HOME TELEMONITORING: Chronic Care Management and Outcomes

1
HOME TELEMONITORINGChronic Care Management and
Outcomes

• Liz Powell RN, MN, CRNP
• Chief Operating Officer
• Visiting Nurses Association, Western Pennsylvania
• Butler, PA

2
VNA, Western Pennsylvania

• 40 yrs., community based, non-profit
• Home Health, Hospice, Private Duty, Medical
  Equipment, Telemonitoring
• 9 county mostly sub-urban/rural area
• Avg. Daily Census (all programs) 1200
• Avg. Daily Census in Home Health 550

3
VNA, Western Pennsylvania

• Started home monitoring August 2002
• Nurses have maintained medical record on laptop
  computers since 1991
• Our agency monitors 150-200 patients/day
• Most monitors are used as a part of Medicare PPS
  reimbursement system for Home Health
• Rare managed care reimbursement for monitoring

4
Defined Goals

• Extend nursing resources
• Improve clinical outcomes
• Cover costs/make profit

5
Selecting the System
The First Step to Success
6
Selecting the System

• Patient Demographics
• Our patient population is primarily rural, frail,
  elderly with primary diagnosis of Congestive
  Heart Failure (CHF)
• Not technically proficient!
• Clinical Program not just monitors!

7
Congestive Heart Failure (CHF)

• Our most common diagnosis
• Poor clinical outcomes
• High emergent care utilization
• High readmission rate
• Responsive to monitoring
• Early interventions could result in avoiding
  exacerbations

8
Choose the right system

• Considerations
• To video or not to video
• Daily vs periodic monitoring capability
• Telephone, satellite, internet or wireless
  transmission
• Availability of peripherals
• Support availability

9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
Point of Care Integretation

• Data from monitoring system flows to our point of
  care clinical program
• Nurse has data from central station accessible on
  laptop computer in the home

14
Appropriate Patients to Monitor

• All patients that we are not visiting daily
• All patients who are capable of following the
  directions to perform testing or who have
  caregivers that can assist
• Cardiac, Diabetics, COPD, etc, etc

15
Results

• Expanded Nursing Resources
• Decreased visits/episode from 19 to 12
• Increased caseloads/nurse from avg. 20 to 25
• Improved clinical outcomes

16
Clinical Outcomes
17
Emergent Care Used During Services
18
Hospitalization During Services
19
(No Transcript)
20
(No Transcript)
21
Case Study Mr. O

• 79 year old male
• History of CHF, CAD, Cardiomyopathy, Multiple
  MIs, previous CABGs
• Cardiac function lt25
• Frequent Flyer
• Physician told wife of poor prognosis
• Patient depressed, despondent

22
Mr O

• Virtually bed-bound on admission to monitoring
• Wt? and O2 sat? predicted future exacerbations
• Early interventions
• Patient and wife took active role
• Pulse ? unexpectedly
• New active lifestyle

23
Reasons for Clinical Effectiveness of
Telemonitoring (not just CHF)

• Data driven
• Patient sees results and recognizes the cause and
  effect relationship between their actions and
  health consequences
• Empowers patients and families
• Allows for early clinical interventions to
  prevent exacerbations

24
Medicares Interest

• CMS has now instructed the QIOs (Quality
  Improvement Organizations) in their Eighth Scope
  of Work to facilitate home health agencies
  implementation and use of telehealth technologies
  to decrease hospital admissions.
• Regular Medicare environment
• PPS payment can cover the cost

25
Reimbursement Issues

• Managed Medicare
• Rare coverage
• Significant growth
• Concern about future outcomes in this population
• Medicaid
• States struggling with options and standards

26
Future

• Develop national definitions and standards
• Video visits
• Daily vital sign monitoring
• Less nursing resources which will require more
  efficient use of nurses
• More emphasis on patient outcomes
• Increased need to extend cost effective health
  care into the home

27
Questions

• ?