Redefining the role of telehealth for cardiovascular disease management

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• Ruth M. Kleinpell, PhD, RN, FAAN

Despite diagnostic and treatment advances, coronary heart disease (CHD) remains the leading cause of death in Americans aged more than 65 years. It is well recognized that CHD, including chronic heart failure (HF), often results in repeated hospitalizations, and represents a considerable economic burden to society.

The use of telehealth technologies, including audio, video, and other telecommunications to transfer information and assist healthcare personnel at remote sites, has the potential to optimize outcomes for patients with CHD. Today, high-quality resolution applications are quickly becoming common, from smart phones to other consumer devices that can be used for more efficient healthcare delivery.

Notably, a number of research studies have found that home-based telephone and telehealth programs reduce readmission rates for patients with HF. A recent Cochrane Collaboration review on the use of structured telephone and telemonitoring programs for patients with HF concluded that both interventions are effective at reducing the risk of all-cause mortality and HF-related hospitalizations.¹

Although research continues to demonstrate the positive impact of telehealth, its use in clinical practice has not substantially advanced. This is especially important because a growing number of patients may have difficulty accessing multidisciplinary HF disease management programs. Lack of a universal reimbursement policy for telehealth services among public and private sector payers has been a limiting factor. Because telehealth reimbursement is not mandated under Medicaid, individual states have had the option to reimburse for Medicaid services furnished through telehealth. In addition, under Medicare's Prospective Payment System, limited opportunity existed for the reimbursement of telehealth applications, with no specific funding for home telehealth delivery.

With the advent of the Affordable Care Act, many healthcare providers are anticipating changes that will benefit patient access to care. Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of chronic illnesses, including cardiovascular disease, insofar as they live in areas designated as underserved. Yet the regulations of the Accountable Care Organization will remain subject to statutory restrictions for telehealth services for Medicare beneficiaries and the Medicare program.² As identified by the American Telemedicine Association,³ telehealth should be an integral part of how the Accountable Care Organization provides healthcare. The benefits of telehealth include reductions of in-person overuse, as in emergency rooms and preventable inpatient admissions, triaging for faster, appropriate specialist care, improved patient outcomes, reductions in disparities to patient access, and decreased unnecessary variations in care.³

The role of telehealth, already shown to be effective in cardiovascular disease management, will need to be redefined if patients are to benefit from ongoing advances in technology. As healthcare providers, we must actively monitor proposed legislation with implications for telehealth, and advocate for promoting the delivery of healthcare by telecommunications technologies. Advances in telehealth technologies can only be beneficial if they can be integrated into clinical care, especially for patients with cardiovascular disease. The time has come to redefine the role of telehealth for CHD care. We have made too many advances in technologies, including the use of telehealth, not to take advantage of maximizing clinical application to augment patient care.

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References 

1. Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2011;8:CD007228
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2. Centers for Medicare and Medicaid Services. Telemedicine. Available at: http://www.cms.gov/Telemedicine. Accessed December 20, 2011.
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3. American Telemedicine Association. Available at: http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3308. Accessed December 22, 2011.
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