CMS offers various telehealth solutions including remote patient monitoring devices, software, and clinical support to improve patient outcomes, reduce costs, and prevent hospital readmissions by allowing patients to be monitored at home and addressing health issues before they require a hospital visit. The solutions help hospitals avoid penalties for excessive readmissions and support post-discharge care. CMS also provides programs and services to support telehealth program development and operations.

1. TeleHealth
Improving Clinical Outcomes,
Reducing Costs
and Preventing Hospital
Readmissions:
CMS TeleHealth Solutions

2. Agenda
• Introduction
• Overview & Current Successes
• Devices, Software & Reports
• Clinical Software Demonstration
• Program Development
• Key Statistics & Return on Investment

3. Optimizing Health Care for Reform
Readmission Penalties:
What does it mean for hospitals?
• Hospitals will be penalized for excessive
readmissions for CHF, MI, and pneumonia
effective Oct. 1, 2012.
• The largest potential reduction for a
hospital:
– 1% in FY 2013
– 2% in FY 2014
– 3% in FY 2015 and every year thereafter
• Payment reduction will apply to all
Medicare inpatient discharges
• Additional conditions, including COPD,
will be added in 2015

4. TeleHealth Clinical Outcomes
• The premises for the Telehealth division is to
improve clinical outcomes, reduce costs and
prevent hospital readmissions.
• CMS offers vital signs monitoring devices with
steady scale for frail patients that can then
transmit findings wirelessly to physicians who
in turn can assess and diagnose the patient’s
status 24/7.

5. How we can help
Hospital to Home

6. Home Healthcare Solutions
“Post Discharge Portfolio”
TeleHealth Solutions
Sleep Apnea and
Respiratory Products
Medication Dispensing
Service: 60 doses/40 days,
90% compliance
LifeLine
CMS offers in
home Respironics
to assess sleep
apnea and other
respiratory
diseases.

7. Key Products and Services
CMS offers Lifeline products and
Medication dispensing devices
CMS offers Home Cardiac
monitoring devices.

8. Remote Patient Monitoring
Proven Results
• Can significantly reduces the risk of death and
hospitalization
• May lead to better clinical outcomes and reduced long-term
healthcare costs due to fewer hospitalizations3
• Can increase quality of life and patient satisfaction through
daily monitoring 4
• The total number of days certain male cardiac patients spent
in the hospital while on TeleHealth was reduced by nearly 80%5
• There was up to a 21% reduction of hospital admissions as a
result of chronic heart failure when patients were on remote
monitoring programs 6
• Mortality was significantly reduced for heart failure patients
randomized to remote patient monitoring 7
Good Medicine
“We’ve had over 650
patients on our program
and we’ve had 26
patients back in the
hospital. That’s less than
the national average, so I’d
say that’s good medicine.”
-Banner Health
Telemonitoring Manager

9. Outcomes-Case Examples
• 10/28/09
Banner Health System, Arizona noted that they have
provided remote patient monitoring services to patients with
heart failure and other chronic diseases since 2006 including
more than 650 patients in the past three years, achieving a
readmission rate of 3.8 percent for patients on monitoring
versus a state average of 21% and national average of 24%.
(press release, October 29, 2009).
• 01/29/10
Sentara Health System, Virginia, rated the top integrated
hospital system by Modern Healthcare in January 2010, noted
in a recent national Presentation that they have been
reducing hospital readmission rates by 70% or more when
patients are remotely monitored in the home. Additional
programs focus on “Hospital to Home” and ED models.
(World Health Congress, January 2009, National Home Care Association, July 2010)

10. Hospital to Home Initiative
The information noted below has been published by several TeleHealth programs
with successful results such as significant reductions in hospital readmissions.
• Patient is discharged to home from hospital and…
• TeleHealth devices are installed within 24 hours
• Medications are reconciled within 48 hours
• Patient is assessed for risk of falls and preventative measures are put in place
within 48 hours
• Patient visits primary care physician within 5 days
• Onsite nurse visits are frontloaded during first 5 days
Results: Zero readmissions within 30 days post DC

11. Vital Sign Measurements with Wireless
Devices
• Award-winning wireless (RF)
measurement devices, designed
for patient ease-of-use.
• Steady scale available for frail
Patients
• Automatic, secure transmission
with cellular option (e-Device)
• Tested and proven to
interoperate with CMS Lifeline
(PERS) and CMS Medication
Dispenser on a single phone line.
• One-button
operation
• Large LCD screens,
buttons and fonts
• Audible & Visual
prompts
• Battery operated
• Connects to ordinary
phone line or cellular
signal
• Surveys in both
English and Spanish
• Backlit TeleStation
and manual entry of
other measurements

12. Personal Health Tablet – My WellBook:
Connectivity & Communication for Patient/Person Engagement
• CMS offers Personal Health Tablet for connectivity and communication for
patient/person engagement. This has specific care plans for education,
tasks/reminders, feedback on vital signs, attainable goals.
Specific care plans:
• Education, Tasks/Reminders, Feedback (vital signs), Attainable goals, Delivers
insight for self monitoring:
“How do you feel?”
Assessment Surveys

13. SoftWare
• CMS offers Dual Monitor Brackets for the Rubbermade
Healthcare Telemedicine cart which is an FDA cleared device
that uses a USB connectivity panel. A facility than can use the
embedded PC to access and EMR system with HIPAA
compliance. This will also enable Microsoft Lync to find
available physicians on line that can assist or meet on the cart or
in a virtual meeting room for a 3rd
party consult.
• CMS offers the Litmann Electronic Stethoscope model 3200
designed to easily fit into a practice’s workflow.
• CMS offers Horus HD Digital Scope system as a multi Integrated
Imaging System.

14. CMS Benefits
• CMS offers highly specialized physicians that can interpret medical data and
submit a diagnosis and plan of care. Excellent scenario for small hospitals with no
direct access to highly specialized physicians. Those hospitals can then retain their
patients in their locality instead of them going to larger hospitals = increased
revenue and = improved patient care.
• CMS offers primary care physicians that can interpret medical data collected by
nurses of nurse practitioners and offer a plan of care at the patient’s location and
thus prevent admission to a hospital. Excellent scenario for the Nursing Home
industry.
• CMS offers in home Medical equipment that can then be connected wirelessly and
transmit data to the designated physician for interpretation, thus being able to
detect minor changes in the patient’s condition, recognize health hazards and
prescribe a course of action focused on keeping the patient at home.

15. Program Support
• Defining your program goals and
metrics. Make sure we stay on track,
hit goals, grow program.
• Program scheduling, operational
timeline and logistics planning
• Inventory management (installation,
de-installation, and cleaning
processes)
• Clinical workflow and business
process consulting. “Current KAM’s
have been doing this for years and
can share best practices”
CMS Video Cloud solutions ensures easy to use, simple dialing with
bridge number, host pin and audio dial-in, state-of-the-art infrastructure,
support and top-tier bandwidth from fully managed datacenters.

16. Resource Planning and Training
• Defining the right operational model for your program
• Online CEU courses and Telehealth resources
• Clinical staff education and training
• Patient education, user manuals, training videos
• Telehealth Certification Program
• Completely HIPAA compliant.

17. Marketing Support
• Demo devices available for
presentations to referral sources
• Referral marketing collateral
• Patient marketing collateral
– English and Spanish
• Brochure customization at no cost
• Financial ROI modeling
• Remote patient monitoring clinical
outcomes and cost benefit studies
• Videos
• Photography
Healthy at Home
TeleHealth Improving Clinical Outcomes

18. Key Statistics
• Target % of HHA average daily census on monitors = 20 – 25%
• Average number of patients on monitors per clinician = 100
• Average % of patients triggering an alert on any day = 25%
• Average length of patient on monitoring
o Hospital-based = 30 - 45 days.
o Home Health-based with disease management = 45 - 90 days
o Disease Management/Health Plans = 6 - 12+ months

19. ROI
Return On Investment
Home Care Focus
• Every 10 new referrals per month cover cost of 100 patients on
monitors
• Every .75 nurse visit reduction per month covers cost of one patient
on monitor
• Re-certifications can be increased (tend to have higher margins)
• Resumption of Care assessments are reduced (saves staff time)
• More effective case load utilization (manage by exception)
Hospital Focus
• Avoid non-reimbursed readmissions starting in FY2012
• Avoid global payment penalties starting in FY2013
• Improve margins with bundled payment

20. Dr. Thomas Ross, President & CEO
Critical Medical Solutions, Inc.
www.cmsteleradiology.com | 1A The Pines Court, Ste C, St. Louis, MO 63141
9115 Bridgeport Way SW, Ste 3, Lakewood, WA 98499
800-758-5120 (O) | 636-203-5820 (O) | 636-216-0101 (F)