Case Study: Does Telehealth Technology Reduce Hospital Readmissions

Through telehealth consultants patients are able to participate in clinical trials unavailable in many rural areas.This

Telehealth has become a preferred method of healthcare delivery for many patients and healthcare professionals alike. Some key benefits include its convenience and cost effectiveness. It also allows patients to play a more active role in their own healthcare, which has been found to dramatically increase patient outcomes. While research suggests that the advantages of telehealth outweigh the disadvantages, it is important to note that not everyone would benefit from this form of technology. It is crucial for the patient’s healthcare team to assess if this method of healthcare delivery is appropriate for that individual patient. In today’s society, staying current on the latest technologies is extremely important. Although telehealth

monitored by medical professionals. According to McKnight (2012), “Studies indicate patients with telehealth care are noted to have a 25% reduction in the number of inpatient hospital days and a 19% reduction in the rate of hospitalizations” (p. 4).

The benefits of telehealth consultations are immeasurable; clients are able to access a knowledgeable health care professional and receive a telephone triage/assessment and recommendations. This allows the patient to have immediate access to good health advice and quicker solutions. Telemedicine is one of the many vehicles of telehealth; for example, the cardiologist orders an outpatient Holter Monitor trial to evaluate arrhythmias. The technician calls the patient at the sign of any abnormal rhythm and investigate the activity performed when the reading fluctuation then the reported is communicated to the cardiologist. If warranted, the cardiology staff will contact the patient with instructions schedule an immediate appointment. Telehealth services resources would benefit the client in this next example, an individual’s come in for a sick visit expecting a prescription to be written for their illness; they receive informative instructions because of the nature of the

Many of these barriers exist from lack of essentially knowing the benefits of what the incorporation of telehealth can offer within the aspect of this type of community. At times, there has been a great interest in telehealth surrounding its potential to reduce health care costs along with the improvement of patient outcomes, but at times there has been no known scientific evidence base underpinning it (McLean, Sheikh, Cresswell, Nurmmatov, Mukherjee, Hemmi & Pagilari, 2013).

Telehealth can help reduce high cost hospital visits such as stroke cases, neonatal intensive care unit (NICU) cases and other emergencies. There have been recent initiatives that collected data to see if telehealth was a cost effective option for healthcare. One initiative, Baby CareLink, places telehealth units in homes of low-birth weight neonates.12 For this initiative, Beth Israel Deaconess Medical Center (BIDMC) in Boston installs the telehealth units in the neonates home for $2,000, and that units replaces a NICU stay of $5,000 per day.12 If a neonate was to stay in the NICU for 7 days, that would be a $35,000 expense that the $2,000 telehealth unit replaces. 12 Different disease states and emergency states will have different cost factors depending on the amount of medical care. However, the amount that a family can save on their newborn by investing in telehealth is quite significant. In a study from the Milwaukee and Iron Mountain Veterans Affairs Medical Centers (VAMC) telepulmonary program, telehealth was found to be more cost effective compared to routine care. This study was conducted over a year and telehealth had costs of $335 per patient per year compared to routine care, which was $585 per patient per year, and onsite care was also compared at $1,166 per patient per year.13 A sensitivity analysis was performed on these values, and it did show that the cost-effectiveness telehealth was dependent on successful telehealth consultation, equipment cost, and

The Affordable Care Act was enacted to improve health care and to lower health care cost in America. The ACA developed different strategies to meet these goals called the “pay for performance” programs. These strategies are aimed at the different providers to improve quality care. The strategy that I selected is the “Hospital Readmissions Reduction Program” this program/strategy is also known as the HRRP and was begun in October of 2012. HRRP is aimed at hospitals and penalizes hospitals that have a high 30 day readmission rate. The penalties are assessed and based on a number of comparisons, those such as, performance, patient demographics, comorbidities and frailty.

This memorandum describes Central Health’s Readmission Reduction Program set to commence in May 2017. The Centers for Medicare and Medicaid Services (CMS) has raised concern over the increasing readmission rate and poor quality of care. To address this issue, Congress has created Hospital Readmission Reduction Program (HRRP) statute under the Affordable Care Act, 2010, which was recently updated under 21st Century Cures Act of 2016. Under the constant pressure of a penalty, Central Health has considered to establish its own Hospital Readmission Reduction Program to address specific imperatives, such as care-coordination, treatment adherence program, and streamlined patient discharge process.

When patients leave from appointments with their physicians, or are discharged from the hospital, they are responsible for their care at home. Oftentimes, patients are non-compliant with their treatment plan given to them by their clinician due to lack of understanding, miscommunication or faulty understanding of the treatment plan, lack of access to facilities or requirement of additional guidance. This creates safety issues and causes negative outcomes in the patients’ health. This is where telehealth comes into play to help to continuously monitor patients and provide the assistance needed to maintain optimal patient function. According Cassandra, Graves, and Mooney (2013) telehealth would certainly reduce readmission rates for chronic conditions by giving patients early interventions, serve wider geographic areas, improve patient outcome, provide better services to patients and allow better time management for

Congestive Heart Failure (CHF) patients and their consistent trending of hospital re-admissions continue to threaten quality care and patient quality of life. Considered a chronic condition, CHF is diagnosed in approximately 13% of patients 85 or older (Clarke, Shah & Sharma, 2011). Re-admissions have become so prevalent among the CHF populations, that Centers for Medicare has initiated a quality campaign and offers incentives when hospitals implement telemedicine programs and show reduction in CHF hospital admissions. In relation to CHF, Conway, Inglis, and Clark (2014) states that, “Telemedicine involves transmission of physiological data, such as weight, … from the measuring device to a central server via telephonic, satellite,

The future faces a number of related goal-driven challenges. The CCHT has cited reduced health care resource use among the targeted high-utilization patients. This impact provides strong economic justification for home telehealth to be an integral component of regular care services for chronically ill veterans at risk for long-term care. Because of the lower marginal cost of adding services to the existing infra¬structure, the VHA is intent on expanding its CCHT program to provide chronic care management, acute care management, and health promotion and disease management for other patients in areas such as weight management, dementia care, and palliative care. They were awarded six national contracts for home telehealth devices and services worth $1.38 bil¬lion over five years. This is particularly challenging as the VHA uses a primary care model that adheres to clinical guide¬lines and sharing of information among

Telehealth is the monitoring via remote exchange of physiological data between a patient at home and health care professionals at hospitals or clinics to assist with diagnosis and treatment. As our society ages and health care costs increase, government and private insurance payers are seeking technological interventions. Technological solutions may provide high quality healthcare services at a distance, utilize professional resources more effectively, and enable elderly and ill patients to remain in their own homes. Patients may experience decreased hospitalization and urgent care settings, and out of home care may not be required as the patient is monitored at home. However, no study has been able to prove telehealth

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.

While evaluating the face to face component of this category, two systemic reviews guided from meta-analyses were included. Both provided substantial, adequate feedback on the use of face to face monitoring or evaluation. Despite the evidence to support the frequent use of telehealth in the outpatient community, face to face monitoring with a physician or clinical specialist in the home does report a reduction in admissions a delay in admission if clinically inidicated (Qaddoura, Ashoori, Kabali, Thabane, Haynes, Connolly & Spall, 2015). All aforementioned studies evaluated heart failure patients with awareness of the pressing subject of heart failure readmission and the costly effect of lapses in outpatient care.

Research conducted into telehealth demonstrates conflicting evidence of its viability as a form of practice. Dreyer N., Dreyer K., Shaw and Wittman (2001) suggest for telerehabilitation to be a viable alternate it needs to be executed with a high-bandwidth system producing adequate video quality for therapists viewing smaller motor movements. This recent study declared a lack of research into the equipment used in executing telerehabilitation for long-term use. Further research on specific evaluation tools, equipment and long-term system use needs to be conducted (Dreyer et al, 2001). The tele-practice roleplay highlighted, how a strong connection is vital to executing an alternate to face-to-face practice. Posing to be a limitation for rural areas where access to high-bandwidth isn’t accessible. Consideration of the equipment used to execute