Friday, August 15, 2008

Remote monitoring, telemedicine - Saving Money and Saving Lives Through Home Monitoring Controlled by Patients Themselves

The Wall Street Journal health blog ( is one of my favorites. Jacob Goldstein, its chief blogger, posted this blog on August 14.

Medicare Could Save Billions By Cutting Re-Hospitalization

Posted by Jacob Goldstein

One possible sweet spot for trimming the growing cost of Medicare: repeat hospital visits.

The percentage of patients who return to the hospital with in 30 days of being discharged could be cut dramatically, says an op-ed in this morning’s Boston Globe. A MedPAC study found that potentially preventable readmissions cost Medicare some $12 billion in 2005.

Perhaps most important is better communication when patients are discharged and better monitoring of patients after they leave the hospital. One medical center lowered readmission rates for cardiac patients by 78% when nurses called the patients at home to check on key signs such as weight, swelling, and shortness of breath.

Medicare should bundle funding for this kind of follow-up monitoring in its payment for the patient’s initial hospital stay, and “claw back” the initial payment for any patient who is re-admitted to any hospital within 30 days, the authors suggest

Jacob did not mention a couple of things:

1) cutting re-admissions saves hospitals a bundle of money since hospitals are paid a fixed amount for a given diagnosis, and patients readmitted within 30 days fall under that fixed amount and frequently exceed it;

2) a number of firms have already developed software and home monitoring systems that dramatically cut readmissions.

I am most familiar with American Telecare, a telecommunications firm in Eden Prairie, Minnesota. I have a chapter on the firm in my book Innovation-Driven Health Care. The chapter is titled “From High Tech to High Tech/High Touch.” The chapter features a case study co-written by Randall Moore, CEO of American Telecare, and Erin Denholm, MSN, CEO of Centura Health.

Using an audio-visual bedside device allowing home-bound patients to talk directly, to examine, and to be viewed by doctors and nurses, American Telecare was able to cut re-admissions to near zero. The most dramatic results occurred in patients with congestive heart failure.

What impressed me what that patients controlled the virtual encounter and learned quickly how to spot complications and manage their own disease. Patients, even frail, home-bound patients with chronic disease are quick learners when qiven the opportunity and the tools.


Gary M. Levin said...

This is an excellent idea....once he infrastructure is in place. That will take some time, and funding.
Another idea is to reduce premature discharges..With the onset of DRGs the onus is on the hospital and MD to shorten the hospital stay.....How many of those readmissions would not occur?
Have the number of readmissions increased since the DRG went into effect?

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