Lowering Readmission Rates with Post Discharge Plans

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Monday, 01 July 2013 18:28

When a patient was being discharged from the hospital, a nurse can spend up to 30 minutes going over discharge instructions and then calling the patient to check in and do a post-discharge follow up.  With the new telehealth technology, healthcare providers can be more efficient with their time with the end result of being more cost effective for the healthcare provider.

As of October 2012, Center for Medicare and Medicaid Services began penalizing hospitals for excess readmission rates, starting with those related to heart failure, acute myocardial infarction and pneumonia.  In Indiana alone, the readmission rate is between 16.8% and 19% across the state.  The use of telehealth technology can drastically improve readmission rates across the country when implemented and used correctly.

Post-Discharge plans are an important part of reducing unnecessary readmissions in any hospital.  Many patients are discharged after a brief meeting of what they should do differently and how they should alter their daily lives to accommodate to the problems they were experiencing when they were admitted and treated at the hospital.  After their length of stay at the hospital a doctor or nurse will explain to them what symptoms they should be concerned about and to call the doctor if they experience any issues.  In many cases, patients not following the medication guidelines correctly, experience alarming symptoms without knowing, or try to get back to their normal routine too early – resulting in an unnecessary readmission into the hospital.  According to the Healthcare Intelligence Network, 11% of readmissions are due to medication non-adherence at a cost of nearly $100 billion annually.

There are several different paths that can be taken with technology now to help alleviate stress on both the patient and the staff and make the discharge process along with the recovery period afterwards run smoother and the transition result in fewer readmissions.  One path that has been developed and implemented recently is a platform designed by Vree Health called TransitonAdvantage.  This platform is designed to help patients hospitalized for heart attacks, heart failure or pneumonia to adhere to a hospital’s recommended post-discharge care plan.  With hospitals and patients using platforms like Vree Health’s TransitionAdvantage preventable readmission to hospitals within 30 days can be reduced preventing penalization from the Center for Medicare & Medicaid Services.

Vree Health’s TransitionAdvantage has been designed around 4 main challenges during patient life post-discharge.

  1. Patient compliance with medication
  2. Coordination across the team
  3. Seamless handoff of patient to PCP
  4. Early warnings to preempt problems


For more information about TransitionAdvantage watch the following short videos:

There are several other telehealth technology programs that are designed around improving hospital readmission rates.  In Danville Pennsylvania a remote patient monitoring and care management program implemented by Geisinger Health Plan using technology provided by AMC Health has shown to lower readmission rates by 44%.  According to Maria Lopes, chief medical officer with AMC Health, technology used integrated directly with the hospital's EMR system and provided customized automated follow-up with patients to gather symptoms, medication compliance and other information that is then entered directly into the patients electronic medical record.

Contact CoreTech Revolution for more information about Vree Health’s TransitionAdvantage and AMC Health’s solution and see how we can help implement these softwares or a similar technology and integrate it with your existing EMR system request more information here.

- Ashley West