One of the tenets of the Affordable Care Act (ACA), aka Obamacare, is that hospitals must reduce costs, by reducing their 30-day readmission rate — the theory being that a hospital ought to be able to do a good-enough job on patients deemed well enough to be released to keep them out of the hospital for at least a month.
As a result, hospitals are scrambling to find ways to reduce their exposure to the problem. Otherwise, thanks to the Hospital Readmissions Reduction Program component of the ACA, they could find their Medicare payments cut by up to 3%. While it doesn’t sound like a lot overall, hospital administrators, armed with spreadsheets and horror stories, would disagree, claiming they need every penny, and then some.
A new study by Israeli medical technology start-up EarlySense could help allay the concerns of administrators — as well as patients, most of whom presumably would want to avoid going back to the hospital as well. In the first-ever test of the EarlySense system that followed heart-failure patients after hospital discharge, the start-up, working with two top US health institutes, discovered that monitoring the respiratory activity of the patients was “the most important risk-adjusted associate of readmission for heart failure,” according to Dalia Argaman, VP of clinical and regulatory affairs at EarlySense.
With “wearables” all the rage now in health monitoring, EarlySense has done things a bit differently: The company has developed the first “sleepable” in a device which, when placed under a mattress, keeps track of how a person sleeps, including whether they toss or turn, the different stages of sleep (REM, etc.), their breathing, and other important sleep data.
EarlySense started out in the sleep-monitoring business in 2004, when it developed a system for hospitals and care centers to keep track of patients sick enough to require continuous tracking, but who were unwilling or unable to have wired sensor devices attached to their bodies while they slept. Designed for use in non-emergency room or even home settings, the EarlySense system uses sensors embedded into a mattress or chair cushion to monitor heartbeat, respiration rate and movement, uploading the data to a server for analysis, or setting off an alarm on a caregiver’s smartphone if something seems wrong. It’s in use in thousands of hospitals, nursing homes and home settings around the world and, according to hospital studies cited by the company, over 90% of staff said that the system was useful in stemming and preventing patient deterioration.
The new study, entitled “Home Monitoring of Heart Failure Patients at Risk for Hospital Readmission Using a Novel Under-the-mattress Piezoelectric Sensor,” was published in a recent issue of the Journal of Telemedicine and Telecare. Led by researchers Mosi K. Bennett (Minneapolis Heart Institute), Mingyuan Shao, and Eiran Z Gorodeski (Cleveland Clinic), the study used the EarlySense system “to monitor physiological vibrations resulting from breathing, pumping of the heart, and body movements, among individuals at home following hospitalization for heart failure (HF). Our objectives were to assess acceptability of the device in the home, to assess physiological patterns, and to determine if altered patterns correlate with readmission,” said the team.
“We inspected continuous nightly physiological profiles and noted differences between patients who were and were not readmitted,” the team said in its conclusions. “Patients readmitted for HF had higher average heart and respiration rates, and more respiration variability. Average nightly respiratory rate was most predictive of readmission.”
While the study was limited to heart patients, the team said, the impact of nocturnal respiratory issues — as well as other physiological signals — on other diseases are worthy of study. But even with these limited results, hospitals can save a pretty penny on their ACA penalties; nearly six million Americans live with heart failure and more than 870,000 new cases are diagnosed each year; according to industry experts, frequent readmissions are a main contributor to high costs associated with heart failure in the US, estimated at $39 billion annually.
If EarlySense systems can help reduce those readmission costs, it certainly makes sense for hospitals to advise patients to get one when they check out — or even to supply them with one, said Argaman. “These data may impact the financial well-being of health systems facing economic penalties for 30-day readmission. Predictive insights from a monitoring solution can translate into millions of dollars saved.”