Readmissions on the Rise

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How Tech Can Help

With the shift to value-based reimbursement models, hospital readmissions are a pressing and costly issue health systems across the U.S. are trying to get in check. Now more than ever, clinicians feel the pressure to improve patient outcomes with efficient and effective care, and hospitals, government and private insurers alike are getting hit where it hurts most – the pocketbook

In 2018, nearly one in six Medicare patients have returned to the hospital within one month of discharge, costing the healthcare industry an estimated $25 billion. This number is expected to increase as the aging population continues to grow and number of people with chronic conditions, such as chronic obstructive pulmonary disease (COPD), rises. In an effort to measure hospital performance, the Center for Medicare & Medicaid Services (CMS) has enforced a set of policies for specific conditions like COPD that penalizes hospitals with higher than expected readmissions. Last year alone, CMS fined over 2,500 hospitals for excessive 30-day readmission rates, totaling more than $564 million.

To address these complex and costly challenges, healthcare stakeholders are turning to technology to effectively monitor, diagnose and treat patients. Specifically, health providers are looking to technologies with early warning scoring, remote monitoring capability and predictive analytics to help reduce adverse events, improve transitions from hospital to home and lessen complications post-discharge. The use of technology – throughout the entire care continuum – can be the helping hand that diminishes costs, reduces readmissions and improves outcomes for all patient populations.

Focus on Early Intervention

Every year, there are an estimated 440,000 preventable adverse events that contribute to patient deaths in hospitals throughout the United States. Early detection and intervention are critical components that can help reduce this number. Patients typically begin showing subtle signs of deterioration six to eight hours ahead of adverse episodes, but with random spot checks and inefficient data, these signs can sometimes be missed.

Clinicians will often face information overload from monitor and device alarms that lack actionable insights, causing them additional stress and forcing them to make judgement calls about what is or isn’t an urgent alarm. Solutions with early warning scoring (EWS) can help avoid this alarm fatigue. By identifying patient deterioration through automated scoring, it reduces the time needed to manually calculate the score, therefore, limiting the possibility for adverse episodes and other preventable complications to occur. The data is then seamlessly integrated directly to the electronic health record (EHR), which produces a single benchmark that alerts clinicians if the patient is showing signs of distress. This ability to track a patient’s vital signs continuously throughout the hospital removes the need for spot checks and enables clinicians to intervene earlier with more confident care decisions. With these insights, clinicians can spend their time more efficiently, enabling them to bring more focus to at-risk patients and intervene earlier to reduce the in-hospital transfers from the general ward to the ICU.

Saratoga Hospital is just one of many hospitals that have seen remarkable results from the use of technologies with automated EWS scoring. Since implementing Philips’ patient monitoring system with EWS in 2015, Saratoga Hospital has reduced patient transfers to the ICU by 63 percent and eliminated patient codes within its 20-bed orthopedic unit, which dropped from three or four codes per year to zero.

As more health systems integrate technologies with EWS, more clinicians can help their patients transition from the hospital to recovery at home.

Address Chronic Conditions Care Concerns with Remote Monitoring

Today, healthcare providers are being tasked with managing larger, more complex patient populations, which often requires more time, energy and resources. In the next 15 years, the number of people with chronic conditions is expected to double. As a result of this rapidly growing demographic, reducing hospital readmissions and improving patient outcomes are increasingly difficult feats. Health systems are turning to remote monitoring and at-home therapy to keep patients healthy and out of the hospital after discharge.

With connected care technologies, clinicians across multiple networks can continue to care for their patients throughout the entire course of therapy. These solutions enable providers, physicians – and even payers – to view critical data through one unified platform, allowing them to provide near real-time feedback to patients about their treatments. For example, physicians treating patients with COPD can tailor a medication adherence plan to each patient, set parameters for alert management and create automatic clinical notifications based on patients’ specific health and usage information. With these insights, patients can monitor their progress or set reminders to take action, which can be especially helpful for when therapy, such as positive airway pressure (PAP) therapy, may take longer to adhere to.

A Philips-sponsored retrospective study recently showed that the hospitalization risk of patients with COPD is at an all-time high and suggests that the use of PAP therapy may lower this risk. Despite its effectiveness, the study revealed that only 7.5 percent of 1.8 million COPD patients in the U.S. actually receive any form of PAP therapy, resulting in patients heading back to the hospital again and again. These frequent readmissions not only disrupt quality of life for COPD patients, but are costing health systems billions. Another Philips-funded study using Philips Trilogy with AVAPS-AE as part of a multifaceted care program found that the use of advanced home non-invasive ventilation (NIV) not only lowered hospitalization rates for patients with severe COPD, but also significantly decreased hospital and payer costs. With improved awareness and implementation of PAP therapy at home, both patients and health systems benefit, as patients can avoid going back to the hospital and health systems can avoid the CMS penalties related to COPD readmissions. Together, these studies show the potential for PAP therapy, as well as the significance of having clinical care team support in place by the service provider. This support, coupled with connected care solutions, keep patients engaged and provide the clinical team with the resources needed to monitor and provide proactive feedback to their patient populations.

In addition, a health system in Alabama partnered with Philips on an integrated COPD care initiative that specifically looked at reducing hospital readmission rates and costs in patients with COPD. Through the implementation of published, evidence-based care strategies, this initiative helped the health system reduce hospital readmissions, lower costs and avoid penalties over the course of three fiscal quarters in 2017. Researchers found that connected care and care coordination can play essential roles in creating positive results for COPD patients. In less than a year into the study, participating institutions have already realized an 80 percent reduction in acute 30-day COPD readmissions, resulting in nearly $1.3 million in savings.

With the success seen from using connected care to help treat patients with COPD, it is important to address the concerns of other populations – such as the growing elderly population – that also significantly impact admissions rates.

Tap into Predictive Analytics for Elderly Populations

Understanding patient populations with the greatest risk of complications can, in turn, help reduce the staggering number of hospital readmissions. Each year, more than half of elderly patients are released without any direct monitoring by a healthcare professional, leaving them cut off from critical care management while at home and at risk for returning to the hospital. With an expected 71 million people to be 65 years and older by the year 2030, it is critical for this patient population to stay connected with their physicians in between check-ups to help monitor their recovery. One way to do this is by tapping into technologies with predictive analytics.

Predictive analytics can provide a clear view of patients in the “white space” – the critical but cloudy area upon leaving the hospital when the risk of readmission is high. By collecting and analyzing data from multiple sources, clinicians can monitor, qualify and assess patient risk. This provides them the opportunity to anticipate a patient’s future fall or identify reasons for potential readmission, such as dehydration and urinary tract infections. Some technologies even have the capability to notify clinicians when a patient is at risk of emergency transport in an upcoming 30-day period.

By being able to proactively manage and anticipate population health trends, clinicians can take another step closer to improving overall health and wellbeing of different patient groups.

Implement Solutions to Improve Patient Outcomes

Today, it is critical for the entire healthcare industry to understand the benefits of connected care solutions and how it can help combat the ongoing challenge of hospital readmissions in an era of value-based care. Health systems and physicians need to work together to implement this technology throughout hospitals and in homecare settings to ensure improved health outcomes at the lowest possible cost. By uniting the healthcare community with connected care technology that empowers physicians, addresses concerns of patients with chronic conditions and monitors at-risk populations, we can continue to cure our country’s costly health systems one less readmission at a time.

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Eli Diacopoulos
Eli Diacopoulos

Eli Diacopoulos, VP General Manager, Respiratory Care Business at Philips

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