Telehealth is arguably one of the best tools available to help lower hospital readmission rates, and it should be more widely leveraged because readmissions aren’t dropping as fast as many stakeholders would like.
The word “telehealth” isn’t in Webster’s dictionary, but if you could look it up, one of the definitions would be technology that improves post-discharge care coordination across an ever-growing care continuum.
Year No. 3 of the Centers for Medicare & Medicaid Services’ Hospital Readmission Reduction Program (HRRP) was a bittersweet, good news/bad news story. The average reimbursement withholding per hospital was less than 1 percent (even though the maximum penalty has risen to 3 percent). But more hospitals are getting penalized because the program now monitors COPD and elective hip/knee replacements, not just the initial triad heart attack, heart failure and pneumonia.
In the last fiscal year, nearly 80 percent of U.S. hospitals received readmission penalties, up significantly from the two previous years. That percentage should begin to decrease next year, but some states (including many in New England) will show little progress because they have fewer exempt hospitals.
It would be discouraging if states with high smoking rates (like Kentucky and West Virginia) made progress in lowering heart failure-related readmissions, only to see their COPD readmission rates climb higher.
Here are two examples of how telehealth can improve post-discharge care and prevent readmissions:
The Pinnacle Health system in Pennsylvania estimates that every avoidable readmission costs them around $8,000. To reduce the financial sting, Pinnacle piloted a telehealth program with nearby Colonial Park Care Center, a 198-bed skilled nursing center in Harrisburg, Pa.
Colonial Park offers specialty care services for patients who have been discharged following strokes, heart attacks and serious pulmonary illnesses. These patients require close supervision, but their specialists can’t physically visit them every day. So Colonial Park deployed a telehealth device onsite that can move to the patient’s bedside and allow a doctor to beam in for a consultation.
With telehealth technology, Colonial Park’s supervising physician can do morning rounds in person, identifying patients who are at higher acuity and at risk for a change in status. He/she can then check on those patients remotely in the evening.
Within three months of deploying telehealth technology, Colonial Park’s readmissions to the Pinnacle system dropped by 5 percent, which represents a $50,000 savings for the hospital.
Virtual visits for transitional care
To improve post-discharge care coordination, Medicare now reimburses physicians for Transitional Care Management (TCM). CMS estimates that TCM services can increase primary care physicians’ Medicare reimbursements by around 4 percent. But to receive this reimbursement, clinicians must perform certain duties within designated time periods: initial communication with the patient within two business days of discharge and a physician visit within 14 calendar days. (For high-complexity cases, the visit needs to be within seven days.)
Since many newly discharged patients are too weak to travel to the physician’s office, a virtual visit is more convenient – and satisfies the reimbursement requirements for transitional care. Using a robust, HIPAA-secure telehealth platform, the physician and homebound patient – both using patient access devices – can discuss the care plan in detail and help prevent an unnecessary readmission.
Hospital readmissions are beginning to decline slightly in most parts of the U.S., but they’ll decrease even faster when telehealth is routinely used for post-discharge care.