While reimbursement remains a sticking point, hospitals say devices that help keep patients at home are worth the cost
As the health system puts more emphasis on keeping patients out of the hospital, providers are turning to an unlikely ally: the TV.
Leading IT hospitals are finding that the boob tube, along with more high-tech devices, are powerful tools in battling disease, especially chronic conditions.
A recent survey found 62 percent of Americans believe communication with their doctors using home medical devices would improve their health. However, just 35 percent of those age 65 and older were interested in home medical devices, even though 90 percent of them live with a chronic medical condition. Providers hope older patients unfamiliar with computers may be more comfortable with emerging technologies that include interactive health monitoring applications that run on Internet-enabled TVs.
Covenant Health, Knoxville, Tenn., has employed a home-monitoring program called HomeCare since 2006. The system evaluates all patients to see if they are at high risk for congestive heart failure, diabetes, respiratory complications, hypertension, wounds, HIV or general debilitation. Initially, monitoring was done by telephone, but Internet-enabled telehealth devices have been added for appropriate patients.
"Any Covenant HomeCare patient is eligible if deemed high risk by the admitting clinician," says Senior Vice President and Chief Information Officer Mike Ward. Currently 1,442 patients are enrolled in phone monitoring and 284 participate in home telehealth monitoring.
Covenant, like most hospitals, receives no reimbursement for HomeCare. Home monitoring was implemented there to help reduce hospitalizations and improve quality of care. It's working: Covenant is 4 percent below the national 29 percent average hospital readmission rate. Typically, readmission rates can be lowered for CHF patients, among others, with monitoring systems that prompt patients to take medication and also take vital signs on home devices that send information wirelessly to caregivers.
Sentara Healthcare, Norfolk, Va., monitors about 300 CHF patients. New cellular telehealth solutions will increase that number by approximately 200 this year.
Sentara is piloting an e-Home protocol that allows home care assessment to occur within 24 to 48 hours of patient admission for diagnoses of CHF, COPD, shortness of breath, respiratory distress and atrial fibrillation. Home care is initiated on day of discharge. "We've had only one readmission for a diagnosis other than CHF within 30 days for 65 e-Home patients," says Sentara Vice President Ray Darcey.
One key to a successful home monitoring initiative is getting patient and family buy-in. "This is a component of teaching the patient self-management," says Ann Casterlin, R.N., vice president of home health for the Lehigh Valley Health Network in Pennsylvania. Casterlin sees health reform nudging health care out of the acute care arena and into the community-based, post-acute care service area. "Telehealth is going to help us manage the health care of regional populations. It allows caregivers to stay connected to their patients," she says.
Reimbursement is still an issue. Monitors can cost up to $8,000. Most insurance companies do not reimburse for telemonitoring charges, although Medicare allows for telemonitoring as part of its episodic payment for skilled home care services for CHF patients.
"While it's a capital expense up front, studies show it's a cost reduction in the end when weighed against readmission," Casterlin says.
Denice Higman, president of Soyring Consulting, advises hospitals to partner with insurers on home monitoring. "Approach top payers with programs you offer related to preventive health and see if there are opportunities to decrease their costs and increase your patient volume. Consider developing strategic programs to help support insurance company initiatives."
Covenant's Ward warns that "what may appear on the surface to be simple home-use technology, such as scales or blood pressure devices, becomes more complicated when dealing with data reporting, logging, data errors, management programs to ensure proper usage, and the process changes needed on the operational side of the business to ensure program support readiness."
Douglas Page is a freelance writer in Pine Mountain, Calif.
This article first appeared in the February 2011 issue of H&HN magazine.