MD Revolution’s co-founder, Dr. Samir Damani, sat down for an insightful Q&A on the pressing issue of hospital readmissions.
Dr. Damani discusses the importance of preventing hospitalizations through effective remote care management and highlights Medicare’s proactive steps in advocating for remote care to reduce these staggering costs. Read on or watch the full interview on-demand.
Q) Talk about the issue of hospital readmission rates. What does the trajectory look like for our healthcare system?
Hospital readmissions cost the system billions every year. Heart failure is the number one cause of hospital readmissions, and the average hospital readmission is $15,000-$20,000. So, at a time when we have 3.5 million people turning 65 every year and we’re on a trajectory to have over 100 million people over the age of 65, it’s bankruptcy for Medicare if we don’t do something about avoiding these costly readmissions. Keeping people out of the hospital and managing them at home is really the future of care. The best way to do that is by not allowing them to get to the point where they need to be hospitalized.
Q) Given the astronomical cost to the system, what are some of the government agencies doing to advocate for this type of ongoing care? Is Medicare advocating?
Absolutely, the fact Medicare came out with chronic care management reimbursement in 2016 is of itself a testament to Medicare’s vision around how important it is that we are connected to the patient. Since that time, Medicare has changed a number of things including the reimbursement for the codes, which made it much easier to put into action. As a practice, you can get to the point where you can actually manage this population and be able to pay your overhead, and maybe even be able to make a little bit extra as you offer this. And rightfully so, because every hospital admission that you’ve prevented is dollars back to the taxpayers. Medicare is doing a lot of really great things with respect to remote patient monitoring and chronic care, and this is just the start.
Q) Can you tell us more about the study that was just released, the cardiac practice that saw a 50% reduction in readmission rates for their patients participating in care management?
This was a multi-specialty cardiac group with 22 providers throughout Arizona. They saw that for their care management patients, there was a 50% readmission reduction at 30 days and that extended all the way out to one year. That differential was slightly lower at a 33% reduction of readmissions at one year, but the number needed to treat was nine to 10. Basically, that means for every nine patients you enrolled in in chronic care management you prevented one hospital admission. The cost for those nine patients was dwarfed by the cost of the hospital admission, so it’s magnified the impact that these remote monitoring programs can have.
Q) This study was based on remote patient monitoring and chronic care management programs together, what does this mean for practices that are considering offering remote care?
It means that if you’re not doing this, you should be seriously thinking about it because the data is there. This is not the first study that has shown these outcomes, we actually showed this in another hospital-based population in Mississippi. These are two different parts of the country where the revenue impact can be quite significant. These programs are designed so that if you needed to devote more time to remote care you could, with the ability to also generate more revenue for your practice. You don’t have to feel the need to only see patients in the traditional models.
Q) With the prevalence of chronic conditions, so many patients are eligible for this care. Why do you think the utilization rates are still low, meaning practice utilization or adoption of these programs?
First, the reimbursements have gone up in recent years, so it’s made it a lot easier to see a return. At the old CCM reimbursement rate of $42.00, it was very difficult to scale and the technology wasn’t there yet. You have to have a platform that can talk to the electronic health record (EHR), because the EHR is the primary platform that the doctor is utilizing. It’s not efficient for the provider to be in multiple platforms. Also, the integration of claims and billing with the EHR is huge. If all the documentation is being done manually, the program doesn’t scale.
I think a lot of practices have worked with CCM companies that didn’t really invest in the technology to ensure that the workflows were optimized for a busy practice. What we’ve done differently is we’ve made significant investments in the platform to make sure that it truly integrates with the workflows of physicians’ offices. We can really scale the case manager. One case manager can handle hundreds of patients because they’re accessing software that is intelligent and enables them to provide that high touch care.
Q) I’m hearing that what it takes to succeed is to partner with companies that have really invested in this technology and really understand this ecosystem of device connectivity, EHR connectivity and data connectivity. Is there anything else that is mandatory for making this work?
The underlying technology and the data are the really important pieces. I think if you have those in place, providers can use their existing infrastructure to implement remote care, primarily because the billing is seamless. Another option, however, is that we have our own care teams, so if providers don’t have the staffing to support checking patients’ blood pressure or checking on their weight, etc., they can outsource the care coordination and clinical monitoring to our clinicians, if they need the assistance.
