Healthcare IoT - Welcome to The Future

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Listen to Dr Pankaj Gupta speaking @ IoT Grand Slam 2015:
https://www.youtube.com/watch?v=bFSm4Xhr4E0 
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The global IoT healthcare market is expected to grow from $30 billion in 2015 to $150 billion+ by 2020 and IoT-enabled connectivity within hospital labs will increase total global laboratory test throughput by more than 3 billion diagnostic tests over the next 5 years. 

The Internet of Things (IoT) is the network of physical objects or “things” embedded with electronics, software, sensors, and network connectivity, which enables these objects to collect and exchange data. This has huge applications and implications on Healthcare. Are we prepared for the next big game changer? 

Every aspect of healthcare has devices from direct care to supporting care and rehab to community care. With the advent of smart mobile phone that space started getting connected and shrinking into the smart phone. Now the smart phones are eating away into the medical devices space. The networks are getting smarter such that the line between IT infrastructure, Networking and Applications is blurring as we move to the cloud. The Digital Hospital has all of these. Whereas Disease management takes this beyond the enterprise into the homes and lives of the person. Insurance and Pharma are analysing the lifestyle data which is not necessarily disease data. Our lives are rapidly getting digitized! 

On the flip side: Imagine what happens if someone changes the calibration of Lab analyser, Radiology modality, Cath Lab, Dialysis devices, ICU or bedside monitors. Or switches off a pacemaker. Or changes the rate of infusion or gas in the OR. All of this and more can be potentially done remotely in an IoT connected world. Scared already? Welcome to the future.

Look for the latest IoT Slam event @ https://iotslam.com/

Fallout of Obama's EMR incentive package

Obama’s incentives package has put power in the hands of Physicians. So what is expected to change:

1. Pharma co: Physician’s reliance on pharma companies for drug education updates will reduce because they will get direct access to latest version of electronic drug databases in the EMR. Many EMR will have CPOE and Medication Management built into it, which will guard against unnecessary/incorrect prescriptions. Cross-selling and Up-selling of drugs will get minimized. However the drug compliance will go up in chronic disease management.
2. Insurance: Private sector Health Plans will have to compete with Public sector Health Plans for their bread-and-butter. US has a very large aging population [Baby Boomers].
3. Hospitals: Will have to figure out how they can increase their Medicare and Medicaid practice. They will also have to depend more on Physicians that already have a greater mix of Medicare and Medicaid practice.
4. CDC: Public Health initiatives and Disease Surveillance will gain power because they will start getting valuable Public Health data through Medicare and Medicaid. So far private enterprises didn’t want to share member/patient/outcomes data.
5. Healthcare Economics: will shift towards measuring clinical outcomes rather than business value. Public Health, Disease Management and Preventive Medicine will gain because US has a very large aging population [Baby Boomers].
6. M&A: New business models and major consolidations should be expected. I can see Pharma companies and Insurance companies buying out EMR/EHRS, Healthcare-IT companies [which one, I keep guessing..].

Initially I was skeptical about what 1 President can change. However Obama is surely exercising the power vested in the highest office of US. This looks like the dawn of a new era in US Healthcare.

Physician Practices become a large Healthcare-IT market in USA

As per my study here is a summary of Obama’s EMR and EHRS Incentive package:

1. $ 2B for developing standards, EMR installation grants and EHRS @ RHIR [I guess new name for RHIO]
2. $ 21B as incentives on EMR adoption. This is the net cost after anticipated savings of $ 15B are subtracted from the total spend of $ 36B on incentive payments.

Incentives will be given to providers with:

1. Use of a certified EMR product complete with ePrescribing capability as determined appropriate by the Secretary of HHS
2. The EMR is connected to the EHRS/ HIE for the electronic exchange of PHI
3. Complies with submission of reports on clinical quality measures
   

The incentives are for the ambulatory space and are paid on a per Physician basis. Hospitals are not eligible with certain exceptions. Provider can claim this incentive thru Medicare or Medicaid depending on their practice mix.

MEDICARE:

1. Physicians operating in a "provider shortage area" will be eligible for an incremental increase of 10% in their bonus payments.
2. Physicians operating entirely in a hospital environment, such as anesthesiologists, pathologists and ED physicians, are ineligible.
3. Beginning in 2015, physicians not demonstrating meaningful use will have their Medicare fee schedule reduced.

For further details you can refer FAQs on AllsrciptsMisys website; There is a table that gives the details of the amount physicians will receive each year through Medicare.

MEDICAID:

A healthcare provider is eligible for incentive payments from Medicaid who:

1. is not hospital-based and has at least 30 percent of the professional’s patient volume coming from Medicaid patients;
2. who is a pediatrician, who is not hospital-based, and who has at least 20 percent of the patient volume coming from Medicaid patients;
3. practices predominantly in a FQHC or rural health clinic and has at least 30 percent of the professional’s patient volume coming from Medicaid patients;
4. is a children’s hospital, or an acute-care hospital that is not described in clause (1) and that has at least 10 percent of the hospital’s patient volume coming from Medicaid patients.

Incentive payments will be based on a calculation that factors the physician’s Medicaid mix in combination with up to $25,000 the first year and $10,000 each subsequent year for five years, all multiplied by 85%. The highest potential for Medicaid payments is $63,750. Additionally, physicians filing under Medicaid must first demonstrate EHR usage by 2015 and will not be eligible for payments after 2021.

HOSPITALS:

Eligible hospitals such as children’s hospital, or an acute-care hospital can get $2 million base payment plus a figure derived from the discharge volume.

Critical Care Hospitals are not eligible for the incentives described above. Instead, they will be allowed to expense the acquisition cost of Health-IT in a single year for Medicare payment instead of depreciating it over a number of years.

For eligible hospitals not demonstrating meaningful EHR use by 2015, three-quarters of the anticipated percentage increase in the fee schedule shall instead be reduced by 33 1/3 percent for fiscal year 2015, 66 2/3 percent for fiscal year 2016, and 100 percent for fiscal year 2017 and each subsequent fiscal year. This reduction will be reevaluated each year, and a hospital can return to a normal fee schedule as soon as EHR use is demonstrated.

ADVANTAGES:

1. Therefore the Small Physician practices suddenly have become a very large Healthcare-IT market in USA! The power base has shifted. I remember the book ‘Power Shift’ by Alvin Toffler.
2. Obama has put life back into Public Sector Health plans - Medicare and Medicaid! WOW This is the work of a genius.

Above is a simplified version of the incentive package. There is more devil in the details. For those who want to go deeper, there is a good analysis provided in FAQ on AllscriptsMisys website.