Can Technology Reverse the Rise of Hospital Readmissions?
Barely two years ago, USA Today reported that 1 in 5 Medicare patients were readmitted to the hospital within just one month of discharge. While some readmissions are unavoidable, the article reported that, in 2004, a shocking $17.4 billion of the $102.6 billion that Medicare paid to hospitals went towards unplanned hospital readmission visits.1 Only 10% of 2009 readmissions were planned.
CBS News reported on the profits earned by extending life by a few days, an already high expense that, if uncontrolled, will rise dramatically as the U.S. population ages. According to a 2009 60 minutes report, 75% of Americans die in a hospital; in 2008, Medicare paid $50 billion for patient care during the final two months of life.2
Fierce Healthcare took it a step further. Citing medication non-adherence as the leading cause of hospital readmissions,3 the online magazine reported that noncompliance costs up to $250 – $300 billion per year in ER and readmission visits.
But medication non-adherence may not be the primary cause. It may itself be caused by an all-too-common practice, sending the patient home with a lack of resources and support for independent recovery. According to a new White Paper by Laura Mitchell of GrandCare Systems, there are six common reasons for hospital readmission and specific technologies that can counteract them.
- Miscommunication between doctors, staff, patients, caregivers, families at discharge.
- Unclear or inappropriate instructions from hospital discharge staff regarding diet, mobility, medication and general care.
- Lack of social interaction and support once home. (30% of the 65+ population and 40% of those with chronic disease live alone.)4
- Misunderstanding of “Red Flag” symptoms that signal likely return to the hospital.
- Limited resources, lack of transportation and no accompanying advocate.
- Lack of supervision at home and resulting noncompliance.
Every home care clinician knows someone like Betty
Meet Betty. In 2008, Betty was admitted to the hospital for an infection in her foot that had affected her kidneys. After 5 days in the hospital undergoing tests and treatment, she was released and given many new rules, diet changes, strength training exercises, as well as a strict medication regimen prescribed by multiple healthcare providers. Betty left the hospital confused and loaded with new responsibilities and lifestyle changes. The pressure and stress of her new routine ultimately led her back into the same hospital bed just twenty days later. This is not an unusual occurrence. In Betty’ case, it was most likely a completely preventable readmission. Betty lacked a clear sense of direction, support and encouragement. She was expected to change her entire life within days without essential resources or available technologies.
The technology solution
To mitigate the turmoil of post-hospital transition, patients and their caregivers need to be equipped with education and resources to make good decisions. Forward-thinking business leaders, care providers, technology innovators, and other change agents are using technology to assist patients, especially seniors and the disabled.
Remote patient monitoring (RPM) or tele-monitoring technologies and telehealth devices provide an unobtrusive method for reporting the patient’s vital signs including blood pressure and weight; biometric data including pulse oximetry and blood glucose levels; and subjective data including disease signs and symptoms, medication, and/or diet compliance. With the safe haven created by in-home technologies, patients are able to feel safe while maintaining their independence.
Remote Patient Monitoring systems to improve patient outcomes, encourage patient self-management and reduce avoidable readmissions, long discussed in healthcare journals, are making their way into finance and investing publications. GrandCare’s Laura Mitchell quotes a stock market analyst writing inMobi Health News Report, to make her point.
“Remote Patient Monitoring (RPM) is minimizing hospital stays, resulting in a reduction of the cost of healthcare delivery. RPM helps healthcare centers reduce costs and increase business opportunities for healthcare service providers, while integrating systems and providing necessary operational facilities. As a result, the Patient Monitoring Systems market stands to gain.“5
Supporting Mobi Health News Report’s position, healthcare researcher Jenny Minott of Academy Health, writes in her report Reducing Hospital Readmissions, “Tele-monitoring high-risk patients alone has decreased readmissions by 15 percent.”6
CMS may not believe, but its sister department does
Studies of significance by the Veterans Health Administration have reported even larger reductions in hospital utilization through the use of in-home remote monitoring technologies. The VHA reports that it “delivers healthcare services that serve 5.6 million unique veteran patients annually. A total of 7.6 million veterans are enrolled to receive VHA care. The number of veteran patients aged 85 years or more that VHA treats is set to triple by 2011 compared to 2000. As the U.S. population ages, people are living longer, staying healthier, and choosing to live independently at home.”7
Next week: Our next excerpt from Laura Mitchell’s white paper will describe a care approach that integrates wellness, smart home systems, activity monitoring and social connectivity to reduce avoidable hospital readmissions.
1Information cited from the article “One in Five Medicare Patients Readmitted within month” from USATODAY.comhttp://www.usatoday.com/news/health/2009-04-02-hospital-medicare_N.htm
3Study shows that 40% of seniors do not comply with doctors’ orders. http://www.commonwealthfund.org/Publications/In-the-Literature/2007/Feb/Physician-Patient-Communication-About-Prescription-Medication-Nonadherence–A-50-State-Study-of-Amer.aspx
5Mobi Health News Report: Patient Monitoring worth $9.3 billion in 2014 http://mobihealthnews.com/10969/report-patient-monitoring-worth-9-3-billion-in-2014
72008 VA telehealth study: http://www.viterion.com/web_docs/VA%20CCS%20Outcomes%20Dec_2008_Darkins.pdf
GrandCare offers a senior friendly, internet enabled, private home touch screen system aimed at maintaining independence, controlling chronic conditions, and reducing hospital readmissions. It combines the technologies of smart home, activity monitoring, wellness monitoring, and social connectivity. The wellness aspect includes wireless physiological readings (weight, blood pressure, oximeter, glucometer), self assessment, and medication compliance with associated rule sets, alerts, and congregate analytics. The social aspect includes one button Skype, wellness videos, reminders, and other standard social media content aimed at reducing isolation, educating the patient, and influencing them to better self manage their health.