At most hospitals, chronic heart failure (CHF) is the No. 1 reason for hospital readmissions. In a typical hospital, CHF patients comprise nearly a third of those cases.
In a pilot project, Texas Health Resources has been able to lower CHF readmission rates from 14 percent to about 10 percent—a drop of 27 percent.
THR’s research arm, Texas Health Research & Education Institute, has been working with AT&T and Plano-based software maker Intuitive Health since April 2011 to monitor CHF patients remotely for 90 days after their hospital discharge.
Patients are equipped with tools to help identify potential complications that can result in readmissions. They are given vital-sign monitors, tablet devices and applications that link the data to the patients’ electronic health records (EHR). The wireless devices include a pulse oximeter, blood pressure cuff, and weight scale.
Patients use the devices to record their vital signs and use the tablet to send the data to their EHRs. They also complete a daily electronic questionnaire that can help flag symptoms that can lead to complications. Abnormal data or questionnaire answers send alert messages to designated provider smartphones and email addresses. In that case, a nurse calls the patients for more information. Physicians and other providers also have instant access to their patients’ status on the EHR.
Clinical research director Tamara Plant said THR initially worked with AT&T to manage chronic disease using the telephone. However, she prefers the immediate response of the digital equipment. She said 46 patients have participated in the pilot, and she plans to have more than 100 total participants by the time the research study ends in December 2013.
Patients are selected based on the severity of their conditions. Some had been readmitted three to six times a year prior to the monitoring program.
Ferdinand Velasco, M.D., THR chief medical information officer, said chronic health failure was chosen for the pilot because the patients are more likely to have problems after leaving the hospital. He said CHF tends to be chronic and requires ongoing medical management because it cannot be cured. He noted that patients generally need to be vigilant about recognizing and acting on troubling symptoms. CHF also often is accompanied by other chronic conditions, such as coronary heart disease and diabetes.
Beginning in October, Medicare will penalize hospitals whose patients with CHF, heart attacks, or pneumonia frequently return. By 2014, hospitals with high readmission rates stand to lose up to 3 percent of their regular Medicare reimbursements.
Lack of Reimbursement a Significant Sticking Point
In 2004, Medicare paid $17.4 billion for unscheduled readmissions. About one out of five Medicare patients were readmitted to the hospital within 30 days. However, about half of CHF patients were readmitted within a month.
Velasco said the CHF project is consistent with THR’s current emphasis on population health. He said other chronic disease patients could benefit from similar electronic monitoring. The challenge, he pointed out, was that most payers will not reimburse for remote monitoring.
“Our goals are to maximize clinical outcomes and reduce healthcare costs. The next step is: How can we get reimbursed for this? Payment models are switching from fee-for-service to paying for value,” he said. “How does the payment model reward us (for reducing those costs)?”
The lack of reimbursement can be a significant sticking point. In a 2011 Archives of Internal Medicine study, Baylor Medical Center Garland was able to reduce 30-day readmissions by nearly half. The facility had a nurse-led team that used health coaching, at least eight home visits, and seven-day phone support.
The rub: The hospital lost $751 on every patient. An accompanying editorial pointed out the obvious. Reimbursement is linked to physician visits, hospitalizations, treatments, and procedures—not for preventing complications. The hospital foots the bill. The payer pockets the savings.
Velasco said the results of the pilot study are so promising, he plans to use the protocol systemwide in the next budget year. Although it is not part of the ongoing study, Texas Health Harris Methodist Hospital Azle plans to use the technology at a new clinic for uninsured patients with chronic conditions, including those with high blood pressure and diabetes.
Plant said patients have responded well to technology and reaped lasting benefits beyond the 90-day experiment.
“When we get alerts and contact the patients, they say, ‘I know I was bad.’ We taught them things about controlling their condition and paying attention on a daily basis so they know when they are getting into trouble,” she said. “Some are relieved at the end (of the study) and say, ‘It’s over!’ (With CHF) it’s never over.”
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected]