Managing Congestive Heart Failure (CHF), Pneumonia (PN) and Acute Myocardial Infarction (AMI) patients as they transition from hospital to home is receiving significant attention as a result of penalties to be levied by the Centers for Medicare & Medicaid Services (CMS). Among Medicare patients, 20% are rehospitalized within 30 days, and two‐thirds are rehospitalized or dead within a year. Many rehospitalizations result from care system failures in the transition from hospital to the next source of care.
eMedonline can smooth this transition, and has demonstrated medication adherence levels of 98% while reducing readmissions from 26.7% to 0% in a pilot study among CHF and PN patients. The application of the eMedonline system in transition care is expected to yield significant savings from fewer emergency room visits, fewer physician office visits, fewer hospitalizations, and fewer reimbursement penalties.
CMS is authorized by the Hospital Readmission Reduction Program to start penalizing for excess readmissions for CHF, PN, and AMI in 2013. In 2015, the number of conditions will expand and will likely include COPD and other vascular procedures. Hospitals with 30-day readmission performance in the lowest quartile will incur penalties against their total Medicare payments starting October 1, 2012. The worse case scenario is a 1% Medicare payment reduction across all DRGs in fiscal year 2013, increasing to 2% in 2014 and 3% in 2015.
The lack of continuity of care from hospital to home involves a breakdown across multiple stakeholders in the healthcare delivery system including the case manager at the hospital, the primary care physician, the pharmacist, and the patient himself. CMS has shown the national average for readmission rates hasn't change in a decade, despite tighter focus on the quality of care for the patients while they're in the hospital and leading up to their release. The Medicare Payment Advisory Commission estimates that up to 76% of readmissions within 30 days of discharge may be preventable.
CMS looked at three conditions—heart attack, pneumonia, and congestive heart failure—and has calculated that readmissions within 30 days of release from these conditions alone cost Medicare an additional $ 17.4 billion per year. Across multiple disease categories on a national level, Medicare expenditures due to noncompliance with medications is estimated to be in the $150-280 billion range per year.
eMedonline's compelling clinical results have established a precedent for managing compliance with prescribed therapies in both transitional and long-term care.
Figure 1. The use case scenario for eMedonline in transition care is shown.
References:1 Hines, S. "Reducing Avoidable Hospital Readmissions." Health Research and Educational Trust. Florida Hospital Association Meeting, June 4, 2010.