Heart failure is the most frequent condition associated with re-hospitalization. As the provisions of healthcare reform are implemented, providers will soon face reduced Medicare reimbursement if their patient readmission rates for heart failure exceed the national average. One health IT startup has developed an early warning system with real-time data to help providers avoid unnecessary re-admissions for these patients.
Driving its call to action and addressing the emotional impact that many providers are no doubt feeling, Health Recovery Solutions’ website includes a Medicare Penalty Calculator.The calculation is based on several factors like publicly available Medicare data for readmission rates, Diagnosis-Related Group reimbursement data and the published formula for how to calculate what a penalty will be. It also had to do some financial analysis to take into account growth rates of Medicare reimbursements and case numbers. Some hospitals are allowed a higher ratio of DRG reimbursement, depending on their socio-economic region.
Chief Operating Officer Rohan Udeshi said when it launched the website last month, it wanted to help providers understand the readmission issue from a financial and clinical perspective. “We wanted to drive it home for hospitals.”
The company is a member of New York-based Blueprint Health accelerator’s current class of healthcare startups.
The system uses a readmission risk algorithm that can be integrated into a provider’s electronic medical records. The algorithm takes into account the patient’s initial wellness level, a daily wellness survey and the patient’s previous 24 to 48 hours of activity. All three of those pieces were discovered through the help of Johns Hopkins professors, clinical advisors and research done by the company.
Udeshi said its system is about creating adherence and innovation in the most cost-effective and efficient manner.
Nurses can view the system in a dashboard format or as part of a patient’s electronic medical record. Patients get a tablet computer for 30 days that helps them and their caregiver monitor their health. If the patient gains weight, for example, that information is transmitted to the healthcare providers who can view it in real-time. The patients also get reminders to make follow-up appointments with their doctor, for example. Caregivers can get this information as well.
Udeshi said the real pushback the company is getting is from the healthcare providers’ chief financial officers who won’t see reimbursement penalties as a problem until they get the reimbursement information the following quarter. “They need to see it as a problem now. Also you need to get everyone on the same page to see that it’s a financial problem with a clinical root cause.”
The company is still testing its system. So far it’s nearing completion of one pilot program and is about to begin another with a New Jersey provider. It added a chief medical officer and co-founder two weeks ago — Sandeep Pulim, previously a senior medical editor with MDLinx.
Among the most helpful feedback it’s received from the mentors for Blueprint’s accelerator companies, said Udeshi, is to put themselves in the patients’ shoes. They need to see where the care breaks down for the patients and the hospitals and to develop a solution with them in mind.
Lots of startups see opportunity to crack the re-admission conundrum since it’s such as significant area of need. Last month a report by Kaiser News Service said more than 2,200 hospitals faced Medicare reimbursement penalties over re-admission rates that surpassed the national average. The penalties amount to $280 million.