Erin Denholm
When applied to the right circumstances and with appropriate planning, remote monitoring can be highly effective at avoiding inpatient admissions and visits to the emergency room for patients with chronic diseases. As a bonus, investments in monitoring technologies and services often pay off quickly, attendees at the American Telemedicine Association's Fall Forum heard Monday in Toronto.
If hospitals are losing money on readmissions due to Medicare's two-year-old policy of not paying for certain preventable readmissions within 30 days of initial discharge, remote monitoring can produce a return on investment in the first year, said Erin Denholm, senior vice president for clinical transformation at Centura Health in Englewood, Colorado.
The 15-hospital system achieved its ROI from reducing the number of home visits by nurses and, as a bonus, has achieved greater patient satisfaction because patients with home monitoring technology feel like they have more "touches" with Centura than those not in the telehealth program, according to Denholm.
The results on the clinical side have been more impressive.
The Centura Health at Home network stems from a telehealth initiative begun in 2004 with one Colorado Springs hospital that was still on a capitated reimbursement model after HMOs fell out of favor, and long before "accountable care" entered the lexicon. The hospital wanted to cut ER visits and readmissions for congestive heart failure by 60 percent. By concentrating on Medicare Advantage enrollees who had had at least three ER visits in the prior six months, Centura saw a 90 percent drop-off in inpatient admissions. Nine years later, not one of the original monitoring group has ever come back to the ER for CHF-related symptoms, Denholm said.
Partners HealthCare in Boston has been running its Connected Cardiac Care program through the organization's Center for Connected Health since 2003.
By monitoring the weight, blood pressure, oxygen saturation and symptoms of CHF patients with daily calls for two months at a time following hospital discharge, Partners has seen a two-thirds reduction in CHF readmissions and 58 percent reduction in all-cause readmissions in the year following program participation, according to Dr. Kamal Jethwani, corporate manager of research and innovation at the Center for Connected Health.
Now, home monitoring has become a standard of care for CHF, and Partners management is fully behind the program, Jethwani reported. Since Partners started requiring cardiologists to opt their patients out of the program within seven days of a discharge order, nonparticipation has fallen from 10 percent to 1 percent.
"Organizational commitment is very important," Jethwani said via telepresence from Boston on an InTouch Health robot set up at the Sheraton Centre Toronto hotel. Otherwise, remote monitoring ends up being yet another silo, he explained.
Likewise, a remote monitoring program should concentrate on the right patients, added Doreen Salek, director of population management at Geisinger Health Plan, the Danville, Pa.-based managed care division of Geisinger Health System.
"You will get a return on investment if you are choosing the right patients," Salek said, emphasizing that not every person with a given condition is worth supplying with technology and care management services. "It's quality, not quantity."
Geisinger has seen a 44 percent dip in CHF readmissions when high-risk patients have access to both case management and technology, either Bluetooth weight scales or interactive voice response to remind them to weigh themselves, Salek reported. The readmission rate is 20 percent lower with both components than with case management alone.
