Chronic Disease and Improved Healthcare Outcomes Through Telehealth Monitoring

Background

As healthcare costs continue to increase, the government’s primary focus has been geared towards inpatient hospital stays for acute or chronic conditions. Acute or chronic conditions that could have been handled on an outpatient basis are the number one area for cost reductions. With the passage of PPACA (Patient Protection and Affordable Care Act), Congress gave Centers for Medicare and Medicaid Services (CMS) the authority to penalize hospitals for excess readmission rates starting federal fiscal year (FFY) 2013 where the initial focus will be placed on heart failure (HF), acute myocardial infarction (AMI), and pneumonia. CMS has already begun reporting readmissions rates for these conditions on its Hospital Compare Web site.

Why Focus on  Readmissions

Beginning FFY 2015, CMS may also begin withholding payments for excessive readmissions related to chronic obstructive pulmonary disease (COPD), coronary artery bypass grafts (CABG), percutaneous coronary interventions and some vascular surgery procedures. Aside from hospitals being penalized by CMS additional reasons to focus on readmissions are listed below.

• Medicare is spending an additional $15 billion a year on readmissions (about $7,200 per readmission).
• Readmissions are widely considered an indication of poor quality care, wasted revenue and inefficient use of resources.
• All-cause 30-day readmission rates per thousand patients discharged with heart failure increased by 11% between 1992 and 2001.
• According to new data from the US Agency for Healthcare Research and Quality Nearly. 4 million hospital admissions in 2008, roughly 1 in 10, could have been avoided if acute conditions or chronic diseases that provoked hospitalization were prevented or better managed.
• About 10 percent of the nearly 40 million hospital stays in 2008 could have been avoided, according to the Agency for Healthcare Research and Quality. Broken out, 4 percent of inpatient discharges in 2008 were for potentially preventable acute conditions, and 6 percent were for possibly preventable chronic conditions, according to a new Healthcare Cost and Utilization Project report.
• Potentially preventable chronic conditions accounted for 2.5 million hospitalizations. Also, 2.5 million hospitalizations were for Medicare. Other above-average factors were rural hospitals, poor patients and uninsured patients.
• The Medicare Payment Advisory Commission (MedPAC) an independent Congressional agency established by the   Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program has concluded that two-thirds of all readmissions are avoidable. MedPAC also estimates that about 12.5% of Medicare heart-failure admissions were followed by a readmission within 15 days, accounting for more than 90,000 admissions at a cost of $590 million.

Telehealth Monitoring

Telehealth monitoring is the remote exchange of a patient’s vital signs (e.g., blood pressure, weight) and other biometric data (e.g. pulse oximetry, blood glucose levels etc.) between a patient (who may be at home or mobile) and medical staff or other providers to assist in diagnosis and monitoring. Some of its features include a home device which collects the patient’s data and subsequently transmits that data to a hospital or doctor’s office for clinical review. Telehealth monitoring uses both wired technology (i.e. phone lines or network cables) or wireless technology (i.e. cellular or encrypted Wi-Fi).The home devices collecting the data connect to a wide variety of leading, commonly used vital signs monitors-weight scales, blood pressure cuffs, blood glucose meters, pulse oximeters and others. It can be as simple as patients just stepping on the scale, or taking a measurement, and the reading is automatically transferred electronically to a healthcare clinician (provider, nurse or allied health professional) in a 24/7 Central Monitoring Station who analyzes, reviews and stores the data and  responds to any out of range alerts-any readings that fall outside of the physician established parameters, and notifies  the patient’s provider (physician, other health professionals) or family members at the patient’s discretion. If no data is received by the patient at the scheduled interval, the agency's Central Station healthcare clinician will follow-up accordingly. The data can often be accessed through secure websites and transmitted to PHRs (Google Health, MS HealthVault) and Electronic Health Records. With this real time data, the patient’s provider can immediately intervene if there is a problem. While sending alerts of potential problems early on Telehealth also allows patients to proactively be treated by their provider thereby avoiding unnecessary hospital admissions, physician office or emergency room visits saving the patient and their family time and money. Education and training are provided to the patient and/or their caregivers on the proper use of the equipment.

Telehealth Benefits

A significant and documented benefit of Telehealth for patients who are independent and need to monitor their chronic conditions, such as congestive heart failure, cardiac arrhythmias, and diabetes, is that Telehealth solutions enable providers to more efficiently and effectively reach post-discharge and post-acute patients, improve health outcomes and reduce costs from unnecessary hospital admissions, lengths of stay, visits to emergency room and physician offices. Telehealth outreach has significant benefits as well to the underserved and rural residents, to better manage conditions that account for most of today’s healthcare spending: diabetes, congestive heart failure, hypertension, asthma and obesity. It also allows greater access to care for many who may have not had care until now.

In one of the largest most comprehensive studies ever conducted on Telehealth with over 17,000 veterans in a home telehealth program, The US Department of Veterans Affairs benefited from a 25% reduction in the average number of days hospitalized and a 19% reduction in hospital admissions. Results were derived by comparing costs to treat these patients in the 1 year period prior to Telehealth versus the 6 months post enrollment

Translating this data as a cost comparison of remote monitoring vs. other patient management options (Average Annual Cost per Patient) may be summarized as follows:

Telehealth Program: $1,600 per year

Home Based Primary Care: $13,121 per year

Nursing Home Care: $77,745 per year

In a widely cited study by Meyer, Kobb and Ryan, the combination of home Telehealth and coordinated care resulted in substantial improvements in health outcomes among a group of elderly veterans with a variety of chronic diseases. Outcomes included a 40% reduction in emergency room visits, 63% reduction in hospital admissions and a 60% reduction in hospital bed days of care, along with similar reductions in nursing home care. These outcomes deliver significant savings to the health care system, particularly for treating chronic illnesses that account for roughly 80% of increases in Medicare costs.

In summary, a sound Telehealth program will provide the following benefits to Providers, Patients and Families:

Providers

• Consistent, cost-effective contact with patients/clients
• Improved quality of care through improved assessment and monitoring capabilities
• Works in conjunction with the entire healthcare team for better outcomes
• Assists in encouraging and educating patient for self-management of care
• Engages both clinical and non-clinical staff in patient continuum of care
• Clinical staff can spend more time with direct and proactive patient care
• Complements service offerings and provider marketing with desirable value added, relationship building features
• Proactively identify changes in conditions
• Attracts new patients who may now have access to care
• Improves staff productivity

Patients and Families

• Eases post-discharge transition from hospital or other healthcare facility to the home
• Shortens the length of expensive hospital stays
• Extends the period of independent living for seniors outside of costly nursing homes or care facilities
• Eliminates unnecessary exposure of well patients to infections in hospital and clinic settings
• Reduces unnecessary and expensive patient transport
• Reminds patient to monitor vital signs
• Can assist with earlier recognition and intervention of a worsening health condition
• Provider can alert family and patient/client when additional care is needed
• Empowers patient and family to take more active role in care and self-monitoring
• Encourages accurate medication adherence
• Reinforces patient and family education on condition and best care
• Helps maintain patient/client independence
• Reassures family members and caregivers that there is consistent contact and monitoring

About CMS Telehealth

CMS Telehealth was founded by Joseph Rabinowitz and William Miska to meet the needs of patients and families, healthcare organizations, employers, providers and insurers in today’s health environment for better post-discharge and chronic condition management. CMS Telehealth follow-up and monitoring systems encourages patient self-management, education and care plan adherence. We meet care providers’ goals in improving outcomes, avoiding unnecessary readmissions and maintaining patient independence. We accomplish this by providing 24 hours a day 7 days a week comprehensive approach to Telehealth in and out-of- home, which includes: complete installation, maintenance, delivery education, training, marketing, distribution and integration of all our products and services, with a 24/7 Central Monitoring Station that is supervised by clinical and technical personnel.

Additional information about CMS Telehelath is available at www.cmstelehealth.com

About the Author:

William Miska, Chief Executive Officer

William Miska is CMS Telehealth’s founder and oversees the company’s corporate strategy.  As  a healthcare executive with extensive entrepreneurial, management, financial, operational and consulting experience in the proprietary and not-for-profit sectors, Willie has worked closely and developed relationships with major healthcare facilities, clinics, physicians, insurance  companies, home health care and durable medical equipment (DME) companies, case managers, discharge planners and unions.

Prior to founding CMS, Willie served in various senior level management positions at one of New Jersey’s premier cardiac surgery teaching hospitals and at other New York teaching hospitals, as well as Assistant Dean for a major Osteopathic School of Medicine.  He also served as Vice President for Operations at a publicly traded Physician Practice Management company where he was responsible for all operations including financial and administrative matters, new business development, marketing and sales.

In addition to having his own companies in waste management, consulting and executive recruiting, Willie has extensive experience in new business development, implementing joint ventures, strategic business development and operations improvement.  He was also directly responsible for restructuring and implementing turnaround plans for hospitals scheduled for closure to make them profitable. 

Willie received his Masters degree in Health Policy Planning and Administration from New York University and his Baccalaureate degree in Psychology from Brooklyn College.

William can be reached at wmiska@cmstelehealth.com or (212)913-9897