Diabetic test could aid telemedicine payments
Providers hope HCFA will pay for remote care
An 11-member consortium of health care groups and providers hopes a pilot project using Internet-based telemedicine to deliver home care to low-income diabetics will convince federal officials to reimburse doctors for electronic delivery of health care. If Medicare and Medicaid endorse the idea, commercial payers are sure to soon follow.
Lead by Columbia University, the consortium is financed by a $28 million grant from the Health Care Financing Administration (HCFA) to install Internet technology in the homes of hundreds of low-income diabetic patients living in medically underserved areas of New York state.
HCFA has funded other telemedicine projects. However, this effort, known as Informatics for Diabetes Education and Telemedicine (IDET), is HCFA’s biggest investment to date in a single demonstration project.
"Presently, HCFA doesn’t reimburse for the electronic delivery of health care services except for very limited circumstances and demonstration projects it funds across rural America," notes the project’s director, Steven Shea, MD.
If IDET shows that low-income Medicare recipients in contrasting neighborhoods such as New York City’s Harlem and rural upstate New York can use and accept the technology, "then this will work anywhere in the United States," Shea says.
"If we can improve outcomes and show telemedicine is effective and cost-effective," the project could serve as a model for treating a wide range of conditions such as asthma, congestive heart failure, obesity, smoking cessation, and depression, he says.
Unlike other federally funded telemedicine projects, the New York project is designed as a randomized trial. Organizers will recruit 1,500 patients, starting in September. Half of them will receive telemedicine services, while the other half receive routine diabetes care. Patients will be enrolled in the study for two years.
The consortium will contract with a home care provider and a technology firm to install the telemedicine units in patients’ homes, teach patients how to use them, and provide technical support. Patients will receive computers equipped with a two-way video camera to take pictures of their skin and feet for signs of infection and a glucometer and blood pressure devices to check their blood sugar and blood pressure levels.
The devices will automatically capture patient data, which will be securely transmitted over the Internet to a clinical information system at Columbia Presbyterian Medical Center.
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