The State of Traditional Healthcare
Federal spending on healthcare in the US is approximately 20% of GDP. Chronic disease accounts for approximately 90% of total US healthcare spending. Research shows that chronic diseases costs as much as 3.5 times the cost of other conditions and accounts for approximately 80% of hospital admissions. Our aging population and increased life expectancy results in a higher percentage of chronic conditions.
Physicians state that if they had the ability to receive and the time to analyze trended patient vital measurements, they can intervene on a timely basis and prevent conditions that if not detected could lead to an acute care admission. Before now, the technology to provide such data on a regular and continuous basis was either not affordable, not available, and/or too difficult to install and maintain. In addition, physicians were not compensated. The result was continued reliance on the traditional office visit model. This model is inherently flawed as it relies on face-to-face visits which at best are months apart. Most times a physician finds out about a patient’s decline in health when they see the patient after an emergent care visit or an acute care admission. Reactive care is viewed as less effective and significantly more expensive than preventative care.Centers for Medicine & Medicaid Services (CMS) recognized that remote patient monitoring (RPM) was required if there a chance to curb the skyrocketing cost of healthcare. Accordingly, in late 2018, the Centers for Medicare & Medicaid Services (CMS) announced a new reimbursement model created to boost the use of RPM. CMS explained it as follows:
“Under this proposal, Medicare will start paying for virtual check-ins, meaning patients can connect with their doctor by phone or video chat,” said Seema Verma, CMS Administrator. “Many times this type of check-in will resolve patient concerns in a convenient manner that gets them the care that they need and avoids unnecessary cost to the system. This is a big issue for our elderly and disabled populations where transportation can be a burden to care as well as to caregivers. We’re not intending to replace office visits but rather to augment them and provide new access points for patients.”
What is RPM and How Can it Benefit Patients and Reduce Healthcare Spending?
RPM can be described as a healthcare delivery system that uses available information technology (IT) to easily and cost effectively collect patient vital system data outside of a physician office visit. Regular monitoring of vital signs can help keep people healthy, allow older and disabled individuals to live at home longer, and avoid having to move into skilled nursing facilities. It can also serve to reduce the number of hospitalizations, readmissions, and lengths of stay in hospitals—all of which help improve quality of life and contain/reduce healthcare costs.
How does RPM Work?
RPM is predicated on the need to collect vitals, transmitting data utilizing HIPAA compliant technology, employing analytical tools to convert this vast amount of data into usable information, and displaying information requiring immediate action as well as all information in a drill down view. This allows for quick and easy identification of patient measurements falling outside acceptable ranges allowing a physician and staff to intervene before an exacerbation occurs.The collection of the data utilizes devices that are familiar to patients such as weight scales, blood pressure monitors, blood glucose monitors, non-contact thermometers, and pulse oximeters. The only difference is that these time honored and familiar devices are now Bluetooth enabled and when linked to a communications device, allows vitals to be collected on a regular and continuous basis.Effective RPM platforms leverage technology in a way that makes patients feel comfortable with assisting in the management of their own health. This comfort increases patient engagement; and by increasing engagement, RPM can help improve quality of care. Not only are patients incentivized to participate with their own healthcare, thanks to quality RPM models, clinicians are also better equipped to understand and manage their patients’ health situations, with a more constant stream of data that provides a much clearer picture of the patients’ health. In short, RPM provides physicians the ability to know what’s actually occurring with their patients and as stated earlier, trended data allows physicians to spot problems and intervene before the need for expensive acute care.
Does RPM Actually Work?
The American Heart Association (AHA) recently posted an article titled Using Remote Patient Monitoring Technologies for Better Cardiovascular Disease Outcomes Guidance. In this post, AHA states:
Remote patient monitoring (RPM) can empower patients to better manage their health and participate in their health care. When used by clinicians, RPM can provide a more holistic view of a patient’s health over time, increase visibility into a patient’s adherence to a treatment, and enable timely intervention before a costly care episode. Clinicians can strengthen their relationships with, and improve the experience of, their patients by using the data sent to them via RPM to develop a personalized care plan and to engage in joint decision-making to foster better outcomes. The American Heart Association supports initiatives that increase access to and incentivize the appropriate design and use of evidence-based remote patient monitoring technologies.
CMS Based PRM Explained
- All Medicare beneficiaries are eligible for RPM regardless of whether they have any chronic conditions.
- There is no pre-determined period over which the benefits are available.
- The only cost to the patient is the typical Medicare co-pay (20%) which is paid to the physician on a monthly basis.
- The physician supplies the medical devices at no cost to the patient.
- RPM can be furnished “incident to” under general supervision. An “incident to” service is one that is performed under the supervision of a physician (broadly defined to include qualified healthcare professionals), and billed to Medicare in the name of the physician.
- Billing Codes:
CPT code 99453
Reimbursement for the work associated with onboarding a new patient onto an RPM service, setting up the equipment, and educating the patient on using the equipment
$18 per patient (one time
CPT code 99454
Reimbursement for providing the patient with an RPM device for a 30-day period and can be billed each 30 days. Requires minimum of 16 recordings in a 30-day period.
$62 each 30 days
CPT code 99457
Reimbursement for clinical staff time that contributes toward monitoring and interactive communication which includes phone, text and email. Requires minimum of 20 minutes per calendar month.
$54 per calendar month
Each additional 20 minutes
$51 per calendar month
- One time cost of Bluetooth enabled devices which typically range from $20 – $35 each.
- Monthly management fee paid to a third party vendor to collect, transport, store, and display the collected data. Ranges from $30 – $100 per patient per month.
- Analysis of the provided data can be performed by clinic staff or outsourced under the general supervision of the physician.
- Items to Consider:
- Elderly patients are typicaly not tech savvy.
- Find a vendor that does not utilize smart phone apps requiring the patient to synch medical devices to the smart phone. Requiring a patient to synch phone apps and devices will be an impediment to adherence.
- Phone apps require patients to open the app each time measurements are taken which will be an issue over time.
- Avoid solutions utilizing a patient’s home WIFI.
- This usually requires some measure of synching and that will be an impediment to adherence.
- Home WIFI regularly drops requiring a re-synch which will be an impediment to adherence.
- Look for a solution that:
- Employs plug-and-play connectivity of communications and devices requiring no ongoing involvement of the patient,
- is always on (i.e. patient steps on a scale and the measurement is taken and automatically transmitted),
- audibly informs the patient that the measurement was taken and transmitted to the doctor,
- informs the clinic on a timely basis when the patient does not take readings. Early and regular communication with the patient about the importance of adherence is a key to success of the program, and
- reminds patients to take medications as prescribed, and when the prescribed readings were not taken.
- Elderly patients are typicaly not tech savvy.
Remote Care Partners is available to assist in the evaluation and implementation of RPM solutions. Please do not hesitate to navigate to the contact form on our website (www.aliveandwelltherapy.com).Healthcare can greatly benefit from the advances in computing and network connectivity and linking patients and care managers is the founding mission of RCP.