Telemedicine: Using Remote Monitoring to Reduce Hospital Readmissions
The Challenge: Reduce Readmissions or Pay Up
Telemedicine and Readmissions: Parsing the Evidence
- Partners HealthCar in Boston implemented a telemonitoring and education program for patients with heart failure and other chronic conditions in 2006. More than 1,200 patients have been through the program so far. The results are startling: Readmission rates for heart failure patients plummeted by half and non-heart failure readmissions rates fell by 44 percent. Partners estimates the program saved more than $10 million in its first six years.
- A similar program through the Veterans Health Administration for patients who had heart attacks reported similar results.
- The University of Virginia Medical Center in Charlottesville instituted a telehealth program that combines real-time data with remote monitoring for patients discharged with heart failure, pneumonia, COPD, a recent heart attack, or a hip or knee replacement. A technician sets up the equipment in the patient’s home within two days of discharge. The simple-to-use equipment consists of a small box that wirelessly transmits data from a blood pressure cuff and oximeter to a registered nurse. If the nurses notice any problems, they contact the patient by phone or, if needed, make an in-home visit. Just a year after implementing the program, the medical center saw its 30-day readmission rate drop to about 10 percent, compared to a national average of 17.5 percent.
- St. Vincent’s Health System in Indianapolis tracked 300 patients with congestive heart failure, COPD or both in the 30 days after they were discharged from the hospital. Half the patients received videoconferencing equipment; half (the control group) did not. A nurse conducted at least 10 videoconferencing sessions with the patients in the intervention, more often if patients needed their vital signs taken. Meanwhile, the control group received typical post-discharge treatment, primarily just a phone call. The results were impressive. Patients in the videoconferencing group had a 5 percent readmission rate compared to 20 percent in the control group.
Confronting the Challenges
- Legal and regulatory issues. State medical boards regulate the practice of medicine in each state, often with differing requirements. What happens when a doctor or nurse licensed in one state delivers telemedicine services to a patient living in another?
- Reimbursement. Will insurers pay for telemedicine services? In most readmission programs, the hospital picks up the cost.
- Malpractice insurance. How does providing virtual patient care affect malpractice rates?
- Privacy and confidentiality. Does the program meet all HIPAA requirements regarding patients’ health care information? For instance, is patient data encrypted and safely stored? Do technicians who help set up the equipment understand HIPAA policies?
Telemedicine at the George Washington University
- The George Washington University’s Telemedicine Institute is an online hybrid institute that introduces the topic of telemedicine to qualified undergraduates, graduate students and interested professionals in a multidisciplinary format while spurring innovation and entrepreneurship in the fields of medicine, engineering, public health, business and law.
- The George Washington University’s School of Medicine & Health Sciences runs the mHealth (mobile health) Collaborative, an interdisciplinary team with GW faculty representation committed to advancing the academic framework of mHealth on GW’s campus. Several courses related to mHealth, telehealth, application design, policy, health information technology, communications and wireless networks are available at both the graduate and undergraduate levels.
- In addition, the mHealth Collaborative is currently working on designing graduate-level certificate programs in the space.
- The George Washington University Hospital is also deeply engaged in telemedicine and mobile health. The hospital has grants to study the use of text messaging to communicate with patients who have diabetes and the use of telemedicine to enable patients to receive dialysis at home. Its clinicians also provide medical services via telemedicine to ships at sea, remote clinics and teams, and correctional facilities. It also offers an emergency medicine telemedicine fellowship to develop future leaders in telemedicine.
- Kvedar J., Coye M.J., Everett W. Connected Health: A Review of Technologies and Strategies To Improve Patient Care With Telemedicine and Telehealth. Health Aff (Millwood). 2014;33(2):194-199.
- American Hospital Association. The Promise of Telehealth For Hospitals, Health Systems and Their Communities. Trendwatch. January 2015.
- Readmissions Reduction Program. Centers for Medicare & Medicaid Services. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html August 14, 2014.
- Rice S. More U.S. hospitals to receive 30-day readmission penalties. Modern Healthcare. October 2, 2014. Available at: http://www.modernhealthcare.com/article/20141002/NEWS/310029947
- Boccuti C., Casillas G. Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program. January 29, 2015. Available at: http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program
- Broderick A., Lindeman D. Scaling Telehealth: Lessons from Early Adopters. The Commonwealth Fund. 2013.
- Darkins A. Telehealth Services in the United States Department of Veterans Affairs. 2014
- VHQC News. UVA Health System, Tech Firm Collaborate to Reduce Hospital Readmission Rates. June 2014. Available at: http://broadaxecarecoordination.com/blog/UVA_HealthSystems_Article-1.pdf
- Shaw G. Remote monitoring to cut readmissions: One year later, Beacon pilot preps for future. FierceHealthIT. November 14, 2012. http://www.fiercehealthit.com/story/remote-monitoring-cut-readmissions-one-year-later-beacon-pilot-preps-future/2012-11-14
- Health Care Executives Say Telemedicine Will Alter Health System. iHealthbeat. Available at: http://www.ihealthbeat.org/articles/2010/5/20/health-care-executives-say-telemedicine-will-alter-health-system