Worried about Medicare readmission penalties? Try home monitoring

By: Neil Versel | Sep 20, 2012        

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Neil_Versel_LargePerhaps you’ve seen last month’s report from Kaiser Health News that more than 2,200 hospitals—almost two-thirds of all U.S. acute care facilities—face Medicare payment deductions starting Oct. 1 because too many patients with three common but treatable conditions were readmitted within 30 days of initial discharge. That’s going to cost those hospitals a total of $280 million during federal fiscal year 2013.

A lot of institutions with high numbers of low-income patients will lose out, but these include some of the supposedly “best” hospitals in America. Barnes-Jewish Hospital in St. Louis – a source of pride in my world because it’s affiliated with my alma mater, Washington University – will suffer the maximum penalty, a 1 percent cut in base Medicare reimbursements. Massachusetts General Hospital, named the top hospital in America by U.S. News & World Report, faces a 0.5 percent reduction, Kaiser Health News reports.

In other words, hospitals no longer can skate by on their reputations. The financial onus now is on them to prevent inpatient complications and provide proper follow-up care for patients admitted for heart attacks, heart failure and pneumonia. (That’s the kind of real reform in the Patient Protection and Affordable Care Act that “Obamacare” supporters and detractors alike somehow don’t want to talk about this election year and that the national media is giving them a pass on.)

By the way, the maximum penalty increases to 2 percent in fiscal 2014 and 3 percent the year after that. The message from the federal government: we won’t pay for sloppiness anymore.

I think hospitals truly are working at getting their readmission rates down, but many seem to be doing it the hard way. The University of Mississippi Medical Center, which escaped financial penalties during the initial measurement period, July 2008 to June 2011, has reduced readmissions for heart failure by having doctors call patients at home following discharge. “It’s a fairly simple approach, but it’s very labor-intensive,” Chief Quality Officer Michael Baumann told KHN.

It doesn’t have to be. As readers of MobiHealthNews certainly know, the phone can be highly inefficient, especially if you get voice mail – and it may not even be OK under HIPAA to discuss specific patient cases in a voice mail, particularly if you can’t be certain that only the patient in question will hear the message.

Remote, home-based monitoring, on the other hand, requires little or no work on the doctor’s part. It’s a reasonably small investment compared to the money hospitals stand to lose by not getting readmission rates down. And the data remote monitoring systems collect certainly are more accurate and detailed than what a patient might report over the phone.

Unfortunately, hospitals still take a 20th Century attitude toward 21st Century problems. And we’re largely stuck with an outdated healthcare “system” – I use that term loosely – where many would rather make excuses and fight hard to preserve the status quo than to adopt new ways that can keep patients healthier and, as a bonus, save providers money.

  • Gary Capistrant

    Creating a “carrot” to offset the Medicare reimbursement “stick” is a Congressional proposal promoted by the American Telemedicine Association.  The proposal would use a “shared savings” arrangement to reward hospitals who do better than their readmission reduction benchmark and to recognize their additional costs in doing so, such as for remote patient monitoring.  Savings would be assured by design, with the total amount based on the actual results.  This proposal is planned for the telehealth package to be introduced when Congress returns for its post-election flurry.

  • http://twitter.com/sbrhealth SBR Health

    yeah, this is a great step towards accountable care. However, I worry that without corresponding action to allow reimbursement for telehealth technologies, such as paying for televideo consults, this policy is getting the ball rolling without sufficiently enabling organizations to properly create the new models of care that they need to deliver higher quality care at a lower cost.  We see many hospitals/health delivery organizations betting on these technologies anyway, but they seem to be more of a hedge bet, only partially “in the game” than all in as a comprehensive operational model. Still, my hat is off to these organizations that realize they need to lead the way with their own pocketbooks as it is the right way to proceed. 

  • Christopher Wasden

    I have stepped up my support for this technology application by stating that to NOT do so is malpractice. Pretty strong statement, but let’s look at the facts from the VA and NHS studies on this application of mHealth.

    It decrease ED visits and hospitalization by over 20%. It decreases care for chronic diseases by over 50%. It reduces readmissions by 25-50%. It yields patient satisfaction scores of 86%. It reduces costs by over 50-90%, depending on the alternative measure you are using to compare it to.

    If a drug company invented any drug that could do half of that it would be considered malpractice not to use the drug on the patient. Why is this not the case here?

  • Sam Daley

    Home monitoring seems to be gaining traction. Wi-Fi weight scales are now between $99 and $159 from Blipcare, Fitbit, Withings. Paired with a MiFi from AT&T or Verizon, this would be a $99-$250 solution!

  • http://www.facebook.com/profile.php?id=1906334 Molly Maloof

    Home monitoring is great but someone needs to actually look at the results. This would create jobs and decrease readmission but it might end up costing as much as it saves. 24-7 Life alert would take a LOT of manpower, not just algorithms.

  • Tsanis

    Hi Christopher, could you please provide some weblinks to those studies? Thank you!