Connected health, reimbursement and the law of unintended consequences

(Reprinted with permission from the cHealth Blog)

We're starting to see some funny economics emerge as healthcare payment reform truly takes shape. Just this last week I saw two interesting, unrelated articles that give us a glimpse into the effects of the law of unintended consequences when it comes to changing the way we pay for healthcare.

The first is from the Kaiser Family Foundation. This article describes the penalties hospitals will have to pay as of October 1 because of changing Medicare regulations related to readmissions. We've known this day was coming for some time, but many hospitals either refused to acknowledge that these penalties were coming or simply had other priorities. For that reason, more than 2,000 hospitals will be penalized and have to pay Medicare back up to 1 percent of their Medicare revenues. The KFF article included a link to a PDF file listing all of the hospitals and their 2012 penalties. A more visually appealing version can be found at www.checkmypenalty.com, a website created by a new company, Health Recovery Solutions, dedicated to helping hospitals solve this problem.  Find your favorite hospital and see how they stand.

The KFF article points out that some of the nation's best hospitals (by other measures) are doing the worst here.  That makes sense to me. In a payment system where Medicare pays hospitals a flat rate per case for inpatient hospital care, an unintended consequence of diagnosis-related group (DRG) reimbursement was to incentivize hospitals to decrease length of stay to improve efficiencies. By moving patients along and discharging them as quickly as possible, you run the risk that they won't be quite ready to go. Up until now, that may have been overlooked because if the patient got readmitted, that started the clock ticking on the DRG-related length of stay again.

But no more.  If these patients are readmitted within 30 days of discharge, the hospital pays a penalty.

About two-thirds of these readmissions are cardiac patients – either heart failure or acute MI. If you go into any given hospital and ask the cardiologists how to solve this problem, they'll educate you about left ventricular assist devices, better stents and improved "door to balloon time." What is missing from the mix is improved patient education and improved patient engagement.

Connected health provides both. In our own experience with heart failure telemonitoring, we noted a 50 percent drop in readmissions. We also see more patient self-care and more just-in-time care, resulting in patients staying healthy at home longer.

The Medicare readmission penalties are just the beginning of a whole series of reimbursement changes that will support making care a continuous function in the lives of our patients. That is what we've been doing at the Center for Connected Health for the past 18 years.
General Electric spends more than $2.5 billion per year on employee healthcare costs. Armed with that fact, no one would be surprised to see the company using whatever levers they can to lower these costs. The tools du jour are high deductible plans and health savings accounts.

Of course, GE is not the only employer to jump on this bandwagon. In an article in the Wall Street Journal last week, it was noted that GE's $18 billion medical imaging business is experiencing a slowdown because nationwide, fewer CAT scans and MRIs are being ordered. We can probably attribute this to consumers experiencing more cost awareness now that they are on high deductible plans! Apparently it's working.

This is an illustration of a principle that, in today's US healthcare system, a dollar saved is a dollar of someone's salary lost. How to deal with this paradox in a down economy has caused great consternation for some industry stakeholders.

Shorter hospital stays can lead to higher readmission rates. High deductible employee benefits plans result in fewer high-cost diagnostic testing. Both of these examples illustrate the law of unintended consequences. As we go through the next several years of change around healthcare payment reform, more examples are bound to emerge.

What examples can you think of?

Joseph C. Kvedar, MD is the director of the Center for Connected Health (www.connected-health.org), a division of Partners HealthCare in Boston. Connected Health is focused on developing new methods of delivering quality patient care outside traditional medical settings. This post appeared at The cHealth Blog.