Geisinger Health Plan in Pennsylvania recently announced the use of home telemonitoring reduced the readmission rate of enrollees with congestive heart failure by 44 percent. FierceHealthFinance spoke with Maria Lopes (pictured), the chief medical officer for AMC Health in New York, which provided the technology for the Geisinger project. Lopes made the business case for using home monitoring to help hospitals cut readmissions--and therefore costs.
FierceHealthFinance: What do readmissions cost the healthcare industry?
Maria Lopes: Rehospitalizations are associated with disparities in follow-up care and can result in a life-threatening event and staggering costs. Based on Centers for Medicare & Medicaid Services trend reports, payments for unplanned rehospitalizations in 2004 accounted for about $17.4 billion of the $102.6 billion in hospital payments from Medicare, making them a large target for cost reduction.
FHF: What would you say are readmission "hot spots"?
ML: Readmissions are more common for certain conditions such as heart failure and vary by race and Medicare coverage. One study published in the British Medical Journal indicates 29 percent to 47 percent of elderly patients with heart failure are readmitted within three to six months of discharge. Another found that African Americans and dually eligible Medicare enrollees--especially those who have experienced a stroke or have diabetes or asthma--may be more likely to be readmitted to the hospital. A recent MedPAC simulation found that Medicare beneficiaries with end-stage renal disease had above average readmission rates, indicating that some Medicare beneficiaries, such as those with multiple conditions, may be at increased risk for readmissions.
Readmission rates also differ across hospitals, states and geographic regions. The Commonwealth Fund's 2007 State Scorecard on Health System Performance found that in 2003, readmission rates for the top five performing states (Vermont, Wyoming, Iowa, Oregon and Nebraska) averaged 13.8 percent, while the average readmission rate for the five lowest performing states (Oklahoma, Maryland, Texas, Nevada and Louisiana) was 21.8 percent.
FHF: What would you say are the weaknesses of traditional case management?
ML: Evidence from a 2010 Cochrane systematic review indicates that in-hospital discharge planning protocols designed to facilitate transition of patients to outpatient settings "probably brought about small reductions in length of hospital stay and readmissions" for older people admitted to a hospital with specific medical conditions, but the scalability of such an effort if done through a manual process with follow-up phone calls and the timeliness of follow-up interventions pose a challenge to successful implementation and outcomes.
FHF: And how does a more automated and technological approach work?
ML: There is a significant opportunity to identify gaps in healthcare and improve care coordination. For the appropriate patient at high risk of readmission, remote healthcare services and technologies can offer a solution. The appropriate patient, coupled with an individualized approach that may involve technology to identify pre-acute trends and early decompensation, gaps in care, and patient symptom assessment or non-compliance, followed by actionable steps as part of care management can improve care coordination and lead to care management triage, trending and more real-time automation of protocols to reduce re-hospitalizations.
FHF: Okay, let's say I am a hospital interested in using AMC's equipment. What is the return on investment?
ML: In the Geisinger program, we used interactive voice response (IVR) technology added on top of a very robust case management program in patients deemed to be at high risk of readmission. It demonstrated a surprising 44 percent reduction in all cause 30-day readmissions. The cost of an IVR call is minimal, but even after factoring in one-time implementation costs (which could be done for around $10,000), including training and software integration, ROIs exceed four to one in as little as six months.
- Ron (@FierceHealth)