Page 27 Telehealth and Remote Patient Monitoring RPM for Long Termand Post Acute Care A Primer and Provider Selection Guide 2013

22

which is liable for and covers health care costs. they get to keep plus any additional fee-for-service
Consequently, such savings or gains should not be payments due to more frequent office-based ser-
included in calculating Medicaid’s ROI, which is vices minus the actual costs of services they deliver
investing in the home telehealth and supportive (for example in medication reconciliation or care
services in this case. coordination), relative to the portion of incentives
they pass through to the LTPAC provider.
6.8.3 ROI to Care Provider In contrast, a partnership between an LTPAC pro-

ROI to care providers can be calculated as: vider and hospital under the traditional fee-for-ser-

ROI Care Provider = Net Gains Care Provider ⁄ vice model, for example, the LTPAC provider may
Investment Care Provider help their hospital partners reduce 30-day readmis-
sion rates for pneumonia, congestive heart failure
For the care provider who makes investments in and acute myocardial infarction (heart attack) pa-
information and communications technology tients, hence helping the hospital avoid Medicare’s
infrastructure, the telehealth technology, as well as payment penalties under the HRRP. The hospital
the clinical and care services, benefits may include: may contract with and pay the LTPAC provider a
lower costs in delivering the same services includ- percentage of the penalties saved for delivering tele-
ing staff efficiencies, staff travel costs (if the payer health that lead to reducing 30-day readmissions
covers the remote services, rather than just the for patients discharged from the hospital after being
in-person visit), and higher reimbursements/pay- admitted for one of the above mentioned three
ment from the payer or strategic partner in terms conditions. The LTPAC’s net gain is again the sum
of incentive payments for avoiding more costly care of all gains accruing to the LTPAC provider in staff
settings, procedures, events, or penalties. efficiencies, increased referrals from the hospital,
traditional fee-for-service payments, and additional
For example an LTPAC provider partnering with a payments received from the hospital, minus the
physician group ACO to manage a chronically ill costs of leasing the home telehealth equipment and
patient population can potentially get a percentage actual costs of services delivered. The hospital’s
of the incentives or shared savings payments the ROI is the portion of avoided penalties they get to
ACO receives from the payer for reducing hospi- keep plus any additional fee-for-service payments
talizations and hospital readmissions, which can be they gain for more referrals due to improved qual-
significant for certain populations. The LTPAC pro- ity ratings minus the actual costs of services they
vider’s net gain is the sum of all gains accruing to deliver, relative to the portion of avoided penalties
the LTPAC provider in staff efficiencies, increased they passed through to the LTPAC provider plus
referrals from the ACO, traditional fee-for-service any additional costs incurred for staff time in care
payments, and additional incentive payments coordination, medication reconciliation, or health
received from the ACO, minus the costs of leasing information exchange, for example.
the home telehealth equipment and actual costs of
services delivered. The physician group ACO’s ROI
is the portion of the payer’s incentive payment that

LeadingAge Center for Aging Services Technologies (CAST)