There’s also a market for apps that aren’t quite as clinical. Livn’it is an app that helps its users develop healthy daily habits like walking or flossing. Developed by Michael Kim, a former director with XBox LIVE, and his clinical psychologist wife, the app draws on elements of social gaming by encouraging the user’s Facebook friends to “cheer on” his or her positive behaviors.
Kim said the app might be good for someone who has a smart phone but can’t afford a therapist or personal trainer, but that it also might appeal to die-hard gamers who “might want to try a more meaningful game.”
So why haven’t foot-rash videos and exercise games already trumped physician office visits, with their manila folders and attendant inconveniences?
First of all, doctors are somewhat set in their ways. Topol called the medical community “ossified,” and Sebelius noted that as personal tech has revolutionized virtually every other industry, “healthcare has stubbornly held on to its cabinet and hanging files.”
The Centers for Disease Control and Prevention estimates that in 2010 only about 25 percent of physicians reported having electronic medical record systems that met basic criteria, and just 10 percent reported having a “fully functional” system.
Moreover, doctors have few incentives to adopt tech innovations. Most medical practitioners aren’t looking to find cheaper alternatives to follow-up visits and extra procedures because under the current payment structure, doctors are reimbursed by health insurance companies for how many services they perform, not by how well they perform them.
“We have a medical system by the yard,” Topol said in an interview. “The more you do, the more you get.”
In another panel, Dr. Stephen Ondra, a senior policy adviser in the Department of Veterans Affairs, likened the current reimbursement system to the “piecework” performed by his grandmother, who worked in a pants factory.
However, Ondra said there are provisions in the Affordable Care Act that may help. The health care law provided for Accountable Care Organizations, which are networks of doctors that manage all the care for Medicare patients and get incentives for keeping costs down. In 2015, the Centers for Medicare and Medicaid Services will begin using “a value-based payment modifier” to pay physicians based on the quality of care they provide versus how much cost they incur.
That could create a demand for cheaper devices like the AliveCor, which costs about $100 in European markets. (A single traditional electrocardiogram can cost $50). And the Vscan portable ultrasound monitor, which Topol also demonstrated on stage, goes for $7,900 — a fraction of the cost of a full-size machine.
Starting in October of next year, hospitals will also be financially penalized for readmitting Medicare patients whose relapses were preventable.
“Whereas previously hospitals might have looked at someone who has congestive heart failure as the gift that keeps on giving, they will begin to look at them as someone who you’ve got to manage in order to keep them from coming back,” West Wireless Health Institute chief executive Donald Casey said during one panel.
The software to monitor patients remotely by Health Interlink costs a hospital about $2,000, but it pays for itself — and then some — if it prevents even a single $10,000 hospital readmission, a company spokesperson said.
There may be some resistance to adopting new technology among medical professionals at first, Ondra said, but the move is inevitable if skyrocketing health care costs are ever to be curtailed.
“The only thing more frightening than changing the business model,” he said, “is the the direction the current model is going in.”
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