Telemonitoring has long been touted as a way to reduce hospitalizations. But when paired with home health care for heart failure patients, that may not always be the case. Still, there are reasons — from both a cost and outcomes perspective — for home health providers to consider implementing telemonitoring for this patient group.
That’s in part according to a new study published in the December 2018 issue of Health Affairs. Researchers analyzed 26 studies, which included nearly 5,000 participants and tested the effectiveness of home telemonitoring in patients with heart failure, specifically looking at reducing mortality and hospital use.
The meta-analysis found that home health care did not moderate the effects of home telemonitoring on hospitalization for heart failure patients. In other words, having a home health worker in the home did not make the telemonitoring technology more effective in reducing hospitalizations. Researchers hypothesize this could be because home health care alone is such a strong transition of care.
“That doesn’t mean telemonitoring is not a useful intervention in home care by way of maybe substituting some visits,” Renée Pekmezaris, medical researcher at Northwell Health System and lead researcher on the study, told Home Health Care News. “It may be a money saver, but not necessarily something that’s going to improve patient outcomes.”
Using telehealth — such as a system to connect patients with clinicians via video — could save home health companies money in the long run, according to Pekmezaris.
“I just think we were asking the wrong question when it came to ‘are we actually going to reduce hospital utilization with it?’ No,” she said. “But I think there’s tremendous potential to become more cost effective in delivering home care using this model.”
Currently, some health care providers associate telemonitoring with increased spending because of the necessary software and hardware costs, among others, that come with it.
“Because the reimbursement models for telehealth — let’s say as part of an episode — aren’t explicitly developed, often home health agencies are funding remote monitoring themselves, and they’re doing that on the basis that they reduce hospital readmissions,” AlayaCare CEO and Founder Adrian Schauer told HHCN.
Montreal, Canada-based AlayaCare is a integrated platform and secure cloud-based system that includes client and family portals, remote patient monitoring and telehealth.
“Their referral partners will send them more Medicare clients, so many [agencies] that we see really have to absorb the cost of better care as a marketing cost, in a sense, because there aren’t the bill codes available as part of episodic pay,” Schauer said.
But there are several ways to cut costs and increase efficiency. For example, home health agencies implementing telehealth should train only a subset of caregivers to use the technology, rather than all of them, according to Brenda Yost, Denver group director of cardiology services at Centura Health, a health care network with a home health unit.
“If you have all your nurses in your home health agency doing this, it’s not nearly as effective as if you have a smaller cohort of nurses that are responsible for these patients,” Yost said, noting that only a subset of patients will be using telehealth.
Additionally, home care companies can help agencies make the most of their caregivers, a role plagued by employee shortages nationwide.
“The days or times you don’t actually lay eyes on the patient in the home, you can still have contact with them and important touch points that really augment your overall ability to be successful with the patient,” Yost told HHCN.
Finally, in addition to cutting costs for home care companies, telehealth could reduce mortality for heart failure patients — at least for the first six months, according to the study.
“What I was surprised by is for so long the telemonitoring industry has been marketing this technology as something that’s going to reduce hospitalization readmissions,” Pekmezaris said. “It’s extremely important to understand that at least for a six-month period — not at a year but at least for the first six months — telemonitoring actually does improve mortality.”
But to fully understand the implications of combining home health care and telemonitoring, Pekmezaris’ study recommends more research be done, as only a few studies exploring the relationship exist.
Specifically, researchers recommend examining the proper ratio of substitutions to live visits and the best duration of telemonitoring.
Such research would likely be of great interest to home health providers, which are actively targeting more specialized care programs for heart patients. Such programs could make agencies more attractive referral partners to hospital and health systems and would position them for success if the Centers for Medicare & Medicaid Services (CMS) revives bundled payments focused on cardiac care episodes.