By Alan Gilbert, VP, Business Development, AxSys Technology Ltd.
Since 2007 and 2008, the Centers for Medicare & Medicaid Services (CMS) and the Hospital Quality Alliance (HQA) have publicly reported 30-day mortality measures for acute myocardial infarction (AMI), heart failure (HF) and pneumonia (PN). More recently, CMS has also publicly reported 30-day readmission rates for AMI, HF, and PN. The Patient Protection and Affordable Care Act (PPACA) allowed CMS the ability to penalize hospitals for excess readmission rates starting in 2013 for AMI, HF and PN. Starting in 2015, CMS will evaluate withholding payments for 30-day readmissions in the areas of chronic obstructive pulmonary disease (COPD), coronary artery bypass grafts (CABG) and percutaneous coronary interventions, among other procedures.
The report above shows the National Average Reimbursement for Heart Failure & Shock w/ MCC (DRG 291): $7,696 - $9,939 based on 3,844 hospitals that submitted readmission rate data for the reporting period of 7/1/2006 - 6/30/2009.
Using technology to empower recently discharged patients to communicate their current health status to providers is one way to help lower readmissions rates.
One example of this is Surgical Site Infection control (SSI) of recently discharged patients. In Scotland, Golden Jubilee - a facility that accepts surgical patients from across the country - found it difficult to monitor patients' post-surgery home-based progress. Patients would be discharged back to their local community with no way of obtaining feedback on their subsequent condition.
The hospital recognized there was a need for continued communication between patient and provider in order to monitor for infections. It implemented an automated post-discharge SSI surveillance system, which provides an interactive telephone-based, patient home monitoring module linked to an electronic patient record. The surveillance nurse, who interviews patients before they are discharged, generates this record. All patients are given instructions on how to use the system. Patients are asked to access the system 15 and 30 days following surgery by calling a free phone number via a touchtone phone. The patient calls in and answers a customized SSI script with questions about the status of their wound. The patient responds to script questions by pressing corresponding numbers on the telephone keypad. Phone responses are fed directly into the system, which automatically assesses their answers and totals the predetermined numerical weight of their answers. It generates an alert if the patient's response scores between eight and 18. If the score is over 18, the system sends an e-mail alert to three members of the hospital's infection control team. All patients with a score greater than nine receive a follow-up phone call to discuss the wound and determine if an infection is present.
Chronic Obstructive Pulmonary Disease (COPD) Care at East Elmbridge and Mid-Surrey Primary Care Trust, in Southern England, is another example of enabling patients to communicate with their caregivers while at home. The process enabled patients to recognize changes in their own condition. The belief was that if patients could be encouraged to take an interest in their own disease and day-to-day care, the frequency of home visits during the year would be reduced. Patients are registered into the system after Respiratory Nurse assessment. After the initial assessment, the patient calls in from home and answers a customized COPD script with questions about the status of their COPD symptoms. After the call, a report is created and an alert is generated - based on defined criteria - if there is a detected deterioration in the patient's condition. This alert is automatically sent to the Respiratory Nurse via text message, who then calls the patient to give advice or take suggested action. After an incident, nurses enter their clinical notes directly into the system and clear the alert. Implementing this process lowered hospitalizations by 44%.
Hospitals need to continue to find creative and cost-effective ways to reduce and prevent readmissions. Empowering patients through the use of technology that already exists in most patients' homes is one way to engage the patient in their own care.