Nursing Notes

April 28, 2011

Residential Health’s med monitoring pilot slashes readmissions

HELP Telemedicine clinic 1

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Here is an article that describes another way that telemedicine can be utilized to prevent readmission.  In reading this article, I was confused by the physicians who did not want to participate in this study.  Why?  If this is a way to maintain a patient’s health while out of the hospital, what is the problem?

Please read the entire article and come back here to tell me what you think, okay?  I really would like to hear from you on this topic.  It seems that telemedicine is the wave of the future and we need to be prepared to use it as nurses.  I think it is a great tool for health.  That’s just my opinion.  What’s yours?

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By Jay Greene

Crain’s Detroit Business

A pilot project by Madison Heights-based Residential Home Health LLC that uses remote medical monitoring held hospital readmissions to 3 percent last year for 239 patients with congestive heart failure and chronic obstructive pulmonary disease.

National data show that 20 percent of all Medicare patients are readmitted to hospitals within 30 days, and 33 percent are readmitted within 90 days, costing Medicare more than $17 billion annually, according to a 2009 study in the New England Journal of Medicine.

In similar patients who did not participate in Residential’s Cardiopulmonary Hospital Admit Management Program, called CHAMP, during the last six months of 2010, the readmission rate was 25 percent, said David Curtis, Residential’s president.

But remote monitoring isn’t universally popular.

“Not every patient wants to use telemonitoring, and some physicians don’t want it,” Curtis said. “In order to drive down readmissions, we need better alignment (with patients and physicians).”

Curtis said the reduction in readmissions comes by focusing on three areas: educating patients within 24 to 48 hours after going home from the hospital, preventing medication errors, and having patients take vital signs with the devices daily.

Residential uses remote medical monitoring devices provided by Philips Telehealth Solutions including wireless weight scales, blood pressure cuffs and blood glucose meters.

Residential nurses and therapists teach patients to use the Philips devices. The data is transmitted daily to Residential, where nurses monitor it and contact physicians if warranted.

But the use of remote medical monitoring devices to reduce readmissions is still in its infancy and studies have shown mixed results.

For example, a study published November in the New England Journal of Medicine showed no reduction in readmissions from use of telemedicine in heart failure patients. However, the study concluded that many of the patients didn’t take daily readings from the instruments.

Curtis is familiar with the studies and says the effectiveness of the remote monitoring devices is only as good as nurses and therapists following up with patients to make sure they are compliant.

“If we don’t hear from our patients by 11 a.m., we are calling to remind them,” Curtis said. “The value of telemedicine is not in the equipment, it is in the process and patient education we use to prevent readmissions.”

Christopher Kim, M.D., a hospitalist at the University of Michigan Hospitals in Ann Arbor and a readmission reduction expert, said some technology vendors are aggressively promoting the use of telemedicine devices to reduce hospital readmissions.

“I am not sure it is completely justified yet,” he said. “The technology can help, but we have to look at our workflow and make sure we coordinate care with post-acute providers to keep patients out of the hospital.”

Besides the program saving Medicare money and improving patient care, Curtis said demonstrating low readmission rates will help bring more patient referrals to Residential from physicians.

“If we have the best outcomes, we can generate new business,” said Curtis, a health care and manufacturing consultant who acquired Residential six years ago with three other partners, including Chairman and CEO Mike Lewis, a lawyer who was a senior partner at Troy-based Dean & Fulkerson.

The company is already one of the state’s largest non-hospital-based agencies with more than 2,200 patients, according to the Michigan Home Health Association.

Annual revenue for 2010 for Residential and its affiliates totaled $48 million, down from $53 million in 2009, Lewis said. The revenue slide came from rising costs and flat Medicare payments, a shortage of nurses and therapists that limited census, and costs associated with expanding into Illinois, he said.

“We had staffing issues last year because of the nursing shortage, but this year we have hired one clinician every other day (more than 50 nurses and therapists),” Lewis said.

Of Residential’s 473 employees in Michigan, 255 are nurses and therapists and 17 employees are part of the company’s marketing and community liaison team, Curtis said.

In Michigan, Residential averages 1,500 patient home care visits per day, a 20 percent increase from last year. The company also has an agency in Illinois that averages about 300 patient visits per day.

Jerry Wilborn, M.D., a pulmonary critical care specialist and hospitalist who refers some patients from Botsford Hospital to Residential, said he uses data collected by Residential to determine…[read the rest here]

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