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Improving Outcomes-Telemedicine Can Help

Scott Berghoff

Written by Scott Berghoff

Death, injury, infection, readmission rates are just some of things associated with outcomes. Let’s break down the seven points CMS uses to measure health outcomes and see how telemedicine fits. “Patient outcomes” is a term mentioned a lot within all aspects of the healthcare universe. When you ask most people involved in care, “What does patient outcomes mean?” you get an answer that hovers around “good results.” It has become an eponym for positive outcome.

The Centers for Medicare and Medicaid Services (CMS) has a detailed definition, and it includes measuring the following as a composite overall outcome score.

  • Mortality

  • Safety of Care

  • Readmissions

  • Patient Experience

  • Effectiveness of Care

  • Timeliness of Care

  • Efficient use of Medical Imaging

The International Consortium for Health Outcomes Measurement (ICHOM) defines health outcomes for patients as, “the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives.”

The worst patient outcome is the death of the patient, so It is no accident mortality is at the top of the list. An example of a positive impact on mortality is Georgia’s Piedmont Healthcare System’s evidence-based care standard of care (SOC) for pneumonia patients.

Piedmont Healthcare has reported community-acquired pneumonia is the fourth leading cause of death among the elderly, over 50,000 patients die from pneumonia every year and there are over 400,000 annual emergency room visits associated with pneumonia. Over 1 million patients are hospitalized each year because of pneumonia leading to more than 5.7 million inpatient days.

Their aggressive and focused approach resulted in a reduction of nearly 57% of pneumonia related deaths . That is an impressive and impactful number. Part of the Piedmont SOC are follow-up appointments and calls. Telehealth provides the means for a healthcare provider to have these follow-up appointments in real-time, while consulting with colleagues, implementing changes in the patient’s care plan, reviewing medical imaging, and talking one-on-one with the patient, all the while allowing the patient to convalesce at home.

Another program using this type of platform to treat pneumonia patients successfully is at The University of Virginia Medical Center (UVMC) in Charlottesville. They used telemedicine to monitor discharged pneumonia patients (also patients with COPD, patients who had a heart attack, or a hip or knee replacement). One year post-implementation UVMC saw its 30-day readmission drop to about 10% compared with the national average of 17.5%.

As the incidences of community-acquired pneumonia are on the rise in the nursing and assisted living home environments, successful utilization of telehealth limits the need for hospital transfers and unnecessary travel. Remote patient monitoring has saved nursing homes $479 million by eliminating almost 7 million transports to on-site physician’s office visits and 387,000 annual ER transports. That alone resulted in a $327 million savings.

Assisted living centers and nursing homes also make good use of telemedicine to prevent readmission, which is more dangerous for older patients who have concomitant conditions and comorbidities. Readmission is one of the most reported outcome measures, particularly since the approval of the Affordable Care Act (ACA) in 2010 and the fines that may be imposed on hospitals that have higher than normal readmission rates. It is estimated in the US $41 billion is spent on avoidable hospital readmissions. Excessive readmissions can impact Medicare reimbursement rates. Hospital readmissions are often because of a simple complication that could've been treated by a follow-up with a physician. If a hospital’s “combined readmission scores exceed its target score, which is adjusted for demographic factors, it can be penalized by up to a three percent reduction in its Medicare reimbursement for the year.”

Almost 800 hospitals in 2016/2017 lost close to $430 million after the CMS fined them for poor performance in regards to the outcome of safety of care, which is aligned to “medical mistakes.” A recent addendum to the definition of the medical mistake is the hospital-acquired infection. CMS included the spread of antibiotic-resistant bacteria when they assessed those penalties. By limiting a patient’s exposure to viruses, potentially resistant bacteria, and fungal pathogens that lurk in all hospitals, this measure can be improved. Not only is this beneficial to patients health outcomes, but it is also beneficial to the bottom line of the hospital. Telemedicine is the best answer to limit this risk factor.

Patient satisfaction, also known as the patient experience, and telemedicine go hand-in-hand. Many surveys have reported patients would prefer using a virtual platform if they had the choice. By adopting a such a platform into a healthcare system, patient satisfaction/experience scores will improve.

  • 74% of patients in the U.S. say they would use telehealth services

  • About 67% of patients said using telemedicine somewhat or significantly increases their satisfaction with medical care

  • About 30% of patients already use computers or mobile devices to check their medical or diagnostic information

  • 74% of patients are comfortable communicating with their doctors using technology instead of seeing them in person

  • Only 16% of patients would prefer to go to the emergency room for a minor ailment if they also could access telehealth services

Effectiveness of care measures the compliance with established best practice care guidelines and achieved outcomes (e.g., lower rates of readmission for pneumonia patients). A good telemedicine platform permits the customization of disease management protocols once the provider records the patient’s chief complaint. By incorporating the best practice care guidelines into the platform’s templates the provider is assured they are following established guidelines and protocols.

Timeliness of care measures the patient’s timely access to care, measuring the time a patient waits to be seen in offices, EDs, labs, and more.  With telemedicine there is no waiting in an overcrowded ED or provider’s waiting room, or long travel times to a care facility. Patients will be seen in a more timely and convenient manner. For every 20 minutes of facetime with a doctor, an average patient will spend over 100 minutes commuting, waiting, and filling out paperwork. Telemedicine alleviates this issue brilliantly by allowing a patient to do most everything from their home.

The efficient use of medical imaging is a basic but very important measure. Medical imaging is one hallmark of telemedicine and it is often the first thing healthcare providers — especially in hospital systems — think of when it is is mentioned. The quality of today’s high-definition mobile devices and computer screens make every detail of these high-quality digital images available.  Fast broadband transmission rates have made the process of reviewing, collaborating and discussing these images much more efficient and effective. The healthcare provider just logs into the medical imaging site, and downloads the digital file(s) into the patient’s chart. If they want to consult with another healthcare professional they need only to use a HIPAA compliant platform to share the files.  No longer will films and images have to be picked up, or mailed, and delivered by hand. The risk of damage to a digital image file is much less than that of a physical piece of film.

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Published: January 28, 2019