- A remote monitoring program has reduced hospitalizations and saved more than $2 million for a New York City-based home care agency that deals with some of the country’s sickest children.
The positive results reported by St. Mary’s Healthcare System for Children could go a long way toward making remote patient monitoring programs a standard of care for post-acute and home-bound populations, though such programs still face serious issues with reimbursement and sustainability.
St. Mary’s, the state’s largest provider of post-acute care services for children with complex health issues, used a $928,668 state grant to set up an interactive voice response (IVR) platform for 500 of its home-bound patients and their families. The 2- to 3-minute phone calls feature several questions, and responses can trigger an alert to an RN at St. Mary’s who would call back almost immediately if necessary.
Elvira Fardella-Roveto, RN, the agency’s administrator and director of patient services, says the IVR platform was designed to connect the agency with families of children often in beds or wheelchairs and on ventilators, many of whom deal with dehydration, seizures, respiratory issues and asthma. The agency’s nurses visit the families every 56-60 days, but many of these kids end up in the hospital in between those visits – a hospitalization rate hovering around 35 percent.
The overwhelmed mother of one child “was basically using the emergency room as a primary care physician,” she said during a recent American Hospital Association webinar.
Supported by the grant, St. Mary’s conducted a study during the first year of using the IVR platform. The organization saw a 35 percent decrease in hospitalizations between October of 2014 and October 2015, from 198 to 121. With these patients typically costing the agency $28,000 per hospital stay, the 77-hospitalization decrease amounted to a savings of $2.17 million.
Fardella-Roveto said St. Mary’s also charted a decrease in 30-day readmissions, from 19 percent before the program to 11.4 percent during the program, and a decrease in 90-day readmissions from 35.7 percent to 22.7 percent.
Fardella-Roveto noted that many hospitalizations are the result of medication compliance issues, and almost 30 percent of the alarms triggered by the IVR platform were medication-related. By enabling a telehealth-trained nurse to talk to the family immediately after an alarm is noted, she said, the agency was able to correct many of those medication issues before they required hospitalization.
When asked if the agency saw an improvement in clinical outcomes, Fardella-Roveto said “anecdotal information indicates that we were successful” in improving the overall health of the children in their care. She also noted improved satisfaction rates for the families and caregivers, many of whom deal with a lot of stress in caring for these children.
The program also produced some unexpected results. With more communication between the agency and the families, the agency was able to pick up on other issues, like caregiver stress, language barriers, even home safety problems. In at least one case, Fardella-Roveto said, the agency was able to help a family make needed home improvements to improve the care environment for a child.
The IVR platform, developed by AMC Health, was designed to be quick and easy, Fardella-Roveto said, so as not to add any burden to the families. They decided when and how often the phone calls should be, she added.
“We wanted to keep it simple to increase compliance and not make it a long, complicated call,” she said. Question templates were tailored to four specific conditions – asthma, dehydration, seizure disorder and respiratory issues – but can easily be adapted for other conditions.
Fardella-Roveto said New York’s Medicare program doesn’t reimburse for this type of service, but she’s hoping the agency’s results to date will open the door to that possibility.
She’s also hoping to introduce a remote patient monitoring platform that includes devices, though “we haven’t been able to find any devices out there for our population.”