Feature: Remote monitoring programs improve outcomes, save money
Studies like the CONNECT trial demonstrate that clinical care can be improved with the use of remote monitoring. In fact, results reflected a cost savings of $1,650 per year per patient for those who switched to remote monitoring—nearly a $1 million savings overall. Researchers also found that length of stay decreased from four days to 3.3 days for those in the remote monitoring arm versus those undergoing standard care. In addition, clinical care increased due to the ability of physicians to better prevent adverse events before they occurred.
With these promising results, more facilities in the future might begin making the switch to remote patient monitoring for the potential to improve their practice and patient care.
How to make the switch
For Saint Thomas Heart (STH), a division of Saint Thomas Health Services in Nashville, Tenn., the first use of remote devices was investigational and took place during the CONNECT trial.
Physicians at STH utilize the CareLink device (Medtronic) to monitor heart patients implanted with cardiac resynchronization therapy defibrillators (CRT-Ds) and implantable cardioverter-defibrillators (ICDs), CONNECT's principle investigator George H. Crossley, MD, president of Mid-State Cardiology and a clinical professor of medicine at the University of Tennessee College of Medicine, both in Nashville, Tenn., said in an interview.
According to Crossley, to begin monitoring patients remotely no infrastructure other than a phone line, a transmitter device and a web-enabled computer is needed. Through the device, a physician can set active alerts that can detect whether a patient is thrown into atrial fibrillation (AF) or there is an event with their implantable devices. In this case, an alarm sounds; data are transmitted from the bedside monitor to a physician’s cell phone and are then monitored from any computer.
In the end, the process saves time, money and often prevents an unnecessary trip to the hospital, said Crossley. Previously a patient would have been rushed to the hospital and charged almost $4,000 to $5,000 for what was accomplished in 10 minutes via telephone, he said.
Typically defibrillator patients are seen by their physician every three months; however, with remote follow-up, the device sends data to the hospital over the weekend and the facility follows up with the patient by the next Friday.
Crossley said that remote monitoring especially helps with the elderly who often have difficulty finding rides into a facility.
At STH, they have begun having nurses, who have previously worked full-time, regulate the patient data remotely from their homes. “This creates a good work model for the new economy and will let us get some of the workload out of our office,” said Crossley.
Similarly, at Winthrop-University Hospital, a 591-bed teaching hospital in Mineola, N.Y., the facilities home health agency provides eligible patients with remote services using the HomMed sentry telehealth monitoring system (Honeywell), Anne Calvo, RN, administrator at Winthrop, said in an interview.
The program began in October 2005 off grant money from the New York Department of Health and currently nurses and physicians at the facility monitor data including vital signs, heart rate, pulse, blood pressure and oxygen levels from 106 units, for 80 patients.
At Winthrop, data are transferred and monitored seven days a week from 8:00 a.m. to 12:00 p.m. by a nurse at the facility or from a nurse’s home.
According to Calvo, Winthrop does not restrict patients based on diagnosis and connects heart failure patients, diabetics, elderly patients and even maternity patients on the home monitoring systems.
“Patient satisfaction is through the roof and 99 percent of our physicians like it,” she said. Additionally, more than 50 percent of the patients on the home monitoring system do not get readmitted to the hospital, she said.
Pros ands cons
While STH has seen a climb in overall patient and physician satisfaction along with cost declines, it was not always easy, Crossley acknowledged. In fact, when the facility first implemented the program the biggest challenge faced was patient resistance.
Patients who had been making office visits every three months to ensure a device was in check felt like they had been “kicked to the curb,” he says. “Now, after the patients have been on remote monitoring for a while, they really don’t want to go back.”
Crossley said the facility also contended with delays in FDA approval of the remote follow-up device pieces, device battery issues and patient carelessness (including neglecting to turn the device on, set it up, etc.)
One challenge at Winthrop dealt with “physician buy in,” said Calvo. “We had to convince our physicians that we weren’t going to bombard them with a lot of phone calls and paper work.”
Cost assessment and reimbursement
In 2009, the Centers for Medicaid and Medicare Services (CMS) clarified codes for the reimbursement of remote monitoring. Today, a facility is reimbursed quarterly for remote monitoring, said Crossley.
“The reason that it was done that way is so there was no temptation to over use the codes,” he said. “CMS’ concern is that doctors would bill it every week just for the sake of billing it. You can’t over utilize the service because it pays you a reasonable rate every quarter. It may not work out perfectly for any given patient but for the aggregate of all patients I think the reimbursement model is OK.”
Billing every quarter for remote monitoring delivers the same returns whether you bill every day or once every quarter.
In New York state, Medicaid covers the monthly costs for telehealth services; however, no other insurance, including Medicare, covers the payments, said Calvo. She added that the units cost the facility approximately $3,000 a piece and also cost $20 per patient, per month to cover data transmission. This $20 fee is currently covered by Medicaid, she said.
Results of the CONNECT trial have shown the use of remote monitoring can move mountains for the prevention of heart failure and stroke. Additionally, remote monitoring enhances clinical care by enabling physicians to mobilize quicker and find treatment options faster. The mean time it took physicians to figure out what to do for patients in the remote arm was 4.6 days, compared to 22 days for those on standard treatment.
As more positive results surface, more facilities will begin to weigh the pros and cons of implementing a remote monitoring program.