Interpretation of rules has created an airplane that has launched with no plans to build the runway in healthcare.
To finish a thought from last week’s blog, sometimes the rules create their own problems. The Centers for Medicare and Medicaid (CMS) created a new risk-sharing payment strategy with hospitals. If someone has health insurance through Medicare, and if they are readmitted to the hospital for the same condition within 30 days, then the hospital will not be paid for the second admission. (Of course it’s a bit more complex than that, but this is the gist).
This ruling has created a whole new ‘market’. A group of very smart technology experts and entrepreneurs have identified this as a place to create new ways to keep people healthy at home. Tools and solutions are created that help people be successful at home after being in the hospital.
- Patients benefits by having new resources to help them maneuver their care at home and stay at home.
- The hospital benefits by losing less money on readmissions within 30 days.
- The new companies, technology gurus, and entrepreneurs make money by being paid through the hospital’s cost savings.
Rules (and solutions) – make sense?
These are the parts that are missing, in my opinion.
- Once we determine how to keep people home safely for 30 days, I anticipate CMS will expand the time window to 60, 90, or more days. So short–sighted solutions will not survive.
- What happens after 30 days? Many of these new solutions involve technology. Who pays for the technology and the monitoring after the 30 days? Will it just be removed from the person’s home? Then what happens? Is that cost effective? Does it even make sense?
- What about people who are fearful of technology? Again, most of the solutions I’m hearing and reading about are based on technology. What if the person doesn’t have internet access or land-line phone access? What if the person has no interest in learning how to use the technology? What if the person just can’t get the hang of the technology?
- As I mentioned last week, I am finding very little data on what users/people with chronic medication conditions want. Solutions are being developed with little to no input about whether people will actually want or use the solutions.
For some of these issues the answers I’ve received are that there will always be exceptions. Those will be dealt with one by one. The goal is to find solutions for the majority.
It was funny, in one of these conversations we likened the current technology solutions boom to the airplane that’s in the air but no one has thought yet about the runway. That seems like a fitting analogy to me right now.
Hope
There is hope. I talked yesterday to a company taking a MUCH broader view of helping people stay healthy in their homes. They are not even thinking about the 30 day readmission rules. They are looking at long-term solutions that are created and maintained around the person that is using them. I know that company is not alone. I’ll put my hope in these types of companies!
For more information about new technologies in healthcare, please contact us at www.medsmash/contact.
For further application, check out my personal blog.
Image source: Office of Research Support; National Institutes of Health; U.S. Department of Health and Human Services.
