Applications & Outcomes in the Nursing Home
The IQ2™'s hemodynamic data will enable improved patient outcomes, reduce the incidence of illness related to asymptomatic dehydration and reduce the number of patients requiring transfer to the Hospital because of cardiac and respiratory conditions.
Transfers to the hospital can result in substantial costs to a nursing center (potential Medicare fines and quality citations, costs related to holding beds, refilling beds and MDS care planning) as well as a reduction in revenue from vacated beds.
Asymptomatic dehydration results in higher costs of care and potential quality citations.
Preventing and Treating Acute Exacerbation of Congestive Heart Failure
Where the IQ2™ is being used in the non-hospital setting, users are recognizing that the IQ2™'s objective data enables them to intervene with their known CHF patients to identify occult decompensation and intervene before it develops into an acute exacerbation. The earliest indications of the onset of acute exacerbation can be discerned days and weeks before any of the classic signs and symptoms are manifest.
In the nursing center setting, the objective data immediately obtainable from the IQ2™ can be used to make a differential diagnosis between cardiac and respiratory conditions. It enables rapid classification of the degree of pulmonary edema, intravascular volume, cardiac reserve and contractility. The continuous availability of the data provides immediate feedback about the effects being obtained through therapy and enables aggressive, safe and confident titration of diuretics, vasodilators and inotropes.
When used to monitor hemodynamic changes continuously during treatment, the IQ2™ provides real-time data with which the physician can interact to support his decisions regarding therapeutic interventions and drug titration aggressiveness with objective, defensible data.
Clinically, the data from the IQ2™ allows caregivers to:
- Determine degree of pulmonary edema ("wet or dry") and to monitor change in degree of edema as therapy undertaken; to determine need for and progress of diuresis and to provide data supporting titration with optimal aggressiveness.
- Titrate diuretics, beta blockers, vasodilators and ACE inhibitors; to monitor effectiveness of inotropic therapy. The IQ2™ supports optimal aggressiveness based on objective, reproducible and defensible data.
- Determine whether patients with a variety of symptomatic or asymptomatic conditions are dehydrated, hypovolemic (volume depleted) or volume overloaded
- Optimize infusion rates for blood products.
- Determine the degree of circulatory derangement or insufficiency which indicates impending shock well in advance of a sharp drop in blood pressure confirming shock.
- Determine with confidence whether a patient can be stabilized in the nursing center and transfer to the hospital can be avoided, (or that transfer is advisable, as the case may be); reduce the time needed for nurses and physicians to make this determination.
Outcomes for the Nursing Center:
With the objective data obtainable using the IQ2™, the nursing center will be able to:
- Increase patient-day revenue by avoiding transfers to the hospital due to heart failure exacerbation, cardiac and respiratory conditions of unknown etiology and conditions resulting from dehydration.
- Increase patient-day revenue by reducing the severity and length of stay of hospitalizations due to heart failure exacerbation.
- Reduce the risk of fines and quality citations for transferring patients to the hospital that regulatory authorities (in hindsight) decide are unjustified.
- Document with objective, defensible data the nurses' assessment that a patient transfer to the hospital is justified.
- Reduce the re-marketing costs associated with unfilled beds. Reduce the costs associated with MDS care planning for replacement residents and those returning from the hospital.
- Document with objective, defensible data that the acuity of a patient's clinical condition and care needs of patients justifies a higher PPS reimbursement to the nursing center.
- Build nursing center revenues based upon referrals from providers with a delivery model based upon global contracts. These providers are undertaking to manage the health care delivery costs of a high-acuity subset of the elderly population. Their business model yields optimum financial results when they can provide care in the lowest-cost care setting possible, with minimal uses of the hospital ED or inpatient services. A nursing center that is capable of managing patients with previously-diagnosed congestive heart failure based upon the IQ2™'s data will present an attractive care setting for these providers.
Decrease the risk that patients transferred to the hospital will exercise their rights to be discharged to a different nursing center.
Outcomes for the Attending Physicians:
- With the data generated by the IQ2™, attending physicians can deliver improved patient care and increased revenue because the procedure has been approved by HCFA for Part B reimbursement. The physician can bill for the interpretation of the data and report based thereon.
- The physician's interaction with the IQ2™'s data and the objective, defensible support the data provides to the physician's assessment of patient acuity will warrant billing for higher E&M codes (99301 - 99313).