Getting at the Heart of Readmissions

heartbeat-thumb-550xauto-83375I will always stay true to my belief that health systems need to take an enterprise-wide approach to mobility. But at the same time, I’m often asked by hospitals CEOs and CIOs how they should prioritize mobility when it comes to different care areas. My first answer is to look at your current challenges and strategic initiatives, and then ask how mobility can help you to get there.  While I always emphasize the benefit of mobility across all departments, cardiology is where I see the potential for mobility to make the most immediate impact – especially when it comes to improving outcomes and reducing readmissions.

Door-to-balloon time is one of the most significant metrics when it comes to cardiology. Today, the average in the U.S. is about 90 minutes. But when you equip cardiologists with diagnostic-quality ECGs coming right from the ambulance, they’re able to make decisions immediately, saving valuable minutes and giving them the option to bypass (ok, poor choice of words) the emergency department to send patients directly to the cath lab. I’ve seen hospitals drive door-to-balloon time – down to 35 minutes. On the flip side, a hospital loses $7,500 every time unnecessarily put together a cath lab team. So the sooner clinicians can identify and communicate a false STEMI, the more savings the health system will see.

More importantly, reducing event-to-balloon time also puts patients in the ICU with less damage to their hearts and who are ultimately “healthier” on their road to recovery. I’ve seen hospitals shave nearly a day from their post-STEMI ICU stays, which saves anywhere from $1,400 to $2,500 per patient. Over the course of a year, a hospital that cares for 200 post-STEMI ICU patients could see a savings of at least $280,000.

And that leads me to cardiology-related readmissions, which are under the most scrutiny with the CMS penalties enacted by the Affordable Care Act (ACA) where hospitals can be docked up to 1 percent of Medicare DRG payments around acute myocardial infarction (AMI) and heart failure (HF). In general, patients who experienced a shorter event-to-balloon time and shorter ICU stay are much less likely to return with complications within 30 days. But there’s even more to that story. For one hospital, we looked at 100 ECGs of patients discharged and noticed that a significant percentage of those patients had difficult-to-detect conditions when discharged, and therefore ended up coming back within 30 days. This was because those patients had a heart condition or weakness that was not detected by the physicians on the floor – because not all of them were cardiologists. Electro-physiologists and cardiologists need to be able to review patient data from anywhere to identify issues and prevent patients from leaving the hospital without proper care.

Mobility also plays a key role in the critical post-discharge period for heart failure patients. They can be sent home with sensors that are constantly uploading ECGs and other data that can be access by a group of electro-physiologists and cardiologists, who in turn identify and ideally prevent potential causes for readmission. A two-year study of patients with congestive heart failure (CHF) showed a 44 percent drop in readmissions through the use of home telemonitoring. If a patient can go directly to the cath lab rather than the ED because a physician is able to remotely diagnosis the condition, then the hospital is not penalized for a readmission under the ACA. And the physician doesn’t need to be at a desktop in the hospital to make that happen. Not only that, when an electro-physiologist needs to consult with a cardiologist about a patient, the two can review the same ECG in virtually real-time on an iPad or any device in two different locations.

The benefits of a mobility platform in every department across a health system are too significant to ignore. But with its time-sensitive and care-intensive environment, cardiology represents the most immediate opportunity for mobility to make a positive impact on both patient care and a hospital’s bottom line.