Spacely Sprockets and the future of medical care
Jacqueline Vance, RN
So does anyone remember the cartoon “The Jetsons”? You know, George and Jane, daughter Judy, son Elroy and, of course, the dog, Astro. It's kind of fun to see how their 1960s and 1980s syndicated views of the future are turning out. (I love Nick at Nite).
Dogs running on treadmills ... check.
Rosie the robot ... sure, we have Nurse Rosie in long-term care facilities. (And Sherrie Dornberger from NADONA has hers dressed with Minnie Mouse ears and a Minnie Mouse apron in anticipation of the NADONA conference in Anaheim in June.)
Superfoods in capsule form ... check.
Cars flying at the speed of sound? ... Absolutely, because last time I was in Texas, I swear there was no speed limit!
On the Jetsons, if they wanted something — poof! — they got it. Today, if you want instant gratification, you also pretty much can have It, thanks to Internet purchases.
There is one particular Jetsons episode that sticks with me, and it appears to becoming a reality today. The episode is called “Test Pilot” and in it, George goes to see a doctor. One doctor is in-person but another is, well, kind of a telehealth doctor, diagnosing and speaking via a computer link.
OK so this telehealth doc radically screwed up (or else the episode would not have been funny) but the point is that the technology exists today.
I was recently reading a study — I know, I read a lot of studies don't I? — titled “Use Of Telemedicine Can Reduce Hospitalizations Of Nursing Home Residents And Generate Savings For Medicare” (Health Affairs, 33, no.2 (2014):244-250). It detailed how the telemedicine intervention involved bringing into the nursing facility a special cart with equipment for two-way videoconferencing and a high-resolution camera for use with things like wound care. When a resident had an off-hours medical issue (the study only used the telemedicine intervention on nights and weekends), a staff member brought the cart into the resident's room and contacted the telemedicine service, and the two-way videoconferencing took place.
According to the study, the researchers demonstrated an average Medicare savings of $150,000 per facility a month. (They used the standard average that one single hospitalization costs Medicare $10,000 a stay; they crunched the data to indicate that the telemedicine intervention stopped an average of 15 unnecessary hospitalizations per month.)
The telemedicine service costs on average $30,000 a month, so while Medicare would reap a hefty savings by not having to pay for prevented hospitalizations, once again the facility would bear the burden. Though of course there is the financial incentive: keep from losing payments from Medicare by rehospitalizing those higher-paying short-stay Post-Acute Medicare Part A patients.
But the $30k per month might not be a wash. Perhaps facilities that have large short-stay populations might be quicker to adapt the “Jetson” style of telemedicine if it works financially for them while largely Medicaid populated homes, especially those in rural areas that could highly benefit from this technology, wouldn't.
We just may have to wait for policy makers to do their thing, for the better of our patients and Medicare program savings. As we saw, based on the study, the Medicare program itself could save on average $120,000 per month if they also paid for the service.
If we extrapolate that loosely, the math shows $120k per month means $1.44 million of savings in a year. Multiply that by 15,465 certified nursing facilities and I believe that comes to a yearly savings of $22,269,800,000 ($22.2698 billion).
That could buy a lot of Spacely Sprockets and Cogswell Cogs!
But facing reality, when we think about how great this futuristic medicine might be, with all of the Medicare cuts to skilled facilities, it's going to be hard to afford to “make it so” (had to sneak in a Treky terminology as well!).
Just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who also is the director of clinical affairs for AMDA – The Society for Post-Acute and Long-Term Care Medicine. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.