At 80 years old with heart disease, Josephine Trujillo is in the hospital every few months.
Now she's part of a program that lets her check in with a "telehealth" nurse every day via phone and computer from her Thornton home. The goal is to catch Trujillo's health problems before they get bad enough to warrant a hospital stay, and more broadly, to cut down on health care costs.
American hospitals have pledged to pitch in $155 billion over the next 10 years for health care reform. While much of the savings would stem from almost everyone having insurance — cutting down on the number of patients who walk into emergency departments with no way to pay — another chunk of cash could come from reducing hospital readmission rates.
About 20 percent of patients discharged from a hospital in this country are back within 30 days.
Trujillo, enrolled in a Centura Health project for Medicare patients, steps on a scale at her house and her telehealth nurse, up to 50 miles away, can see her weight. She puts on a blood-pressure cuff and her nurse reads it. The nurse also measures the oxygen in Trujillo's blood and listens to her heart and lungs through a stethoscope and a toaster-sized transmitter box attached to Trujillo's phone.
"To me, it's just been a blessing," said Trujillo's daughter, Chris Vigil. "I'd rather have her at home where she's more comfortable than in the hospital."
The program has been hugely successful, in terms of readmission rates, said Erin Denholm, chief executive officer of Centura Health at Home.
Since the telehealth program started five years ago, it has saved the hospital an estimated $5.2 million. Only about 9 percent of the 897 patients in the program were rehospitalized within 30 days, less than half the national rate.
Centura, with 12 Colorado hospitals, is one of the few systems in the state with a home-health division that offers follow-up care for patients. Denholm is indignant when people advocate cutting in-home programs to save money on health care.
"There needs to be some real intelligence — not just cutting for the sake of cutting," she said. "If you cut home health care, you may see readmissions go up."
Another project starting Nov. 1 at St. Joseph Hospital also will include having the hospital take responsibility for patients' care after checkout.
The government will test whether it can save money by encouraging Medicare patients to get surgery at hospitals with the best outcomes.
The Denver hospital was among five in the nation selected to take part in the Medicare demonstration, a cost-cutting experiment President Barack Obama referenced in his speech to a joint Congress on Wednesday night.
St. Joseph does the most cardiovascular surgeries — about 420 per year — of any Colorado hospital, though 16 hospitals in the Denver-metro area do open-heart surgeries. St. Joseph's clinical outcomes for cardiovascular surgery are in the 99th percentile nationwide.
The hospital will give Medicare a discount of several thousand dollars per heart surgery. Medicare will waive the patient's deductible, as well as pass half of the surgery savings to the patient.
For its part, St. Joseph is responsible for a patient's health for 30 days after discharge. If a patient is rehospitalized for pneumonia or some other heart-related problem, the hospital does not get paid again.
"We have every incentive to work hard now to ensure patients' health," said Robert Minkin, chief executive officer of St. Joseph.
Much of the discussion regarding hospitals, just like the national reform debate in general, focuses on a major goal: shifting the payment system from one based on volume to one based on quality.
"If you pay us to do more volume, we're going to do more volume," said Steven Summer, president of the Colorado Health and Hospital Association. "We need to radically change the payment system."
Hospitals divided on reform
The way the system works now, a hospital collects money from private insurance, Medicare or Medicaid per hospitalization, no matter the reason. If hospitals were forced to take responsibility for patients 30 days after discharge, they likely would make sure patients followed through with prescriptions, physical therapy or home health care.
Hospitals are split on whether it's reasonable to make them responsible for patients up to a month after discharge, but Centura Health's Denholm supports the proposal.
"I do think it would work," she said. Otherwise, "there is just going to be a revolving door."
In Colorado's HealthOne hospital system, where readmission rates average at 18-25 percent, a committee is searching for ways to lower those rates. Patients get follow-up phone calls, but there is no home-health program.
HealthOne executives say they are unsure if they would support making hospitals financially responsible for patients after discharge. "There are too many questions to blanketly say yes or no," said hospital spokeswoman Leslie Horna.
Jennifer Brown: 303-954-1593 or firstname.lastname@example.org