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Wearables: The evolution in post-acute care

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David White 
Market Research Analyst,
Philips Connected Sensing

Hospitals are where sick people go to get better, right…?  Actually, that’s only partly accurate – let me explain.  For some patients, that isn’t the whole truth.  For seniors in particular, the treatment they receive in an acute care hospital is often just the first step on the road to recovery.  For 1.7m Medicare beneficiaries each year, the next step after being a hospital inpatient is a stay in a skilled nursing facility (SNF).  Many others will be discharged directly to home, but will receive additional rehabilitation and help from a home health agency (HHA).
 

Unfortunately though, that next step of the rehabilitation journey doesn’t always go according to plan.  Currently, 22.6% of Medicare patients discharged to a SNF are re-hospitalized.  Likewise, 25.4% of patients are hospitalized during an episode of home health care.  And those hospitalizations don’t just come loaded with an excessive financial cost to Medicare.  They take a toll on the patient’s health too.   Seniors rapidly lose muscle mass and strength when bed-bound.  Ultimately, that makes the road to full rehabilitation steeper, and less likely that the patient will reach the top.

...the potential for cost-effectivepatient monitoring in skilled nursing and the home has never been greater.” 

Why are readmissions so high?

 

So, what changes beyond the hospital walls?  Why is it that almost a quarter of those seniors bounce back to the hospital for further treatment?  One notable difference is that the extent of patient monitoring – either automated or manual – is greatly reduced.  Patient monitoring in acute care hospitals can be very intensive.  For example, critical ill patients are routinely monitored using telemetry devices that cost thousands of dollars.  But, once outside the hospital in post-acute care, things are very different.  The extent and frequency of vital sign monitoring and oversight by clinicians is greatly reduced.  That provides scope for patients to deteriorate unseen, to the point where a costly intervention is required.
 

It could be argued that patients in a SNF or under the care of a home health agency shouldn’t need such intensive monitoring.  Patients are, after all, supposed to be further down the road to recovery.  But, on the other hand, SNFs are much less able to pay for costly patient monitoring solutions.  For example, in 2010, Medicare paid an average of $21,317 for a major joint replacement, without major complications or comorbidities.  $11,942 - 56% of the total sum - was paid to the acute care hospital for a 3.5 day hospital stay.  Only $3,678 (17% of the total) was paid to the SNF for a much longer stay.  (The median payment to a SNF for all episodes – not just major joint replacement - is $463 per patient per day.)  And since SNF’s or home health agencies are rarely equipped to deal with critically ill patients, serious patient deterioration almost inevitably means a return to the acute care hospital.

Patient Monitoring Beyond the Hospital Walls

 

However, the potential for cost-effective patient monitoring in skilled nursing and the home has never been greater.  The economics of continuously monitoring vitals is changing dramatically.  By using disposable wearable biosensors to monitor vital signs for example, it’s possible to continuously assess the health of a patient – even during a lengthy recovery period.  Changes in vitals could be tracked, trended, and analyzed by software in the cloud, eliminating the need for any additional hardware or software in the facility.  Caregivers can be discretely alerted, automatically, to any significant patient deterioration.  And, since wearable biosensors are wireless, vital signs could be monitored wherever the patient goes:  Not just lying in bed, the patient can be monitored anywhere in the SNF, or in their home, or even out in the community. This is critical, because being up and mobile is one of the keys to recovery.  And yet, it’s important to be able to monitor patients as they begin to exercise, gently exerting their bodies as they work their way back to wellness. 

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i MedPAC Report to Congress, March 2017

ii Medicare Nursing Home Compare

iii MedPAC Report to Congress, March 2017

iv Effect of 10 days of bed rest on skeletal muscle in healthy older adults, Kortebein et al, 2007

v Findings from Recent CMS Research on Medicare, Niall Brennan.

vi Length of Stay is Critical to Total Hip and Knee Replacement Cost of Care, Accelero Health Partners

vii MedPAC Report to Congress, March 2017

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