Benefits of Telehealth for Discharge Management and 30-Day Readmission Prevention

Beginning on Oct. 1, 2012, the Centers for Medicare and Medicaid Services (CMS) under the Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP), a pay-for-performance program that lowers payments to Inpatient Prospective Payment System hospitals with too many readmissions. Effectively, the program links payment to the quality of hospital care patients receive, measured through patient readmission.

Under HRRP, CMS withholds up to three percent of regular reimbursements for hospitals if they have a higher-than-expected number of readmissions within 30 days of discharge for six conditions:

• Chronic lung disease
• Coronary artery bypass graft surgery
• Heart attacks
• Heart failure
• Hip and knee replacements
• Pneumonia

 

This incentive is driving change for discharge management to proactively prevent patient readmission. The change has been slow in coming, however: In 2017, 2,573 hospitals faced readmission penalties under the HRRP. The American Hospital Association also found that, since the start of the program, hospitals have experienced nearly $1.9 billion in penalties, including $528 million in the 2017 fiscal year.

These findings prove that there are still steps to be taken to optimize discharge management and prevent readmissions. However, as telemedicine has become more mainstream, hospitals now recognize that one of the most effective approaches to address readmission and proactively manage newly discharged patients is through the use of telehealth.

Improved Clinical Efficiency and Quality Care

Treatment Adherence
To maintain patient wellness and improve outcomes, telehealth provides a new avenue of communication for hospitals. Patients now have the monitoring support they need for medication adherence or treatment plans which were previously dispensed/ delivered in the hospital. Discharge management and the 30-day readmission program, combined with the ability to intervene through virtual visits, means enhanced treatment adherence and more timely interventions for better outcomes.

Convenience
If an issue arises, patients can access care through the comfort of their own home on a smartphone, laptop, or desktop computer. Digital health devices can also now gather data in the cloud and produce insightful reports and track trends that are shared with providers as part of a virtual visit, eliminating the need to come to the clinic or hospital for follow-up care.

Access to Qualified Care
For patients who live in remote areas, congested urban areas, or that have trouble traveling, discharge management via telemedicine enables them to have their health monitored by skilled providers and other specialists without requiring an in-person visit.

Collaborative Care
Difficult-to-manage and expensive patient populations often require collaborative care across medical specialties or intensive management by highly specialized teams. Virtual visits for discharge management can be a complement to visiting nurse and other care programs to provide higher levels of insight for managing the most fragile patients, such as those with advanced medical needs, to prevent readmission.

Enhanced Efficiency and Reduced Costs

Reimbursement
Payment for virtual care services has improved considerably in the last five years. Reimbursement for the prevention of readmission through the CMS’ HRRP incentivizes hospitals to work better with patients and caregivers on post-discharge planning. The CMS withholds up to three percent of regular reimbursements for hospitals if they have a higher-than-expected number of readmissions within 30 days of discharge.

Reduced Urgent Care/Emergency Room Visits

Urgent care and emergency room visits for patients with side effects or post-operation issues are expensive for medical centers and patients and directly affect Medicare reimbursement. A substantial portion of these visits can be avoided as a result of virtual discharge management and can be done at considerably lower costs for greater patient/provider convenience.

Easier Collaboration
Telemedicine makes it easy for caregivers to interact directly with other specialists, and virtual discharge management is able to enhance quality of care and determine the right services needed, which may help prevent patient readmission. Pharmacy consultations or post-op follow up can easily be delivered remotely, providing more complete patient support.

Innovation
Providers know that improved health and wellness programs can produce long-term benefits for the total cost of care for patients. Discharge management in combination with virtual visits to prevent readmission within 30 days can realize the promise of population health programs and value-based care.

The PrimaHealth Telehealth Solution for Discharge Management and Prevention of 30-Day Readmission

PrimaHealth’s Telehealth platform is a complete digital clinic that allows for virtual discharge management to monitor patients following surgery or treatments for advanced conditions such as heart failure, pneumonia, coronary artery bypass graft surgery, elective primary total hip arthroplasty and/or total knee arthroplasty. Our industry-leading digital exam room provides all the tools needed to engage patients in one click and provide continuous monitoring and scheduled or on-demand follow-up visits to deliver convenient and timely care when it matters most.

Key features of the PrimaHealth Telehealth platform for discharge management and 30-day readmission prevention include:

Enterprise-level dynamic scheduling system enables appointment scheduling by providers, administrative staff, or directly by patients themselves; true on-demand encounters can be facilitated via a unified patient queue versus the antiquated, one-dimensional booking-based approach used by others.

Screen sharing enables clinicians to present/review X-rays, CT scans and MRI images from PACS systems, diagnostic reports, and education materials in real-time to patients or other health care providers as part of a live encounter.

Family-based accounts allow a single member of the family to function as a chief medical officer and manage the accounts of loved elderly family members tied to one user name and log-in, yet with separate protected health information for each family member.

Multi-participant sessions allow multiple persons to be engaged in a single session. A son or daughter of an aging parent can join a multi-participant encounter to provide informed consent. Additional providers can also be invited to the encounter should a second opinion be needed and/or a case requires escalation.

Powerful rules engine for intelligent workflow, with customized rules that can control patient registration and ensure patients are routed to the appropriate provider.

High-definition video for virtual exams that can support multi-participant and/or clinician-to-clinician sessions, enabling timely care and decision-making. This high-quality video experience can also improve intimacy with the patient to enhance the clinical encounter.

Market-leading compliance adherence and security layers, including HIPAA, HITECH, GDPR and COPPA-compliant software, combined with complete logging of all transactions, with data available for extract to meet audit requirements.

Robust set of API and SDK libraries to provide integration with third-party systems or development of complementary applications.