It started with telehealth’s rise to popularity. As a result of the COVID-19 pandemic, telehealth took on a new life. Patients weren’t comfortable traveling to their doctor’s office unless it was absolutely necessary; a telehealth visit was safer. Consequently, physician offices embarked on crash courses in telehealth.
The Centers for Medicare & Medicaid Services (CMS) helped expedite the surge in telehealth use by easing prior restrictions for use by rural patients only. Consumer adoption of telehealth increased, from 11% in 2019 to 46% as of April of this year, in order to replace cancelled health care visits, according to a McKinsey & Company report. Furthermore, 76% of consumers said they were highly or moderately likely to use telehealth in the future.
According to the report, virtual health is the next frontier of care delivery. As a result, opportunity exists for health systems to enhance their value proposition for consumers in a way that creates new interactions or loyalty. Providers may build new capabilities that could lead to success in risk-based reimbursement models. Prior to the COVID-19 pandemic, one study found that health systems, under value-based care arrangements, demonstrated 17% savings when they provided virtual care with their existing health care professionals instead of using an outsourced provider.
In addition to serving the needs of a broader consumer base, virtual health can provide an opportunity to improve care and value for chronic disease patients in a way that could position health systems to succeed in risk-based reimbursement models. In a February 2020 consumer survey, 48% of respondents aged 50 or older said they would be likely to seek virtual channels of care in addition to or in place of physical visits. Not surprisingly, they cited convenience of accessing health care from home (including the ability to avoid the commute and time away from work or family) and easier access to a doctor (including shorter wait times and the ability to access care during off hours). Bringing care closer to the patient through the use of virtual health technologies may be critical to capturing growth opportunities as consumers demand more integrated and accessible care solutions.
Remote Patient Monitoring Enhances Telehealth
Telehealth can’t do it all. While providers can “see” patients in a telehealth visit, they can’t monitor vital signs. The increased use of telehealth during the pandemic exposed some of the limitations of the technology. Vital sign readings, such as blood pressure, temperature, and oxygen saturation, were missing. That is the role of remote patient monitoring (RPM): enhancing the telehealth visit by providing a more complete picture of the patient’s health. With the onset of COVID-19, RPM soon became the disruptor shaping the future of health care delivery.
The use of RPM accelerated rapidly when COVID-19 hit, as patients were being monitored at home rather than making trips to the doctor’s office or a health care facility, thus avoiding potential coronavirus exposure. Although RPM has accelerated the value of telehealth during the pandemic, its real purpose is for chronic care monitoring.
RPM can connect patients to their care teams, providing the real-time data needed to control symptom and disease progression. According to the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion, chronic care management represents 90% of total health care spending in the United States and typically involves resource-intensive support along the continuum of care.
RPM provides a better care path. The physician sets the target parameters for each patient’s vital signs, and patients take their vital signs every day. An ideal RPM program triggers a critical alert if a patient’s vital signs fall out of their normal range. These critical alerts serve as proactive intervention to address any health issues that arise, which can help keep patients out of the emergency department and prevent readmissions.
Ideal Patients for RPM
While RPM can be utilized for any patient, “well” patients are not a high risk for readmission and are less likely to monitor their vital signs on a daily basis. These patients would benefit from a telehealth visit on an as-needed basis.
During COVID-19, RPM is being utilized to monitor patients at home, keeping them out of the hospital or the physician’s office, reducing contact with the medical staff, and essentially decreasing the need for personal protective equipment.
RPM’s ongoing use, however, is for chronic care management. It is very beneficial for patients with chronic illnesses such as congestive heart failure, diabetes, and COPD. RPM also is useful for patients who are considered “moderate to severe” in their disease state or who have comorbidities, eg, hypertension, obesity, or coronary artery disease. RPM can detect high blood pressure, low oxygen levels, increases and decreases in weight (due to medications), arrhythmias, high temperature, and elevated blood glucose levels.
Reimbursement Is the Key to Broader Adoption of RPM
Physician reimbursement for RPM is encouraging and is certainly a factor in determining its use. Medicare and many commercial payers cover RPM, and, according to the Center for Connected Health Policy, 23 state Medicaid programs currently reimburse for RPM. It started when CMS expanded chronic care management to include RPM. There are CPT codes for the work typically performed around RPM programs, including training patients on equipment, supplying devices, receiving and collecting electronic transmissions, monitoring clinical data, and interactively communicating with patients.
Additionally, CMS just recently expanded its guidelines to begin allowing clinical staff to perform these services under the supervision of physicians. Under this guideline, physicians are no longer required to be on site when the associated services are performed, so physicians can devote their time to more complex treatments and procedures while clinical staff perform these monitoring services.
The Future for RPM
Despite the questions that exist around post–COVID-19 telehealth, RPM is here to stay, and its utilization will increase significantly.
A recent Medical Economics article points out that the next wave of innovation in the fight against COVID-19 must focus on expanding the use of RPM tools to help predict future outbreaks and serve as early warning systems for detecting the virus in individuals in order to contain exposure and spread.
The future of RPM is yet to be seen. Beyond its primary use for monitoring chronic disease patients and its developing role with COVID-19, the future of medicine may lie with the expansion of technological advances in virtual care.
— Jorge Rodriguez is vice president at WITHmyDOC, a digital health company that uses a web-based intelligence platform for remote patient monitoring to transform health care. He has worked in health care for 25 years. Rodriguez can be reached at firstname.lastname@example.org or 786.621.2910.