Early telemedicine try didn't cut Medicare costs

NEW YORK Mon Jul 6, 2009 3:47pm EDT

NEW YORK (Reuters Health) - A telemedicine program designed to help Medicare beneficiaries with type 2 diabetes take care of their health didn't cut costs, and had only a "modest" effect on patients' health, researchers report in the journal Diabetes Care.

But that doesn't mean that similar interventions can't help patients and reduce health care spending, according to Dr. Lorenzo Moreno of Mathematica Policy Research, Inc., in Princeton, New Jersey, who led the research.

"Increased home-based tele-visits from nurses and self-tracking of progress could improve patients' self care behaviors," Moreno noted in a statement. "These improvements could help participants avoid long-term health complications, which in turn would reduce use of acute care services, hospitalizations, and Medicare costs."

Medicare commissioned the current study, conducted in 2000-2002, as an independent test of the cost impacts and clinical benefits of the Diabetes Education and Telemedicine (IDEATel) program. Participants included people aged 55 and older on Medicare who lived in parts of New York State with limited access to doctors and other health care professionals.

The program used a desktop PC that allowed patients to check and track their blood sugar and blood pressure, have video conferences with nurse case managers, and use educational materials on the Web. The current study looked at two phases of the program, conducted at one site in New York City and another in upstate New York. In the second phase, the home telemedicine unit was redesigned to make it less cumbersome.

The researchers looked at two groups of patients: 1,665 who were included in the first two phases, and another 504 in the second phase only. All were randomized to receive standard care or "intensive nurse case management" via telemedicine.

There was no reduction in health care costs for the patients in the telemedicine group, the researchers report; in fact, these costs were 71% to 116% higher than they were for the control group.

The program was so costly, the researchers say, because the home telemedicine units were expensive, and the budget of the project was quite large.

However, they noted, other telemedicine programs have been shown to cost much less.

"With adjustments, a Medicare program such as this might provide real benefits to beneficiaries," Moreno predicts.

SOURCE: Diabetes Care, July 2009.