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There’s no doubt the pandemic stressed healthcare in ways it never has before. However, COVID-19 may have also pushed the healthcare industry to make changes that are here to stay, including implementing quality improvement tools in healthcare.
For instance, a 2021 report from the U.S. Department of Health and Human Services (HHS) found that large increases in the use of telehealth helped maintain some healthcare access during the pandemic.1 This was particularly true for those on Medicare. The HHS report stated that Medicare telehealth visits increased 63-fold in 2020, up from approximately 840,000 in 2019 to 52.7 million.
“Though telehealth adoption was driven by necessity, some aspects of it were also realized as simply a better way forward, with or without a pandemic at large,” says Rebecca Russell, director of sales and program management at RemetricHealth.
Russell points to remote patient monitoring (RPM) tools as one of those aspects. Biometric monitoring devices, such as blood pressure monitors, blood glucose meters and spirometers are quality improvement tools in healthcare. These tools are helpful during virtual video visits because they provide doctors with the clinical data they need to make treatment and care plan decisions.
“[But] it’s also a tool for those with chronic conditions to use on a daily basis, in between routine visits (in-person or virtual), enabling their condition and trends to be monitored more frequently and over time instead of just a single snapshot,” says Russell.
A systematic review published in 2021 found that RPM can reduce acute care use for patients with cardiovascular disease and COPD.2 Findings like this may push for a trend toward RPM. For instance, according to Insider Intelligence, 26% of the U.S. population (70.6 million people) will regularly use RPM by 2025.3 Additionally, a 2021 survey conducted by Vivalink reported that 35% of hospitals and clinics expect RPM will surpass inpatient monitoring by 2026.4
How to identify the best patients for RPM
In 2021, the Centers for Medicare & Medicaid Services (CMS) confirmed that RPM could be rendered to patients with chronic disease as well as to those with acute conditions.
When identifying patients who are a good fit for effective remote patient monitoring, Russell said most organizations begin with their most complex patients, which is most often those with at least one chronic disease, such as hypertension, diabetes or congestive heart failure. Other determining factors for patient selection could be those patients who:
- frequent emergency care
- require frequent vital sign monitoring (such as blood pressure monitoring at home)
- have Medicare
While Medicare reimburses for RPM services, Russell adds that commercial payers — depending on the state and plan — are covering it as well.
In 2020 CMS changed its ruling to allow RPM to be delivered under “general supervision” (instead of direct supervision), meaning RPM services could now be rendered by clinical staff outside of the physician’s physical location while under the physician’s general supervision. “Prior to this update, in order to get reimbursed for RPM, an onsite nurse or medical assistant had to manage the program, usually on top of their existing workload, and it was a real struggle,” says Russell.
Though practices can still designate an employee to manage this process, companies like RemetricHealth now provide this clinical service. “Most clinics are short on staff and time so being able to help them implement, manage and truly grow their RPM program is a wonderful thing. We’ll ask the doctor to provide a list of patients they feel would benefit from the program and complete a patient care plan that our nurses will follow,” Russell notes.
For instance, if a patient is going to use a blood pressure machine at home, the doctor would indicate the targeted numbers for systolic and diastolic pressure, as well as parameters for when to contact the patient based on their readings in the care plan.
How to engage & train patients on RPM
Though there will always be some patients that don’t want to or physically can’t participate in RPM, Russell says that overall, she finds most patients understand the benefits of monitoring their health at home. “I see so many patients that absolutely love this program and who find comfort in the fact that someone is looking out for their wellbeing on a regular basis,” she says.
For a successful transition, a discussion between the provider and the patient around the benefits of RPM is the first step, Russell points out. The doctors then purchase the devices from a supplier like McKesson Medical-Surgical. From there, a company like RemetricHealth steps in to ship devices to the patients, provide patient education and training on the devices, perform daily biometric and compliance monitoring and frequently interact with patients.
“In the initial stages, some patients often have trouble remembering to use their device(s), especially in the elder populations. As an example, in our home health population, the average age of an RPM patient is 86. These patients often require friendly phone calls to remind them to use the device(s) and why it’s important,” notes Russell. Patients are given a designated nurse to communicate with, so over time, they build a relationship.
How RPM benefits physicians
Because RPM devices have a wireless connection, which allows data from the medical device to automatically transfer to an electronic record, providers have access to real-time data at any time. Russell said some physicians access data through a designated system while others set up an EHR integration.
“They will always have access to that patient data at any time. Most physicians review data periodically when a patient comes in for a regular visit, and some look at it more often,” explains Russell.
This provides physicians with improved quality measures and increased patient satisfaction and engagement.
In addition to the benefits RPM provides to patients, she says there are financial gains for physicians who use RPM, such as codes for:6
- CPT 99453: Patient education and device set-up
- CPT 99454: Supply of biometric medical device
- CPT 99457: First 20 mins of care management and monitoring by clinical staff
- CPT 99458: Additional 20-minute increment of care management and monitoring by clinical staff
“There are a number of different reimbursements for utilizing the program that the doctors can bill at the end of the month. We provide each customer with a monthly activity report for billing purposes. This helps the billing department quickly identify which codes are appropriate for submission each month,” says Russell. “The reimbursement that doctors receive on a monthly basis exceeds the cost of our RPM program. It makes great financial sense for physicians, enables a more efficient way to manage the growing number of patients with chronic disease and provides better patient satisfaction and outcomes.”