Cost Effectiveness of a Telerehabilitation Program to Support Chronically Ill and Disabled Elders in Their Homes

Abstract

Chronic illnesses account for approximately 75% of all healthcare costs in the United States today, resulting in functional limitations and loss of independence, as well as increased medical expenditures. The elderly population is at a higher risk for developing chronic conditions, increasing their risk for disabilities. Given the rapid growth of the aging population, and the chronic illnesses, disabilities, and loss of functional independence endemic to elders, novel methods of rehabilitation and care management are urgently needed. Telehealth models that combine care coordination with communications technology offer a means for managing chronic illnesses, thereby decreasing healthcare costs. We examined the effects of a Veterans Administration (VA) telerehabilitation program (Low Activities of Daily Living [ADL] Monitoring Program-LAMP) on healthcare costs. LAMP is based on a rehabilitative model of care. LAMP patients received adaptive equipment and environmental modifications, which focused on self-care and safety within the home. LAMP Care Coordinators remotely monitored their patient's vital signs and provided education and self-management strategies for decreasing the effects of chronic illnesses and functional decline. The matched comparison group (MCG) received standard VA care. Healthcare costs 12 months preenrollment and 12 months post-enrollment were examined through a difference-in-differences multivariable model. Using actual costs totaled for these analyses, no significant differences were detected in post-enrollment costs between LAMP and the MCG. For LAMP patients, the provision of adaptive equipment and environmental modifications, plus intensive in-home monitoring of patients, led to increases in clinic visits post-intervention with decreases in hospital and nursing home stays.

Development and implementation of technologies for physical telerehabilitation in Latin America:

“…Perhaps this is due to the fact that several telerehabilitation initiatives retrieved in this study have emerged as technological developments more than real clinic applications. In contrast to reports from other regions around the world [9], [10], [12], our findings demonstrate that in Latin America there are no previous studies of economic and assistive benefits regarding these kind of assistive technologies used by ei-ther government or private health care systems to provide rehabilitation services. Therefore, a huge multidisciplinary effort by clinicians and researchers is necessary to validate-from the clinical and economic point of view-the profitability of assistive technologies used in remote urban areas in each country in this region.…”

“…A retrospective study with 155 patients and 155 control subjects shown that the costs of hospital bed days of care (1,449 days) in the year before the implementation of telerehabilitation programs totaled approximately $1,500,000, which decreased more than around $804,000 the year following the implementation of the telerehabilitation program, which represents a 46% decrease in costs and a decrease of 826 days of care [10]. Likewise, primary care and geriatric visits decreased by over 100 during that year.…”

“…Besides, the charges depend on the cost of living in each country, a fact that makes more difficult to estimate constant economic benefits of telerehabilitation. Therefore, the cost effectiveness of telerehabilitation programs has been evaluated for a specific disability, as described in [8]- [10], [12]. Thus, telerehabilitation is still considered a growing alternative to traditional face-to-face therapy that employs technological solutions to remotely provide rehabilitation care in both clinical centers and in-home programs.…”

Medical utilization and cost outcomes for poststroke veterans who receive assistive technology devices from the Veterans Health Administration

“…Unlike those covered by the VA, these individuals cannot get coverage for mobility devices needed for IADL because these activities are not limited to mobility functions "in the home" [1][2]. We know that the use of ATDs is associated with decreased disability [3][4], which reduces falls and subsequent hospital admissions/institutional care [4][5][6][7][8][9][10][11] and, thus, healthcare costs. It makes sense then, in the context of healthcare reform (reduction in emergent care and rehospitalization [48][49], implementation of the medical home model [50]) that the savings be reinvested in expanding the provision of ATDs.…”

“…This CMS determination conflicts with legislative actions that mandate individuals with disabilities be provided with the necessary supports to live as independently as possible in their communities [1]. Even though increased use of assistive technology devices (ATDs) has been cited as one of the reasons for decreasing disability [3][4] and has positively affected health-related costs by reducing falls and, subsequently, hospital admissions and institutional care [4][5][6][7][8][9][10][11], fewer than 50 percent of older adults with chronic disability and fewer than 25 percent of individuals with recent disabilities received ATDs [12]. Further, only 6 percent of community-dwelling Medicare beneficiaries received any ATDs from Medicare [13].…”