TCS Daily

Mr. Jefferson's Technology

By David Charles - March 1, 2002 12:00 AM

Personal privacy is a rare luxury for anyone elected to national office, so most Americans know that Vice President Cheney is being treated for heart problems.

Any casual newspaper reader could learn that the Vice President, who is, as the expression goes, a heartbeat away from the Presidency, is having his own heart constantly monitored, and at times, possibly treated by a tiny device medical device implanted in his chest. The newest versions of this exciting technology can not only monitor the heart but they can also treat heart conditions by acting as pacemakers and automatic internal defibrillators. These tiny devices can also store lots of information on the heart's performance that can be reviewed by the doctor and aid in the patient's future treatment plans.

It's the digital version of having a highly trained technician constantly monitoring the Vice President's heart and keeping a detailed log. It's an amazing piece of medical technology. Even more amazing, the technology exists today for any heart patient in America to get the same level of care, even if they live hundreds of miles away from the nearest heart specialist.

The technology is called remote monitoring, and it provides the ability to electronically monitor a patient's condition while they are at home. In the near future it will be an exciting new technology not just for heart patients, but also for patients with many kinds of diseases and chronic conditions. Remote monitoring systems can collect and securely transmit medical health data in just seconds, through a simple computer modem or via the internet, to a doctor who might be across town or across several states from the patient.

Unfortunately, millions of Medicare patients are being denied this potentially life-saving and cost-saving technology. Why? Because the reality of Medicare reimbursement hasn't crossed into the 21st century along with health care technology. Under current Medicare billing guidelines, a physician cannot be reimbursed for most services not delivered face to face. As a result, remote monitoring and telemedicine applications aren't being widely used, even though they have been overwhelmingly successful wherever they've been tried.

This is both wasteful and dangerous. Consider the implications for an ordinary citizen over 65 with a heart condition similar to the Vice President's. From her home, the doctor's office could receive information from her implanted device. If necessary, changes could be make to her treatment plan that could head off a serious condition and avoid an office or emergency room visit or the data could prompt a reassuring call from the doctor that everything is fine.

But that kind high-tech, cost effective service wouldn't be covered by Medicare. Instead, the patient would have made a drive to the physician's office to have the doctor, or more likely a clinician, review the data from the device. If an urgent situation arose that might have been prevented with remote monitoring, she would then have an expensive ambulance ride to the hospital. This would cost the Medicare system thousands of dollars more than the alternative offered by remote monitoring, and certainly wouldn't provide better care.

Fortunately, this gap between current medical technology and current Medicare billing policy would be corrected by a bill now pending in Congress. The Medicare Remote Monitoring Services Coverage Act (S 1607, HR 3572) deserves the support of anyone who's interested in seeing that older people take advantage of what remote monitoring can provide.

The legislation would provide the same Medicare coverage and level of reimbursement for electronically based remote patient care that it provides for the same services provided face-to-face.

Of course, remote monitoring wouldn't replace in-person care completely. It can, however, open up vast possibilities for monitoring patients, collecting data and having it analyzed by specialists quickly, regardless of geography. And with all the talk about high-priced technology driving up the cost of health care, here is technology that will make first class care more cost effective.

The legislation would close the gap between what policy allows and what technology can deliver. I salute the Congress for considering the bill and applaud the bi-partisan leadership of Senators Olympia Snowe of Maine and Jay Rockefeller and Representatives Richard Burr of North Carolina and Anna Eshoo of California, and think no less a statesman than Thomas Jefferson would do the same. After all, one of Jefferson's quotations inscribed on the Jefferson Memorial advises: "Laws and institutions must go hand in hand with the progress of the human mind." Recognizing the benefits of new remote healthcare technologies would do just that.

Dr. Charles is Director of the Movement Disorders Clinic at Vanderbilt University Medical Center and Chairman of the National Alliance of Medical Researchers and Teaching Physicians.

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