Saturday, April 11, 2009

Consumer-driven care - Mind Piece

Give us the tools, and we will finish the job.

Winston Churchill, Radio Broadcast, 1941

A mind is a terrible thing to waste.

Slogan of United Negro College Fund since 1972, now part of American vernacular

If you don’t mind, here’s a piece of my mind.

I believe minds of home-bound, chronically-ill, recently discharged from the hospital, elderly patients may be one of the most underrated and greatest single source of Medicare savings.

The April 2 edition of the New England Journal of Medicine contains a special article, “Rehospitalization among Patients in the Medicare Fee-For-Service Programs.” It says 20% of Medicare beneficiaries discharged from the hospital in 2004 were rehospitalized with 30 days, and 34% within 90 days. For those rehospitalized within 30 days, 50% had no record of a physician visit between discharge and readmission. The authors estimate the cost of unplanned rehospitalizations in 2004 was $17.4 billion.

The good news is you can cut these readmissions to near zero for patients with congestive heart failure, who comprise the bulk of readmitted patients, by using existing technologies and the minds of patients.

The technologies are ordinary phone lines, an audiovisual device smaller than a breadbox through which patients can talk and listen to doctors and nurses , and some space age stuff that allows caregivers to weigh patients, take blood oxygen levels, and listen to hearts and lungs.

But by far the greatest thing is the minds of these ill patients. Their bodies may be compromised but their minds are not. They have proved to be quick spotters and learners of complications of heart failure – fluid retention, malaise, chest pain, shortness of breath, even mental short circuiting.

And, not a small thing, patients can initiate communication with their care overseeing, who are only a phone call and a direct audiovisual observation away. By taking control of their situation, patients can ameliorate or ward off complications, and avoid those dreaded emergency room visits or return hospital visits, and Medicare can save a passel of money.

Most of what I know about this subject stems from chapter I wrote in Innovation-Driven Health Care: 34 Key Concepts for Transformation (Jones and Bartlett, 2007), which in turn, was based on interviews with Randall Moore, MD, CEO of American Telecare, and Erin Denholm, MSN, CEO of Centura Health. In a 6 month study at Centura using the audiovisual device, re-hospitalization costs dropped 73% after paying for the telehealth program, and home care nursing visits dropped from 11 per episode with telehealth to 3.5 visits. This study is just one of many and shows the power of a combined high-tech/high touch approach.

In worshipping power of computer technologies,

for our mind we make unnecessary apologies.

We tend to forget a perfectly sound mind,

accompanies most diseases of mankind,

The mind can overrule and overcome most pathologies.

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