Date: Fri 10-Apr-1998

Publication: Bee

Author: KAAREN

Quick Words:

VNA-telemedicine

Full Text:

VNA Sees Possible Cost Savings In "Telemedicine"

(with cut)

BY KAAREN VALENTA

Several times a week a registered nurse checks on the condition of an elderly

homebound man who suffers from congenital heart failure.

The nurse talks with the man, performs a visual assessment of his condition,

checks his blood pressure and listens to his heart and lungs. She does all

this without leaving her office or visiting the man's home.

The technology that makes this possible is being used by an increasing number

of health care agencies across the country as an alternative to the

time-consuming process of having a nurse drive to each patient's house to

perform a routine checkup. Even its critics -- who say it can never replace

the human touch -- admit this technology is the harbinger of the future.

Local health providers got a look this week at the Aviva 1010, a personal

telemedicine system made by American TeleCare of Minneapolis, Minn. A

miniature television camera and microphone, installed in the home, allow the

nurse to see and hear the patient. Other equipment monitors blood pressure and

pulse, and listens to heart, lung and bowel sounds. The results are

transmitted over telephone lines to the nurse in the medical office.

Insulin syringes, IV pumps, pump readings, medications, and wounds also can be

viewed, and the information can be stored in the patient's record for future

use.

Looking For Savings

Jean Mahoney, director of the Danbury Visiting Nurse Association, sees

technology as the answer to the federal government's intention of

significantly reducing Medicare reimbursements.

"We believe we could save $350,000 a year using this type of equipment -- at

least 25 percent of our costs," she said.

As managed care providers and insurance companies have reduced the length of

in-hospital stays, the amount of money spent on home health care has soared.

Medicare pays for many of those visits. In response, the federal government is

proposing to pay a lump sum for each Medicare patient's home care, rather than

paying for each visit.

"Under the Balanced Budget Act of 1997, the reimbursement for home visits

would be set at the agency's cost during the 1993-94 fiscal year," Ms Mahoney

explained. "Agencies that are cost-efficient such as VNAs are being punished.

Our cap would be $3,000 per patient, but agencies that haven't been efficient

might get as much as $5,000."

The funding cutback threatens the very existence of the VNAs, she said.

"We estimate that 65 percent of the VNAs will go out of business," she said,

unless Congress makes changes in the legislation.

At the same time that the reimbursement methodology is being changed, the

status of patients also is changing.

"We are delivering care to sicker patients," Mrs Mahoney said. "They are being

sent home from the hospital much sooner because of managed care."

Pilot Project

Mae Schmidle, president of the Newtown VNA, would like to establish a pilot

project at Nunnawauk Meadows using some of the new technology to see whether

it is feasible to augment nurse visits with telemedicine.

"I think our VNA has to look to the future -- at least three to five years,"

she said. "Newtown should be on the front line of what is new in health care.

Although no system is meant to be all things to all people, it is something we

should consider."

Ms Mahoney said she has been talking about telemedicine for two years but has

not been able to convince Danbury Hospital to allocate the money. Instead, she

is now trying to get a grant.

"We could monitor a lot of patients this way," she said.

The Aviva system incorporates a computerized video terminal which would be

placed in the home health care office and mobile units that are placed in the

patients' homes. The central unit leases for $250 a month; each patient unit

is $175 a month.

Outright purchase is $7,500 for the central unit; $5,000 per patient unit. But

Nicholas P. Randazzo, northeast region sales manager for American TeleCare,

said the company recommends leasing because the technology is changing so

fast. "The cost is going down and the features are increasing," he said.

Mr Randazzo said in areas of the country where the units already are being

used, they are commonly placed in the homes of patients suffering from chronic

conditions such as congestive heart failure, diabetes, asthma, and cancer. The

units spend an average of three months in the patient's home and are used to

augment the standard number of nurse visits each week.

"These typically are patients who are getting multiple home visits each week,"

he said. "The technology enables the provider to maintain high quality care

and frequent contact with the patient but at a lower cost. The two-way

interactive video helps reduce patient anxiety and there is 24-hour access to

care so it has been shown to cut down on unnecessary emergency room visits and

on re-hospitalization."

Mrs Mahoney said each nurse with the Danbury VNA makes seven in-home patient

visits a day; the average for health care agencies is five.

"We could see a lot more patients with a telemedicine system," she said. "We

(the Danbury VNA) will survive because we are affiliated with Danbury

Hospital. But the next two years will be very, very difficult for home health

care agencies."

The meeting at town hall also was attended by Newtown Health District Director

Mark A.R. Cooper, and representatives of the town's social services

department, the senior center, the Commission on Aging and other interested

persons.