RPM – remote patient monitoring – is a helpful tool and can help healthcare providers address many complex clinical, administrative, and financial situations. RPM is a powerful tool, but to use it effectively, you need a goal or a set of goals. We’d argue that the readmission rate is a terrific goal for an RPM deployment.
Readmissions indicate something hasn’t gone as expected with your patient medically. The underlying cause of the readmission requires some medical detective work. But generally, providers try to avoid patients readmitting (even if the patient is on a commercial fee for service insurance). It creates a horrible impression in the patient’s mind (I thought that was fixed). It’s often an unplanned visit that can cause havoc with a schedule. And it may cost the provider money if they are providing value-based care (VBC), operating in a bundled payment arrangement or if the patient is on a Medicare Advantage Plan.
The most straightforward illustration is a provider that operates in the VBC arena as a member of an Accountable Care Organization (ACO). As an ACO member or sponsor, the provider has agreed, contractually, to manage outcomes, and the readmission rate is a crucial outcome measurement. There are different levels of ACO risk/reward, but readmissions are penalized (either directly or by loss of incentives). And the penalties get expensive: we worked with one provider managing 500 patients in an ACO cohort, and the exposure to lost stimuli from Centers for Medicare and Medicaid Services (CMS) under the shared savings format was nearly a million dollars. And this was not their only or largest exposure. I realize it’s not unusual to see clinical billings exceeding several hundred million dollars or more, making a million dollars seem too small to bother with. But most providers operate with single-digit profit margins – 5% is not unusual. That means a $200m revenue line only drives $10m in profit – and that million-dollar incentive now adds 10% to the gain. I don’t know anyone in healthcare services that wouldn’t jump at a 10% profit increase.
How does RPM reduce readmission rates? RPM helps you track your patients across multiple vital and non-vital parameters daily. And a good system alerts patients whose condition is deteriorating and suggests works flows to stabilize and improve their health. So you can see the patients that are decompensating before they need to be readmitted. And as an added benefit, your patients feel better and are more engaged. Win, win, win.
How much of an improvement can you expect? It depends on your current readmission rate and the type of patients you want to manage. We can’t promise you’ll see these kinds of results, but we’ve helped providers with a readmission rate above 20% get below 7% - so dramatic improvement is possible.
Learn more about Harmonize Health’s industry-leading RPM platform.
