Dorothy Devlin hopes to never again step foot in a hospital.
It’s a tall order for an 88-year-old woman who has had multiple bouts of congestive heart failure, suffers from chronic lung disease and needs daily medical checks.
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But, for now, she is getting her wish. The Fort Myers resident is one of almost 100 Lee Memorial Health System patients in a new program that allows medical staff to check her daily by way of home equipment electronically linked to system computers.
The “telemedicine” initiative provides a more comfortable and, the system believes, less expensive alternative for patients who might otherwise take up hospital beds.
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And this kind of daily supervision may help cut the number of patients who are readmitted within weeks of discharge, the system believes.
Health care organizations across the country are increasingly turning to telemedicine to drive down the number of patients who are return to the hospital within weeks of discharge.
Although some programs elsewhere have been in place for decades, the technology is gaining new importance with last year’s federal health care reform law.
Beginning in 2013, hospitals could face a 1 percent cut in their Medicare reimbursements for all hospital inpatient charges if they are seeing too many of these costly readmissions, a cut that could cost the system millions of dollars annually. That percentage would grow to 3 percent in 2015.
Insurance does not reimburse the system for the telemedicine enrollees, but it may in the future, said Marjory May, who oversees post-acute care for the system.
“It will save them (insurers) a lot of money, and it already has,” May said. “The primary goal is to prevent the patients from being readmitted. And it’s a benefit to them from a clinical perspective.”
Readmissions
Readmissions can happen for a variety of reasons.
Sometimes patients don’t react well to their medications or forget to take them altogether. Or they may have changes in, say, blood pressure or weight that might otherwise go unnoticed but indicate a serious problem.
By the time they notice a problem, often at the doctor’s office or emergency room, their condition is so serious that they need to be hospitalized again.
For the next couple of weeks, Devlin’s weight, respiration and blood pressure is checked every morning. If there are dangerous changes, nurses will notice it immediately. The machines also remind her to take her medicine.
“It’s not an inconvenience,” Devlin said. “It’s a great big help.”
About 660 patients have taken part in the program, run through Lee Memorial Home Health, since it got under way last year.
Of those, the system believes 137 were not readmitted thanks to the home monitoring program. The resulting savings to insurers has been about $767,000.
Even so, medical experts are divided on the benefits of telemedicine.
Needed equipment is often expensive – about $3,200 for each home set in the system’s case.
And studies over the years have not consistently shown better patient outcomes after treatment through telemedicine, said Dr. Jeremy Kahn, associate professor of critical care, medicine and health policy at the University of Pittsburgh School of Medicine.
Still, Kahn expects more health care organizations to jump on the telemedicine bandwagon.
Lower readmission rates and decreased patient deaths may simply be the result of more diligent checks on patients, he said. The technology provides an excuse for staff to better monitor patient recoveries, but it is not necessarily needed, he said.
“It’s very natural for hospitals to look for technological solutions for these problems,” Kahn said. “But I caution about investing too much faith in technology. There are many, many things that can influence readmission rates.”
Rates improve
A few chronic health problems account for the majority of readmissions.
Among the most common are chronic lung disease, heart failure and complications after heart attacks.
Generally, 20 percent to 25 percent of them will have to go back to the hospital within 30 days of discharge, according to the U.S. Department of Health and Human Services.
System hospitals have readmission rates roughly in line with these national averages.
The system has reduced those numbers through the telemedicine program, May said. The most dramatic statistic: Congestive heart failure readmissions average about 24 percent systemwide but are about 12 percent for those in the program, she said.
Given that, the system hopes to expand the program with machines that could service the thousands of patients who might benefit from them at any given time, she said.
Eventually, it would like to add video cameras in some homes to allow medical staff to visually check patients.
“We will have a smart home for the patient,” May said. “That’s where we’re going. Everyone wants to stay out of the hospital anyway.”
http://www.news-press.com/article/20110608/HEALTH/106080380/Lee-hospitals-check-patients-home
