During the American Association of Homes and Services for the Aging's (AAHSA) Annual Meeting and Exposition in Chicago last week, the association unveiled its Idea House, a 2,600 square-foot model home that uses innovative technologies and design to help older adults maintain their independence at home.
"The majority of older adults would prefer to remain in their home where they can have a higher quality of life and the cost of care is much lower. The Idea House displays technologies that would allow them to do this while enabling caregivers to provide a high level of service," says Majd Alwan, PhD, director of AAHSA's Center for Aging Services Technologies (CAST) in Washington, DC. "It really brought the future of technology in long-term care to life on the exhibit hall floor."
The Idea House displays a variety of products, 90% of which are already on the market and available to consumers and providers. In addition to helping older adults remain independent in their homes longer, these technologies and designs can reduce healthcare costs, improve health outcomes, and provide caregivers with up-to-date health information.
Some technology and design highlights included in the Idea House are:
Automatic medication dispenser and reminder
Electronic medical records
Height-adjustable bath and kitchen appliances
Automatic personal emergency response system
Interactive gaming system
Artificial intelligent robot in place of live animal therapy
"Although the Idea House is designed as a single-family home, many of the architectural design features, such as the wide doorways, zero step entry between rooms, common socialization areas, or adaptability of cabinets, could be easily adopted by nursing homes, assisted living facilities, greenhouse models, and other long-term care residences," Alwan says.
In addition to health and safety technologies, the Idea House includes products to help seniors maintain their social network.
"Although the Idea House aims to help people remain in their home, we don't want to isolate them; we want to give them a dignified and fulfilling aging experience," Alwan says. "The Idea House displays several technologies to support social connectedness, such as social networking sites for seniors, communications portals, two-way video conferences, and technologies that work to stimulate seniors both cognitively and physically."
The Idea House displays a wide variety of groundbreaking technologies and designs, but perhaps the most remarkable was Cyberdyne's Hybrid Assistive Limb (HAL) device.
"Cyberdyne's device is a robotic suit that uses the bio-electric signals a person's brain and nervous system sends to muscles to activate an electromechanical limb, which is attached to the actual limb of the person," Alwan says. "It assists in the motion and can multiply the force of the limb by up to ten times."
HAL can be used as a temporary rehabilitation device, a permanent device for a disabled individual, or a device to help caregivers provide more support and weight-bearing assistance to the people they care for.
Although the Idea House was dismantled and packed away after AAHSA's Annual Meeting and Exposition ended, it will be available for viewing again at next year's meeting, where it will display new ideas and products.
Economic and bureaucratic barriers have thwarted an ambitious $1.7 billion Medicaid demonstration project, "Money Follows the Person," from getting elderly and disabled beneficiaries released from long-term care so they can return to live in their communities, according to a report from the non-profit research firm, Mathematica Policy Research.
Instead of transitioning 4,000 individuals back to their homes or community-based care programs in the first 15 months, as the program intended, only 1,482 individuals were given that opportunity, according to Mathematica. The program had intended to transition 34,000 individuals to home and community care by 2013.
The company was contracted by the Centers for Medicare and Medicaid Services to write the report.
Mathematica detailed several reasons why the program has stumbled in all but four of the 29 states and the District of Columbia that agreed to participate.
In half of the states, community level barriers, such as lack of affordable and accessible housing and rental vouchers, hindered the states' ability to transition as many people as originally planned.
Worsening state budgets because of the economic downturn strained state Medicaid management resources and staff, as well as the capacity of many home and community service organizations to take in more residents.
Many states lack affordable and accessible housing options.
One-third of the states report shortages of home- and community-based services, providers and direct care workers, making it difficult to ensure environments that are safe and provide adequate care.
In two-thirds of the participating states, programs began late because of delays in meeting planning and reporting requirements.
In some states, assisted-living facilities were excluded from the definition of a qualified community residence, although some participants may prefer that type of housing.
The six-month minimum institutional residency requirement was seen as too strict because many candidates had not been institutionalized that long. Those who had been institutionalized for that length of time frequently have complex medical or mental health conditions that make it difficult to provide care and support for them in the community.
Qualifying individuals are Medicaid beneficiaries who had been institutionalized at least six months in nursing homes, hospitals, intermediate care facilities for the mentally retarded or institutions for mental diseases.
Qualifying residences where they could move to include their homes, an apartment or a small-group home with no more than four unrelated individuals.
Researchers affiliated with Harvard institutions are reporting a variation on the theme "the emperor has no clothes" regarding benefits from health information technology, the second such report to become public this week.
The latest study, published today in The American Journal of Medicine, says that despite Congressional support to the tune of $19 billion, claims of efficiencies from computerizing hospital system records "rest on scant data."
Even "the 100 banner hospitals that are the most wired" are not seeing any cost savings nor do their electronic medical record systems make the administration of healthcare more efficient, says author David U. Himmelstein, MD., associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital.
His study was based on a review of 4,000 hospitals over a five-year period that had implemented various levels of electronic records.
"The idea from this administration that we're going to pay for health reform out of savings from electronic medical records is baseless propaganda," Himmelstein tells HealthLeaders Media. "It may be politically attractive, but it's nonsense."
He and co-author, Harvard professor of medicine Steffie Woolhandler, MD, are both affiliated with Physicians for a National Health Program, which advocates for a single-payer system. Adam Wright, also of Harvard, is another listed author.
Their report said that the Veterans Administration hospitals, which function as a single-payer system "have improved quality and decreased use (mostly of diagnostic tests)" because of their electronic record system, but that is a rare exception. The VA system's success is because "global budgets obviate the need for most billing and internal cost accounting, and minimize commercial pressures," according to the report.
The authors speculated that physicians and hospitals that are implementing electronic record systems are doing so to raise revenue rather than to improve quality or efficiency.
"Coding and other reimbursement-driven documentation might take precedence over efficiency and the encouragement of clinical parsimony," the authors wrote.
In an interview about the study, Himmelstein was asked why hospitals that have implemented EMR have not found savings. He replied: "What kind of an idiot hospital administrator would buy a system that will actually decrease what you can bill to payers? These systems help them extract more money."
He explained that electronic medical records have the capability of allowing billers to scan patient histories for items that might result in justifiable reimbursement.
"Hospital information systems help you do this, to find every co-morbidity that helps you jack up the charges," he says.
Hospital officials who advocate for the use of health information technologies heatedly dispute the researchers' findings.
"In my experience, some of the most wired hospitals in America are here in California, and they have the most opposite reaction," says Pam Lane, vice president of health informatics for the California Hospital Association.
"They would never go back," she says. "They've seen gains in patient safety and the ability to provide quality care across the continuum."
Himmelstein's report linked an annual survey of computerization at about 4,000 hospitals from 2003 to 2007 with cost data from Medicare Cost Reports and cost and quality data from the Dartmouth Health Atlas in 2008.
They then calculated an overall computerization score and three subscores based on 24 individual computer applications, including practitioner order entry and electronic medical records.
"We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality," the authors wrote.
The results: "Hospitals on the ‘Most Wired' list performed no better than others on quality, costs, or administrative costs."
Himmelstein's study is the second this week that disputes the benefits of EMR.
On Monday, The New York Times reported on a presentation by Ashish K. Jha and Catherine M. DesRoches of Massachusetts General Hospital. They compared 3,000 hospitals at various stages of adoption of computerized health records, and according to the article "found little difference in the cost and quality of care" between those that had adopted and those that hadn't.
The authors could not be reached for comment.
Terhilda Garrido, vice president of strategic operations for Kaiser Permanente, also disputed the two researchers negative views of EMR. She says her large HMO has "in fact, seen significant benefits from its investment in Kaiser Permanente HealthConnect, our robust and sophisticated electronic health record."
One of several studies conducted found that "two years after EHRs had been fully implemented, office visits had fallen, with doctors replacing some visits with telephone appointments—and quality measures remained unchanged or slightly improved."
She cautions that the systems may not work well for some institutions. "Merely plunking down information technology—a piece of hardware and some software—does not improve healthcare.
"If a lumberjack upgrades his equipment to a chainsaw but continues to use it the way he used his axe, he won't see much success. He has to change how he cuts down trees in order to make the most of the new technology."
Karen Bell, MD, senior vice president of HIT services for MassPro, the designated contractor for the Centers for Medicare and Medicaid Services quality and improvement effort in Massachusetts, cautions that for most hospitals and other providers, it is just too soon to appreciate benefits of health information technology because the systems take so long to install, understand, and use effectively.
"It's going to take several years, after you've done a full implementation, to see full improvement," Bell says.
Perhaps the Harvard researchers may be "jumping the gun," she suggests. "They have agendas that they would like to see supported. I would love to see a single-payer system in the country too, but I don't think it's going to happen and we have to improve our cost quality equations given what we have."
As Senate Majority Leader Harry M. Reid worked to nail down the votes needed to move to a final debate on healthcare legislation, a tepid assessment of the public insurance plan he crafted emerged as the latest potential obstacle to its passage, the Washington Post reports. A Congressional Budget Office analysis of the scaled-down public plan that Reid included in his $848 billion measure said it would have relatively little impact on the current system, would charge "somewhat higher" premiums than its private competitors, and would draw only about 4 million subscribers.
The House has approved a $210 billion measure to avert steep cuts in Medicare payments to doctors. The legislation, known on Capitol Hill as the "doc fix," would prevent a 21% cut in Medicare payments to doctors set to take effect in January, and also prevent further cuts in the years ahead. The bill seeks to correct a flawed payment formula that stems from earlier legislation intended to control the steep rise in Medicare costs. But Congress has stepped in repeatedly in recent years to avoid the cuts to doctor payments, the New York Times reports.
The Senate is expected to vote Nov. 21 on whether to take up health legislation that would cover five million fewer people than a companion bill passed by the House, but would cost less. A major difference between the bills is the effective date for important provisions, like the requirement for people to obtain insurance and the obligation of employers to help pay for it. Many provisions of the House bill would take effect in 2013. But to help hold down the cost of the bill, Senate Majority Leader Harry Reid decided to delay the effective date for many provisions by one year, to 2014.
In a unanimous vote, University of California regents approved a partnership with Los Angeles County that clears the way to reopen the Martin Luther King Jr. medical facility, possibly by 2013. The agreement creates a nonprofit entity to oversee the hospital and handle all hiring. Under the plan, the King hospital will be considerably smaller than it had been, 120 beds instead of 233. It will include an emergency room and three operating rooms but no trauma center.
Two new recommendations, calling for delaying the start and reducing the frequency of screening for breast and cervical cancer, have been met with anger and confusion from some corners, reports this article from the New York Times. The backers of science-driven medicine have cheered the elevation of data in the setting of standards. But many patients—and organizations of doctors and disease specialists—find themselves unready to accept the counterintuitive notion that more testing can be bad for your health, the Times reports.
As its customer base slips and healthcare reform looms, Aetna is laying off 625 employees now and will make a similar number of reductions early next year, the company announced. The layoffs are across many areas of the company, and Aetna is not exiting any markets or businesses, the company said. Aetna grew rapidly between March 2007 and September 2008, adding 5,700 jobs nationwide. The company had about 1,000 layoffs at the end of 2008 and no 2009 layoffs until now, the Hartford Courant reports.
A major physicians group in the California's San Fernando Valley, struggling with the rising cost of medical care, has joined another Southern California healthcare network that will now serve more than 600,000 patients, the Los Angeles Times reports. Lakeside HealthCare Inc., a medical group providing care for 200,000 patients through more than 1,800 staff and contract physicians, was acquired by Heritage Provider Network Inc. The financial terms were not disclosed, but the deal provided a needed infusion of cash to Lakeside, which was struggling with an unforeseen rise in medical costs, executives said.
