Silver Linings: Remote rehab -- Telehealth helps seniors recover in rural areasBy GRETCHEN M. GROSKY
New Hampshire Union Leader
December 10. 2016 8:43PM
Samuel Brown was laughing with co-workers when his legs suddenly gave out. He ended up at a New York City hospital and then sent home. The next day he was back at the emergency room with limited feeling in his legs and with no real answers as to why.
A month later, the 86-year-old is rock climbing, playing soccer, and skiing - all without leaving the rehabilitation center where he is recovering.
Brown is part of a program at the New Jewish Home in Manhattan's Upper West Side using a videogame console-like system outfitted with a Microsoft Kinect camera that monitors 25 points on his body. It tracks his movements and relays the data back to his health care team who can remotely watch his progress and adjust his program as necessary.
"I love it because it's interactive. It's like a game, but it's helping me get well," Brown said.
The program being used by Brown is called Jintronix and is part of the emerging health field of telerehabilitation. In the coming year, the New Jewish Home is hoping to discharge some 30 patients with this equipment as part of a pilot program to provide occupational and physical therapy at home.
Jintronix CEO Mark Evin says the at-home program is being used with great success in rural parts of Kansas and by the Veterans Administration to serve veterans in remote areas.
Here in New Hampshire, such technology cannot be used in a home setting unless an actual physical or occupational therapist is in the room with the patient. Dr. Stephen Bartels, of The Dartmouth Institute and one of New Hampshire's leading proponents of telehealth, said therein lies the rub.
"We don't have enough therapists in this state to have them drive two hours to help someone who is frail living in a log cabin," Bartels said. "In rural areas, this is the future."
Paying for it
Whether it be a stroke or cardiac issues or a hip replacement, seniors find themselves often in the care of an occupational or physical therapist. In a state that is rapidly aging and where two-thirds of its residents are living in rural areas, it would seem telerehabilitation and other forms of telemedicine would be welcomed.
But Bartels said in many cases, telemedicine in New Hampshire is only covered by insurers when the work is being done in a facility. Medicare and Medicaid only pays for some telehealth when it's done in a rural area, meaning Rockingham and Hillsborough Counties are left out.
In the case of rehabilitation, New Hampshire licensing laws prohibit the use of remote therapy without a therapist present.
"It's a regulatory issue and this is a big deal in telehealth," Bartels said. "In most cases, it's only reimbursed if it's office-to-office or from clinician-to-clinician."
Regina Melly, senior vice president of business development for the New Jewish Home, said if its pilot program is approved, the 30 patients would receive the Jintronix equipment free of charge. The hope is a successful pilot program will lead to managed care providers picking up the cost of the equipment for future patients, she said.
Andrew Solomon is project manager for the Northeast Telehealth Resource Center, a federally funded group providing technical assistance to telehealth programs in New England, New York and New Jersey. He agrees telerehabilitation is beginning to trend, but said the challenge is getting someone to pay for telehealth in general.
"Reimbursement is certainly a challenge," Solomon said. "We find many payers are generally not covering telehealth services at home."
Bartels believes some of the reasoning for not funding telehealth in the home is based on fears that the technology will be overused and overprescribed, resulting in more expenses for Medicare and Medicaid.
"That is something that can be dealt with with quality audits," Bartels said.
Earlier this month, the U.S. Senate unanimously passed legislation which may open some doors to more coverage of telehealth programs. The ECHO Act aims to help expand and evaluate telehealth programs to underserved and rural areas. Proponents say it's a measure that could result in a $4.8 billion savings in health costs annually. It's based on a University of New Mexico program called Expanding Capacity for Health Outcomes (ECHO), where hub hospitals connect with providers in remote areas through virtual clinics to better treat patients where they live.
For the programs Evin is working with, Jintronix is a way of incentivizing health care facilities by avoiding costly rehospitalizations. The programs paying for and using Jintronix are rewarded by Medicare by sharing in the cost savings of keeping a person healthy and out of facilities.
Other goals of the Jintronix system is to provide better access to therapy and improve a patient's compliance with their regimen. According to the company's website, 65 percent of rehabilitation patients fail to adhere fully - or at all - with their programs.
"My goal is not to remove the therapist from the mix," Evin said. "The goal is to allow the patient to have more and more endurance and provide more motivation for the patient."
Melly said the use of Jintronix at the New Jewish Home has resulted in a 60 percent reduction in rehospitalizations of these patients.
"The more engaged the patient is, the better their outcome is," Melly said.
At the center, Melly said you will see others in the rehabilitation room or patient's families gather around to cheer on the patient as they go for soccer goals or reach the pinnacle of a rock climb.
"How much fun is that?" she said.
On this day, Brown scored a 6 out of 6 in soccer and 5 out of 6 in skiing. When he leaves the facility, Brown said he plans on buying a Wii videogame console to keep up with his therapy.
"It's something I can do at home," he said.
Evin said Jintronix is actually safer than a Wii for people like Brown because the program is tailored to the patient and the patient's progress is monitored by their health team and tracked.
Bartels said there is "a lot of activity" in the field of telerehabilitation and there are other similar programs in development. He points to the future in sensors.
At Northeastern University, researchers are studying the use of sensors in ceilings to track a person's movement, their gait, and their level of exercise. He said a person's gait tells a lot about a person's health. He said it's one thing to watch a person walk across the room once for the doctor - it's another thing to watch a person walk 50 times back and forth a day between the bedroom and the kitchen.
"A slower gait may mean an infection or something with medication and side effects or they're depressed," Bartels said.
At the Dartmouth Institute they are using sensors to monitor overweight elders.
Melly said she expects the New Jewish Home to be using more of this type of technology in the future.
"It's the case of technology finally catching up with the medical needs," she said.
Silver Linings is a continuing Union Leader/Sunday news report focusing on the issues of New Hampshire's aging population and seeking out solutions. Union Leader reporter Gretchen Grosky would like to hear from readers about issues related to aging. She can be reached at firstname.lastname@example.org or (603) 206-7739. See more at www.unionleader.com/aging.