Remote Patient Monitoring (RPM) is gaining recognition as a proven method to reduce Hospital Readmissions. So much so that CMS has released CPT codes specifically meant for reimbursement of these services. If you haven’t had a chance to review the new codes – check out my previous blog post that explains the different codes and what services can billed under them.

Important Difference Between Telehealth and RPM

Unlike telehealth, which simply provides another access point for episodic treatment or utilization of healthcare services, Remote Patient Monitoring is a platform that provides continuous engagement between patients and providers. Think of telehealth as another single point of interaction in a patient’s record or chart whereas Remote Patient Monitoring provides a continuous stream of data and interaction that exponentially increases everything from communication to the collection of diagnostic information. Coupled with the correct algorithms to monitor health metrics and care coordinators to engage patients, Remote Patient Monitoring is a game changer in comparison to a simple remote office visit facilitated by telehealth services.

So, How Does Remote Patient Monitoring Help Reduce Admissions

Simply put, Remote Patient Monitoring allows providers to collect and access diagnostic and compliance information linked to a patient’s specific needs for care management, giving them the power to make decisions that are timelier and better informed. What’s more, the new CPT codes mentioned above, allow providers to utilize vendor partnerships and clinical staff to perform much of the work analyzing, engaging and educating patients which may be enough of an intervention to slow disease progression or prevent an admission or readmission.

Potential Impact of Remote Patient Monitoring on the Diabetic Patient Population

Looking at just diabetic patients, the peer reviewed journal American Nurse Today noted that “patients with diabetes account for approximately 480,958 hospital in-patient stays per year with a 30-day readmission rate of 97,784, accounting for a 20.3% hospital readmission rate.”

Now consider, many of those admissions and readmissions are caused by out-of-control glucose levels, inactivity, compliance with medications and adherence to diet restrictions. A diabetic patient on an annual or semiannual follow-up with their primary care provider will only offer that practitioner one or two snap-shots of their health and an often-inaccurate account of their compliance with the prescribed treatment plan. This doesn’t provide the PCP with much of an opportunity to engage, educate, correct or intervene in a timely manner, often leading the non-compliant or progressing diabetic to seek care in another setting such as an urgent care or emergency room. Depending on the severity of the episodic condition or disease progression this can lead to an admission and/or readmission.

Put that same set of diabetic patients in a remote patient monitoring program with the correct set of diagnostic and compliance measures collected and couple it with an algorithm that alerts providers to negative changes in health metrics, and you create a new level of engagement that allows you to correct the patient’s compliance and treatment plan. This gives you the opportunity to help the patient avoid an ER visit, admission or progression of their disease. And for diabetic patients, that may mean avoiding further risk or complications associated with vision loss, neuropathy, infections, kidney disease and heart disease.

An End-to-End Solution to Help Reduce Admissions

HealthKOS is an end-to-end solution that was developed by doctors to improve patient engagement, compliance and outcomes. HealthKOS™ provides direct savings to the physician and healthcare organizations both in time and money as well as improving patient outcomes.

What makes HealthKOS™ different is that it utilizes automated algorithms, real-time data, and quality metrics to involve patients in their own care, as well as keeping healthcare providers and family constantly informed. HealthKOS™ allows the healthcare team to monitor patient progress outside the practice office, leading to timely interventions, preventing disease progression and unnecessary hospitalizations.

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Hospital readmission rates have become a growing concern in the effort to improve the national quality of healthcare. It is a stressful process for physicians and patients alike when flaws in treatment plans lead to a hospital readmission, especially within a short period of 30 days. In the current world of value-based treatment plans, multidisciplinary teams of providers are assembling to tackle this issue.

Based on CMS data reports, an estimated $17 billion is spent annually on preventable hospital visits after discharge. Reading this, it is no wonder that over 2000 hospitals have been penalized in the past year due to the overwhelming cost of these visits.

Medicare penalties, under the Hospital Readmission Reduction Program (HRRP), are now taking into consideration a number of targeted conditions when evaluating hospital readmission rates. These conditions include congestive heart failure, septicemia, pneumonia, chronic obstructive pulmonary disease, and cardiac dysrhythmias. The majority of Medicare patients who were readmitted to hospitals in 2017 were affected by one of these top conditions.

Reductions in hospitalizations may be as clear cut as simple improvements in discharge treatment plans. However, this is easier said than done. It is no longer about briefly speaking with a patient and sending them home with an education pamphlet that they may never set their eyes on. Innovations through healthcare technology, patient engagement, and transitional care plans are now becoming the forefront to improve patient outcomes and reduce hospital readmissions.

In lieu of HRRP reforms, the majority of hospital readmissions were found to be caused by inadequate transitional care plans following a hospitalization. The Institute for Healthcare Improvement (IHI) suggests that one third of a total $2 trillion in hospital costs can be remediated by implementing effective transitional care plans.

Transitional Care

Transitional care, according to the National Association of Clinical Nurse Specialists, embodies healthcare services provided when a patient moves from one care setting to another. These services can include follow up monitoring and medication reconciliation when a patient is discharged from the hospital to a nursing home, for instance.

Management of transitional care plans is vital for the improvement of patient outcomes, especially in regard to chronic health conditions. Medicare patients and their families need extra support when they are oftentimes discharged with changes in complex medication regimens. Several studies have shown that this population is particularly susceptible to degradations in care when they are not contacted for follow up and treatment overview.

A randomized, controlled trial determined that hospital readmission rates 90 days after discharge were lower in patients who underwent transitional care interventions compared to patients who did not receive transitional care. The study design included active remote monitoring from a provider to support patients and their families. Further data showed that average hospital costs were reduced by up to $5000 per patient.

In addition to transitional care plans, cloud-based platforms, such as HealthKOS, make it easy to follow up and monitor care with increased patient engagement (hyperlink to patient engagement page). Studies show that healthcare technology which drives patient engagement can generate reductions in hospitalizations through early interventions. Transitional care plans in combination with innovations in healthcare technology may spell out the ultimate solution to reduce hospital readmission rates.

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