No holiday break for healthcare finance news

The holiday season is usually a time where everyone takes some time off. Not so this time around.

I don't know if the imperatives of the fiscal cliff or our inexorable movement toward instant communication played a factor, but the last days of 2012 were comparatively frenetic for me. I conducted interviews on Dec. 26 and Dec. 28, a first for me. That people were even available to be interviewed in that traditionally still week came as a bit of a shock, but they were.

So, perhaps there should be little surprise that were two bits of news connected to the healthcare finance front that emerged during the holiday season. On their own, each is pretty minor. Taken together, they could have significant implications on hospitals and physicians for years to come.

The first item came from a San Diego firm called Critical Diagnostics. It announced that its test for determining levels of ST2 would be offered by LabCorp and Quest Diagnostics, the nation's largest testing laboratories for physicians and hospitals.

So what, you ask?

Well, ST2 indicates levels of cardiac stress in patients suffering from congestive heart failure (CHF). Elevated levels of ST2 have been connected to a three-fold increase in hospital readmissions and mortality. There are 6 million Americans currently living with CHF. Another 600,000 cases are diagnosed every year.

As everyone is aware, last October the Medicare program began levying financial penalties against hospitals for avoidable patient readmissions for chronic conditions, including congestive heart failure. That is among the reasons you're seeing some crazy quilt plan preventative care models. My favorite involves the telemetric bathroom scale that notifies a CHF patient's doctor if they put on a couple of pounds in a day or two, which could warn of a relapse.

While there has been some success in avoiding readmissions using these scales, they don't take into account whether a patient has overeaten, or whether the providers actually are paying close enough attention to order their patients in for prompt follow-up care. Now, there's a test available to truly differentiate patients who are at much higher risk for CHF readmissions or even CHF-related death. That will allow these ancillary measures to be targeted much more efficiently.

Such esoteric technology doesn't come cheap--it can run up to $3,000 for a single molecular-level lab test like the one Critical Diagnostics is offering (I don't actually have the costs for its ST2 assay, so it may be less than that). But according to the Agency for Healthcare Research and Quality, that would be a relative pittance versus the costs of a readmission.

AHRQ data indicates it costs $9,923 to treat a CHF patient who is readmitted within 30 days, and $13,463 to treat a patient readmitted within 90 days. Nearly 23 percent of CHF patients are readmitted within 30 days, and more than 54 percent are readmitted within six months.

The second development was a ruling from the U.S. Department of Health & Human Services' Office of the Inspector General involving an unnamed public hospital that wanted to provide a free electronic interface to community physicians to place orders for laboratory testing and other services. The OIG ruled that offering such an interface for free did not violate federal physician kickback laws, as there was data but nothing of specific monetary value flowing back and forth between the facility and the doctors. Although the ruling is not binding on other arrangements, it provides a roadmap for hospitals and providers in the community to exchange information.

Take those two developments together, and it becomes possible for not only hospitals and doctors to know which of their CHF patients are much more likely to face an expensive readmission, but also keeps both parties in the communications loop on such a matter.

Meanwhile, as my regular post-holiday routine returns and pace resumes its regular relentlessness, I look forward to reporting more of such developments in this space during 2013. - Ron (@FierceHealth)

Suggested Articles

Humana has added additional providers to its orthopedic bundled payment models, the company announced. 

States that spend more on primary care have better outcomes, including fewer hospitalizations and emergency department visits, says a new study.

Technology company Philips has acquired Boston-based startup Medumo, the developer of patient navigation and engagement solutions.