The implementation and reimbursement of remote patient monitoring is a transformative development in healthcare. While its robust adoption during the Covid-19 pandemic reflected the needs of the time, there are many benefits to remote patient monitoring that should make a significant difference in improving clinical practice workloads, chronic disease management and the patient experience.
In a recent webinar Sponsored by 100More, the health and medical technology company provided a roadmap on how its program works, including device deployment, working with clinicians to assess patient eligibility, as well as implementation and reimbursement.
Dr Mintu Turakhia, Cardiac Electrophysiologist, Outcome Investigator, Clinical Essay and Consulting Medical Director at 100Plus, explained the differences between the CMS Chronic Condition Management Program and the more recent adoption of remote patient monitoring.
CPT code 99457 is a monthly billing code for remote patient monitoring that reimburses providers for the direct expenses associated with remote monitoring of physiological data while a patient is being treated. To qualify for reimbursement, clinicians and other healthcare professionals must provide at least 20 minutes of interactive patient care per calendar month. 100Plus facilitates interactive remote care with its Clinician Patient Portal, making remote patient monitoring easy and accessible by bridging the gap between visits with consistent patient data.
Turakhia shared the results of a clinical study conducted by the University of Pittsburgh Medical Center on patients with type 2 diabetes who participated in a remote patient monitoring program with connected blood glucose meters. Participants were successful in reducing H1C levels.
He also pointed to a 100Plus study of 14,309 patients – 42% men and 58% women – who received Medicare. The first results included a significant drop in blood pressure in patients with hypertension for 180 days and weight loss.
Turakhia also shared her perspective that although asynchronous care is here to stay, remote monitoring of patients may change over time as it adapts to the needs of practices and the evolution of the government agenda.
Mike Wurm, Director of Product and Strategy at 100Plus, provided an overview of how 100Plus helps practices integrate into their RPM program. He pointed out that unlike many RPM programs that use bluetooth, he chose to use texting / cellular data as no setup is required since almost everyone has a phone that provides texting. Wurm also noted that 100Plus can help determine which patients in a doctor’s office are eligible for RPM coverage.
Patients are given devices capable of transmitting cellular data. The devices may include a blood pressure cuff, digital scale, blood glucose meter, pulse oximeter, and digital thermometer. He also plans to add a spirometer.
Patients interact with an engagement platform called Ava. The AI-based virtual medical assistant prompts patients to use their devices to transmit physiological data. The goal of the CMS RPM program is to provide a richer time series of clinical parameters on which physicians can provide better preventive care to reduce reactive care such as hospitalizations and emergency room visits.
Nadia Ziyadeh-Hammad, RPM coordinator, at Greenville Healthcare Associates, which uses 100Plus, noted that the large screen and fonts on the devices made them easier to use for elderly patients.
She also recounted how an elderly patient who did not like seeing the doctor agreed to be monitored remotely and was helped by the platform. Physiological data transmitted by the devices of the male patient indicated that he had experienced tachycardic events. When Nadia’s team followed up with patients, they reported fatigue and chest pressure. They asked him to come in for an ECG and the data indicated that the patient was about to have a cardiac event.
Although RPM has been available for 3 to 4 years, a new variation of the program, which CMS is currently piloting, is therapeutic remote monitoring, which focuses on lung and musculoskeletal conditions. He understands five new RTM codes, all of which will be put online from January 1, 2022.
National law review cited these hypothetical examples of how the final rule might work in practice:
An asthmatic patient is prescribed a rescue inhaler fitted with an FDA approved medical device that monitors when the patient uses the inhaler, how many times during the day the patient uses the inhaler, how many puffs / doses the patient has uses each time, and the pollen count and environmental factors that exist in the patient’s location at that time. These are non-physiological data. The data is then used by the treating practitioner to assess the patient’s response to therapy and adherence to the asthma treatment plan. This can allow the practitioner to better determine how well the patient is responding to the particular medication, what social or environmental factors affect the state of the patient’s respiratory system, and what changes could be made to improve the patient’s health.
In just two years, the RPM program paved the way for wider adoption of virtual health tools. As we emerge from the pandemic with a greater level of comfort in using digital health tools in the care of chronically ill patients, it will be interesting to see how the CMS RPM program evolves and how 100Plus responds.
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Photo: Maria Symchych-Navrotska, Getty Images