CMS payment changes represent an opportunity for remote monitoring

The proponents of remote patient monitoring have an enormous opportunity right under their noses, but I'm not sure that they see it. This opportunity has to do with the changes in hospital reimbursement methodology that the Centers for Medicare and Medicaid Services (CMS) soon will start to phase in.

Starting in October 2012, CMS will begin placing 1 percent of hospitals' Medicare payments at risk as part of its value-based purchasing (VBP) program. If a hospital scores high enough on CMS' quality and patient satisfaction goals, it will get that money back. In the following fiscal year, hospitals also will be judged on their performance in reducing hospital-acquired conditions and other safety goals. Since 2008, Medicare has declined to pay for treating certain hospital-acquired conditions; beginning next year, it also will penalize hospitals for excessive readmissions.

Not coincidentally, more than 1,500 hospitals already have pledged their support to a new government patient safety program, the Partnership for Patients, announced only a few weeks ago. The double thrust of that CMS initiative is to reduce hospital-acquired conditions and prevent readmissions. Several hospital executives have told me that one reason their institutions signed on to the Partnership was to avoid Medicare penalties and to prepare for the VBP program. The biggest challenge, they indicated, was figuring out how to work with non-hospital providers and engage patients to improve post-discharge care to avoid readmissions.

Now, it doesn't take much imagination to see that remote patient monitoring could play a big role here. Not only could it help patients with heart failure and other conditions remain at home, but it also could enable early identification of patients developing serious complications in nursing homes.

Remote monitoring advocates are aware of these possibilities. At the HIMSS conference in February, Chuck Parker, executive director of Continua Health Alliance--which includes computer, medical device, and drug companies, as well as a couple of big healthcare providers--noted that remote monitoring can help prevent hospital admissions. With some new software, he suggested, it also could be used in post acute-care settings. Moreover, he pointed out, the advent of bundled payments and accountable care organizations (ACOs) might make remote monitoring attractive to providers who want to keep patients out of healthcare settings.

But bundled payments and ACOs are future propositions--and unless CMS modifies its ACO rules, the latter may only be a pipe dream. CMS payment changes, in contrast, are right on the doorstep, and some already are in place. It's not much of a stretch to suppose that some providers, such as Partners Healthcare and Ascension Health--both Continua members--might be thinking about how to use remote monitoring to reduce their readmission rates. In fact, some institutions already are investigating it, as are some health plans, as well.

Of course, remote monitoring is only one component of a strategy to prevent readmissions, and the majority of the literature regarding the value of this technology in preventing readmissions focuses on congestive heart failure. More studies are needed on the efficacy of this approach for patients with other conditions to convince hospitals that it's worth their investment. - Ken

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