If you care for Medicare patients, here are facts you should know:

• Congestive heart failure (CHF) is the most common Medicare DRG for readmission to a hospital, accounting for more costs than any other disease condition.
• The national readmission rate for patients with CHF is 21%.
• Total annual direct and indirect costs of CHF are $28 billion (See here).

Facing increased pressure to lower the cost of health care, hospitals will not be reimbursed for readmissions that occur within 30 days of a discharge for the same condition starting in 2012. Why should physicians be concerned about hospital payments – or nonpayments?

With accountable care organizations taking shape across the nation, hospital revenue declines will have direct impact on physicians in a community, suggested Alan Snell, M.D., chief medical informatics officer for St. Vincent Health. There’s also concern that if hospitals stop getting paid for readmissions, physician payment may soon suffer too.

But Indiana is already at work on the problem.

The Beacon grant project
Last year, the Office of the National Coordinator for Health Information Technology (ONC) awarded the Indiana Health Information Exchange (IHIE) more than $16 million, naming Central Indiana a Beacon Community. One activity supported by the grant is a demonstration project to reduce readmissions among high-risk senior patients.

“With the Beacon grant project, we are enrolling several thousand patients from various hospitals in Central Indiana

(46 counties with 45 percent of the state’s population) in a research study to measure the effectiveness of home monitoring and to identify a sustainable, replicable business model. Then we will disseminate our results to other Beacon communities,” explained Dr. Snell. He is involved because St. Vincent is an IHIE subcontractor for the Readmission Study.

A randomized trial, the grant project involves monitoring patients in their homes every day for 30 days following a hospital discharge for CHF or chronic obstructive pulmonary disease (COPD). Various devices – weight scales, blood pressure cuffs, pulse oximeters and more – will be used, as well as videoconferencing with the nurse contact center at St. Vincent.

A technician visits the patient’s home to set up the mobile device and other equipment, and stays on hand to help with the first videoconference. “It’s plug and play,” said Dr. Snell, “and it doesn’t require a patient or family to use their own PC or phone line.” Video education sessions and question time with a nurse help boost communication and ensure patients play an active role in managing their chronic disease process.

Results, responses – so far
To date, there’s no residence that could not be connected using wireless networking. And while official numbers are not significant yet, only one readmission has occurred among the first 50 patients enrolled in the project; that patient suffered an allergic reaction to medications.

About the videoconferencing, Dr. Snell reported, “Patients love it. They say it’s like ‘Skyping’* with their kids, and they particularly are pleased with the interactions they have with the nurses.”

At a time when nursing shortages and home health caregivers are in increasing short supply, Dr. Snell sees videoconferencing and other monitoring technologies as a way to fill the gap. The costs of technology are decreasing and the speed of networks is increasing. But he also believes an aging baby boomer generation, already comfortable with technology, will accept the idea and fuel “an explosion” in the direction of telehealth.

Joseph Kvedar, M.D., from Partners HealthCare System and director of the Center for Connected Health, said telehealth is all about “getting people to care for the one they care about the most – themselves.” (Check out the report here.)

*Skype is a software application that allows users to make voice and video calls and visits over the Internet.