Thank you for the opportunity to testify this morning. LifeWatch is a Health IT telemedicine service provider that represents the future of medicine in the United States. It is our privilege to serve The Department of Veterans Affairs in almost 40 facilities. Currently our services help diagnose patients suffering from arrhythmia and obstructive sleep apnea in an ambulatory and near real time environment. LifeWatch has built a virtual healthcare service solution that supports efficient data transfer of critical health data to providers for diagnosis and treatment. This virtual service environment is a launching pad for future disease specific management of health data supporting improved patient outcomes, continuity of care, reduction of Emergency Room visits and unnecessary hospital readmissions.
We are most certainly at a crossroads in healthcare. As the estimated 40 million Americans aged 65 and older enter the insurance pool in the coming years, our nation’s health care system will be faced with many challenges to effectively meet the needs of our Aging population. Older patients with chronic diseases will consume an ever increasing portion of total health care spending. Moreover, funding constraints coupled with an increasing shortage of healthcare providers and a deficient hospital capacity to meet this ever-growing demand will further challenge our present system.
The Department of Veterans Affairs in particular will be serving a significant percentage of our Aging population with one or more chronic health care diseases, and the increased demand for limited healthcare resources is an issue that has and will continue to be an issue for the VA. According to data from Department of Veterans Affairs the percentage of Veterans age 65 or greater is expected to increase roughly 7 percent in the next 20 years.
Given this environment it is critical that we continue to identify, research, and incentivize new delivery methods for healthcare in the United States. Telemedicine offers significant promise for reducing barriers regarding supply & demand, geography, a changing patient-provider relationship, and most importantly for reducing cost and improving outcomes for chronic diseases. The technology is here now. Whether it is provider-to-provider video consultations, remote telediagnostics, remote chronic disease management, or wireless monitoring, the technology is all readily available today and in many cases proven many times over.
Despite overwhelming evidence regarding the benefits of telemedicine, CMS has been slow to adopt reimbursement structures that incentivize providers to adopt the technology in addition to supporting innovation among device manufacturers, software providers, and medical services. CMS has been challenged with managing costs without abuse to the system because telemedicine is a new method of healthcare delivery with unique costs.
The Department of Veterans Affairs has been a bright spot in terms of the adoption of innovative wireless and land based telemedicine solutions which have been proven to reduce cost, improve outcomes, and support the large population of rural veterans in geographically challenging locations. According to the Office of Rural Health an estimated 38 percent of all veterans live in either rural or very rural geographies.
The Office of Care Coordination under the leadership of Dr. Adam Darkins has proven that telemedicine overcomes challenges in managing chronic diseases even among the most difficult to treat and historically noncompliant patient population. According to Dr. Darkin’s research, the VA telemedicine program managed a 25 percent reduction in number of bed days of care as well as a 19 percent reduction in hospital admissions for patients using telemedicine to manage chronic diseases.
While telediagnostics with the use of our services has not been as centrally driven as chronic disease telemonitoring, we have a number of shining examples of VA facilities utilizing our wireless service to overcome challenges in treating rural patients.
The LifeStar Ambulatory Cardiac Telemetry (ACT) service platform is based upon an algorithm that automatically and instantly detects and transmits clinically significant changes in heart rate and rhythm. For example, if you are complaining of feeling dizzy, lightheaded or a racing heart your cardiologist might prescribe our service for 30 days to help diagnose what is causing the changes in your heart rate or rhythm. The VA Medical Center completes the enrollment to LifeWatch and we in turn ship the device directly to the patient’s house with all the necessary equipment and a prepaid envelope to mail it back following completion of the study. Following a successful implementation of the service the patient simply goes about their daily activity while the device and service continues to work.
The transmission is sent via a cellular network such as Verizon to one of our Joint Commission Accredited monitoring facilities in which certified cardiovascular technicians are staffed 24 hours a day, 7 days a week. The technicians view transmission, edit the ekg data, create a report, and provide it back to the clinician via a secure password enabled website or a direct EMR interface. The LifeStar ACT service increases the diagnostic yield compared to antiquated technology increasing the likelihood that a diagnosis will be made and a treatment plan incorporated which ultimately improves patient outcomes and reduces the cost of cardiovascular disease and stroke.
An improvement in the incidence of stroke increases quality of care and at the same time significantly reduces cost. Research from the Stroke Queri team based out of the Indianapolis VAMC indicates that stroke cost the Department $315 million in FY05 with a cost per patient of over $18,000. The importance of stroke within the VA is emphasized by the fact that stroke patients account for over 10 percent of the VA’s complex caseload, with a cost per patient that is over 3.4 times the overall VA average.
Additionally the service allows veterans to remain in their home, reduces travel reimbursement expenses, and allows VA medical centers to shift employee resources to other more important responsibilities. The impact for rural veterans is even more pronounced in regards to cost savings, access to care, and improved outcomes.
We have seen significant success stories of VA Medical Centers that have made the leap into utilizing advanced technology like the LifeStar ACT to the benefit of their patient population. For example prior to utilizing the LifeStar ACT service, the Las Vegas VA Medical Center was flying patients to San Diego to be hooked up on antiquated technology. The clinic made the decision to utilize our service which significantly reduced travel reimbursement expenses, allowed the VA to shift employee resources to other more important responsibilities, and allowed veterans to remain in their homes for extended diagnostic care.
LifeWatch has also recently introduced a home sleep testing service to the market for the diagnosis of Obstructive Sleep Apnea. The NiteWatch service has the potential of significantly reducing costs for severely overburdened sleep labs within the Department of Veterans Affairs, and at the same time stands to save the VA millions in lost revenue from fee service commercial sleep labs. Wait times for sleep labs within many VA facilities exceeds 6 months and as a partial solution many facilities utilize Fee Service to push patients to commercial sleep labs at Medicare rates. Our service is less than half the price of using a commercial sleep lab, stands to eliminate chronic patient waiting lists, and helps improve compliance as the testing is all completed in the home. According to a recent article published in the USA Today, “veterans are four times more likely than other Americans to suffer from Sleep apnea. About 5 percent of all Americans suffer from sleep apnea compared to 20 percent of veterans”. The number of claims for the sleep apnea has gone from 39,145 in 2008 to 63,118 in 2010.
While there are many success stories we have also had our fair share of struggles within the VA. We are a GSA small business vendor and despite our status on the Schedule, procurement remains a struggle. It can take upwards of 2 years for some facilities to finalize the budgeting and contracting process despite the clinicians request to utilize the service. The disjointed nature of contracting and procurement necessitates that we work facility by facility on the contracting and procurement process. We have seen some success with Project Hero. As an in-network provider the program appears to expedite the process and simplify procurement for facilities in the four VISN’s under the demonstration project.
Additionally we’ve struggled with a lack of a quality standard of care for remote cardiac monitoring. In 2004 CMS placed a requirement on remote cardiac monitoring which included the necessity of providing 24 hour live attended coverage for patients wearing ambulatory devices. The VA does not follow the same standard of care across the board. While there are many VA facilities that do utilize LifeWatch or a similar service, many VA Medical Centers own their own antiquated equipment and provide their patients with their own monitoring often without providing 24 hour live coverage. For example, if a patient were put on a VA owned monitor and had a serious cardiac event on Friday evening the clinic would not hear about it until the patient call to transmit the data on Monday.
Lastly we have struggled with a lack of clarity on how to interface our data with the Vista Imaging/CPRS electronic medical record system within the VA. Multiple cardiology clinics have requested that our data be interfaced and in fact many facilities will not use our service until we are interfaced. Despite the demand among cardiology clinics, we have hit multiple road blocks in terms of how to move forward. We are eager and ready to provide a secure interface with the Department of Veterans Affairs which will most certainly improve the standard and efficiency of care for our VA customers.
Mr. Chairman and Members of the Subcommittee, LifeWatch sincerely appreciates the opportunity to submit testimony and looks forward to working with you and your colleagues on improving the quality of care for our nation’s veterans with the use of advanced technology.
That concludes my written statement and I would welcome any questions you may have.
 Veteran Population Model; VetPop 2007. Office of the Assistant Secretary for Policy and Planning Office of Policy (008A2). https://www1.va.gov/VETDATA/Demographics/Demographics.asp
 The Office of Rural Health, Departement of Vererans Affairs https://www.ruralhealth.va.gov/RURALHEALTH/About_Rural_Veterans.asp
 Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, Lancaster A. Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions. Telemedicine and E-Health December 2008;vol. 14 no 10 1119.
 Department of Veterans Affairs, Stroke Queri Strategic Plan and Annual Report, 2007; 8-9