opens the doors for some unique applications. android has immersion – a great company to follow with a great mix of products, worth mentioning are their medical related haptic devices. check it out here.

new map application: apple has made significant moves to become a player and tighten their vertical integration. this app should be nothing but fantastic and introduce features never seen before on smart devices. one option could be an augmented reality turn by turn navigation, integrated with location meta data and the users social graph.

iOS 5 is around the corner (updated)

iOS 5 image

update: this post was written thursday of last week. it is now semi confirmed the developer of mobileNotifier is hired by apple and that iCloud will be presented by jobs tomorrow.

one major revamp is the bare minimum as there are areas lacking where either android or cydia leaves the current OS lagging. and no doubt we will get what we are expecting.. just a gut feeling… here is my short list of enhancements that i’d like to see:

1. improved notification system: bar non that most important and required change to iOS. face it, the current notification system sucks big time. in the past, the real incentive to jailbreak your phone was mywi, my3g and going even further back, multitasking and naturally the most important feature – sim freeing your phone (Screw you apple and ATT for violating FCC regulations). now-a-days, mobileNotifier is THE reason why my phone is jailbroken. aggregate all notifications into a single window utilizing the empty space created when you double click the home page. apple – pls take note, this guy has done a great job.

2. dynamic home icons: ala windows8. yes you heard right. big chunky icons that actually display content and not just a static image. one good example is available on cydia and is called ‘weather icon’. it changes the degrees on the weather icon to display the current temperature. it also allows the temperature to be displayed on the status bar. really useful stuff. apple, please expose an API to do so.

3. OTA updates: not likely but definitely nice to have… over the air updates makes lots of sense. please – no more plugging in to itunes and backing it all up. this ties up to the next item that is most definitely making an appearance on monday:

4. iCloud content sync: this will probably make a big eco. iCloud can and will take cloud services to the next level. apple doing what they do tiered up, may see music sync and later down the road app sync.. so iCloud will probably allow you to purchase music from iTunes and stream it directly from your cloud storage. no need (or an option) to download and sync stuff. fantastic. one viable option is to open a US front against spotify, the EU-stream-the-song-you-want kind of service in the US. imagine a yearly/monthly plan ($20-$50/year) where you can listen to what you want… that’s a nice one.

WHAT’S MISSING? iphone5 with 4G, NFC and iWallet, A5, double down on RAM, larger display and IR.

Why Apple TV and Ping will fail

Major snore from Apple in my opinion. I think that the event itself, and the fact it was streamed to Mac machines and Safari browsers only is THE reason why Apple had failed and will continue to fail (in my eyes) with the latest announcements. I am talking about a close eco system and spoon fed experience.

Apple failed with the TV expenditure. Steve did not show us numbers, but clearly it was a failure. The big changes were sizing, pricing of shows and streaming, as opposed to storing. Is that what the users really want? To a certain degree, yes. Users do not want to worry about storage, they want to pay less for a device and for content. Apple did deliver on this, but it will not be enough, I believe, to be a killer device like the iPhone, and take over the living room with a storm. WHY? Because of the closed eco system and spoon fed experience.

Apple did a great job in educating the users and providing a great user experience across the board. I argue that user experience is what Apple is really selling and why people are using it. Coupled with the motivation to challenge and innovate, and you have a winning strategy.

This does not and will not work for the TV because only Apple fanboys will forget everything they know, and start a fresh with Apple TV, and forget all they know and do with their many years of habit. The TV is one area where users do not want to get the Apple filter applied to. Users don’t mind it with their iPod shuffle. They don’t mind it with their Mac OSX based machines, and to a certain degree they agree to it with their iPhone (mainly because Android did not step up it’s UX game to be considered a worthy competitor. yet).

Apple will gain a small market share and will have to come up with something much better than that to capture the imagination of the bigger market. I believe that can be done by turning the Apple TV into a real entertainment center to compete head to head with the Sony PlayStation and the Nintendo Wii as a console, introducing the iOS appStore for the TV. That can be killer. But even that is not enough. An Apple TV can only be better than, let’s say, a Mac Mini hooked up to a TV, if it is open. By open I mean I can do whatever I want to do, as opposed to whatever Jobs wants me to do (buy his content that he chose for me).

Examples for this behavior are ample and sad. Apple removed Camera+ from the AppStore recently because TapX3 released a hack which allows you to fire up the camera from the volume button. Apple initially declined the feature, claiming it will confuse people. So Apple is stepping up to the plate as our parents (more like a big brother), deciding what is confusing for us. Clearly, releasing the shutter speed in an ergonomic way may confuse us. I feel over estimated, and I do not think it is for Apple to decide for me what’s confusing and what’s not.

Apple’s attempt at social media is probably the most interesting news to date from that event. A social network around music, which is mutually exclusive from Facebook. Did I snore yet again? While I do believe this is a GREAT idea and a fantastic opportunity for Apple to increase sales on iTunes – the segregation is peculiar. Even worse – who wants to live inside iTunes? Though revolutionary, iTunes is hate by many. Looks and feels old and clunky. Navigating through your music sucks and discovery with genius is, well, boring…

Apple’s notion that people will have iTunes open to see what their friends are listening to is optimistic at best. Not web based, not facebook integration. Only one hope – it integrates with iTunes on your mobile device. I cannot imagine myself opening up iTunes when I want to listen to some music, and getting up to speed with what’s going on with my music buddies.

Apple can definitely relax a little. Let go of the grip and think of a more open way to provide users what they do best. Or not. My personal opinion is that they will not do that, and continue to thrive with a small market share that pays hefty sums to be a part of the cult.