At the start of 2020, widespread adoption of remote patient monitoring was still in the distance. The technology was struggling to get off the ground despite it being available for years.
Most of the hesitancy on RPM implementation seemed to be because of limited reimbursement opportunities as well as lack of incentives for providers offering such services.
Then COVID-19 hit. The pandemic exposed the need for the rapid adoption of increasingly innovative digital health technologies. And while telehealth, a key component of this, has received much of the focus and spend, RPM has been gaining traction since the beginning of the pandemic.
Healthcare IT News interviewed Dr. Lucienne Ide, founder and chief health innovator at Rimidi, a cloud-based remote patient monitoring technology company, to gain her insights and expertise into the state of RPM – and where it goes from here.
Q: What are the benefits of RPM during and beyond the COVID-19 pandemic, especially among underserved, uninsured or Medicaid populations, where already there are disproportionately high rates of chronic disease and other barriers to care?
A: Minority communities have long endured limited access to care and a greater likelihood of experiencing chronic conditions, such as diabetes, heart disease and obesity. Add COVID-19 to the mix, and we're now witnessing higher rates of infection and death from COVID-19 among African Americans, Hispanics and rural residents.
Adding to the problem is the likelihood of minority groups to delay or go without needed care. A recent study noted that African American and Hispanic adults are less likely than white adults to have a usual source of care or have had a health visit in the past year. And those living in rural areas face a range of barriers accessing care, from proximity and availability of providers to lower income and lack of insurance coverage.
These inequities take an economic toll, too. It is estimated that disparities cause about $93 billion in excess medical care costs and $42 billion in lost productivity annually, not to mention economic losses due to premature death.
As healthcare further shifts from a fee-for-service to a value-based care approach, care delivery is shifting from an in-clinic, episodic, reactive model of care to one that is continuous and proactive, and a blend of in-clinic and remote. RPM is an effective way to ensure all patients are able to receive the quality, continuous care their condition requires.
Medicare currently doesn't reimburse federally qualified health centers (FQHCs) or rural health centers (RHCs) for RPM. Though some state's Medicaid and private insurers do reimburse, FQHCs and RHCs are mostly relying on a hodgepodge of grant opportunities to expand their digital health capabilities – including virtual models of care like RPM. This clearly is not a sustainable approach.
In addition to the technology, widely available education is crucial. Poor management in underserved communities has become more normalized, but it is important to recognize that inequalities in outcomes are a symptom of inequalities in opportunity and access.
Digital health education that is accessible to the patient at home or on their smartphone is one way we can bridge the divide. Whether digital health education is administered through a community center, pharmacy or a primary care doctor, we must change this narrative and begin to provide a framework in which providers can address the causes of disparities in various educational settings.
Q: What is the connection between telehealth and RPM, and how can the combination of these technologies make healthcare more streamlined and efficient?
A: At the start of 2020, widespread use and adoption of telehealth and RPM was still struggling to get off the ground, despite the technology being available for years. A majority of the hesitancy on telehealth or RPM implementation was due to limited reimbursement opportunities as well as lack of incentives for providers offering such services. Then came COVID-19.
There are several different types of telehealth approaches designed to help clinicians virtualize care. A video session with a patient is an important option for healthcare providers. It keeps exposure minimal and has proven an effective and convenient approach.
However, it is important to note that a video call is simply a proxy for an in-clinic visit. Moving our care delivery approaches to a more continuous approach (to match the continuous nature of chronic conditions) is essential. RPM is one way to do this.
Simply put, RPM refers to the use of connected medical devices like glucometers, blood pressure cuffs and scales to monitor how patients are doing outside of the times they are in the doctor's office. In "normal" times, RPM helps health systems meet quality metrics and prevent unnecessary ER visits and hospital admissions while ensuring better patient outcomes.
During COVID-19, RPM allows patients to still get the care they need while keeping them out of healthcare settings to limit potential exposure to the virus. Monitoring patients with chronic conditions like hypertension, high blood pressure, Type 2 diabetes, heart failure and obesity are common use-cases for RPM.
Today this takes on a special importance, as more data is emerging that people with these conditions are at the greatest risk of developing severe symptoms of COVID-19.
Q: You say there is an imperative need for permanent RPM reimbursement reform and a need for the industry to come together to influence and drive forward this change. Why? What is the problem?
A: At the beginning of the pandemic, HHS and CMS released an interim final rule to give providers more flexibility to furnish services using remote care technology for the duration of the public health emergency. Here's what we know:
During the PHE, the office of the inspector general said it would not penalize doctors for not collecting patient copays for telehealth services, including RPM. Permanently waiving copays for virtual services will take an act of Congress, but is much needed.
CMS granted that RPM could be furnished to new patients as well as established patients during the PHE. Following the PHE, CMS will again require RPM to only be furnished to established patients.
CMS also granted that consent could be obtained at the time RPM services are furnished, allowing for virtual care rather than in-person consent. CMS is proposing keeping this flexibility.
Finally, CMS clarified that practitioners could furnish RPM services for acute and chronic conditions, and confirmed this was not a temporary measure tied to the PHE.
The issue here is, it is currently unclear how long the PHE will last. And some of these points were only temporary to provide relief to providers during the pandemic. Today, we know that the use-cases and benefits of RPM are clear. But for RPM to live up to its potential, our industry needs reimbursement reform.
Q: Who on the care team should be managing RPM (doctors versus nurses, case managers, etc.)?
A: We are starting to see different approaches to RPM emerge. It's rarely the doctor who is managing RPM, but nurses or physicians' assistants monitoring the patients, only escalating to the doctor when they notice a concerning trend in the patient's data that requires the doctor's attention.
A wonderful thing about this is that more people in the practice begin operating at top of licensure, creating more career development opportunities and higher levels of job satisfaction. A nurse monitoring a patient might confer with a physician on a patient trending high on blood glucose and agree on a change in prescription.
A couple successful approaches that have emerged are using a centralized team – whether that's an in-house team or a third-party RPM administrator – to manage RPM. We've seen clinical pharmacists, medication management or population health teams really successfully support primary care teams in managing RPM, because when it comes down to it, RPM is another method of achieving greater population health and greater adherence to medication.
Third-party RPM administrators also have become popular – similar to a third-party chronic care management team. In fact, many third-party chronic care management or even revenue cycle management companies have started seeking RPM solutions to offer their clients.
This is in part because CMS has re-emphasized and clarified that auxiliary personnel, including contractors, can furnish CPT codes 99453 (device setup and patient onboarding) and 99454 (remote monitoring of physiologic parameters) services under a physician's supervision.
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.
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