- Not content to wait for insurers to reimburse them for telehealth, some health systems are launching remote patient monitoring programs with an eye to avoiding unnecessary expenses.
In Hudson, N.Y., Columbia Memorial Hospital is sending telehealth kits home with about 50 patients in an effort to keep them from returning to the hospital. The kits, which include Bluetooth-enabled scales, blood pressure cuffs and pulse oximeters and an iPhone programmed with an RPM app, enable those patients to check their vital signs daily, answer a questionnaire and communicate with their case manager when necessary.
“Sometimes these patients go home and they start deteriorating, but no one is around to pick up on that quickly enough, and we see them right back here,” says Dr. Ronald J. Pope, medical director of CMH Care Centers and the program’s creator.
Pope, who secured grant money for the initial batch of 50 RPM kits, developed by a local telehealth company called YouThisMe, says roughly 20 percent of discharged patients end up back in the hospital within 30 days due to complications that could have been avoided had the hospital been able to monitor those patients at home. For a typical hospital, those readmissions will cost the hospital between $500,000 and $1 million in penalties.
Pope figures the program will pay for itself if it can reduce hospitalizations by at least one-third.
He says he’s seen some interest from private payers, and is checking to see if the program qualifies for New York’s Delivery System Reform Incentive Payment (DSRIP) program, which reinvests Medicaid money in innovative programs that reduce avoidable hospital use.
“We’re kind of at the cutting edge of these projects,” he says, estimating that the health system is now about 20 percent value-based and 80 percent fee-for-service. “We want to reduce costs, but we’ll need data to demonstrate value.”
The challenge isn’t new. Remote monitoring pilots and programs across the country have sought to prove that home-based telehealth can reduce hospitalizations, improve clinical outcomes and cut down on unnecessary medical expenses. In 2015, a group of organizations led by the American Academy of Family Physicians, AARP and Stanford Health Care urged the Senate Finance Committee to compel the centers for Medicare & Medicaid Services to improve RPM reimbursements.
“Achieving the goals of value-based care will require investment in new tools that improve patient engagement, increase care coordination, decrease inappropriate resource utilization and allow providers to monitor and communicate with patients for whom they will now be responsible for total cost and quality of care,” the letter, directed to Senate Finance Leader Orrin Hatch and ranking Democrat Ron Wyden, said. “Connected care technologies like telemedicine and remote patient monitoring are an investment that will help actualize the vision embedded in these transformative programs and deliver on the promise of value over volume in healthcare.”
The RPM market also caught the attention of research firms like Spyglass Consulting and Chilimark Research. But while Spyglass founder and managing director Gregg Malkary saw the market as being “very bullish” in 2015, Chilimark urged healthcare providers to wait, saying the market hadn’t reached maturity yet.
“Outside of the small pack of large provider systems innovating, the average health system or small hospital will simply wait until there is a better reimbursement climate,” the firm said.
The potential is evident: “Though we are in the early days of this market, connected health holds tremendous potential for everyone involved: For health system executives tasked with bending the cost curve, for nurses and doctors charged with caring for a highly complex patient population, and especially for patients and their loved ones tasked with figuring out an illness they may not understand or be able to manage on their own.”
Among the successful implementations of RPM technology was a year-long program undertaken by Pennsylvania-based Capital Blue Cross and mHealth company Geneia in 2016. That program found that an RPM platform for patients with heart failure saved more than $8,000 per patient and reduced hospitalizations by 30 percent.
“Overall, the Geneia remote monitoring study, like other similar studies, shows largely positive clinical, utilization, cost and patient experience outcomes,” officials said of the @Home study. “When combined with a quality case management program, appropriate clinical support and a robust technology platform capable of collecting and synthesizing biometric device data, the @Home program demonstrates potential to reduce costs, improve outcomes and maintain a high quality of life for patients with chronic disease.”
Still, however, the environment is challenging. In a report issued this year, the Center for Connected Health Policy found some 22 states reimbursing through Medicaid for RPM, though those states vary greatly as to what they’re reimbursing.
“These differences are to be expected, given that each state defines its Medicaid policy parameters, but it also creates a confusing environment for telehealth participants to navigate, particularly when a health system or practitioner provides health care services in multiple states,” the CCHP report said.
Even the Government Accountability Office weighed in, noting in a report issued in April that providers aren’t embracing telehealth because they’re not being paid for the services.
“Regarding remote patient monitoring, officials from another provider association stated that Medicare’s valuation methodology for services results in low payment rates for remote patient monitoring, which these officials said remains a principal barrier to the use of these services,” the GAO reported.
As a result, providers like Columbia Health and MultiCare Health are looking beyond reimbursement and focusing on what they can save.
In Tacoma, Wash., the six-hospital MultiCare Health System’s Telehealth Chronic Disease Management program connects care providers with home health patients dealing with a variety of issues, including heart disease, COPD and pneumonia. The program launched roughly 13 years ago and now features about 100 nurse managers overseeing remote care for 80-90 patients apiece.
“You have to look at this from a cost-avoidance perspective,” says Lynnell Hornbeck, MultiCare’s home health manager, who notes Medicaid offers few reimbursement opportunities and Medicare shies away from nurse-coordinated RPM programs. “Cutting down on readmissions is our biggest driver.”
Hornbeck, whose department uses Honeywell Life Care Solutions’ tablet-based telehealth platform, says the technology helps caregivers collect physiological data, manage medications, make sure the patient adheres to the doctor’s care plan and schedule appointments.
“You’ve got to go right in there … and engage immediately” after the patient is discharged, she says. “This is a very good way to bridge that gap [between hospital and home] and manage these patients in their homes.”
“Prior to this, it was basically a phone call,” she adds.
Aside from collecting patient data and managing care coordination, the program also plays an important role in improving patient satisfaction rates, a key metric for measuring the health system’s adherence to accountable care initiatives. Hornbeck says MultiCare recently launched its own survey to gauge how its patients feel about their care.
“They are able to engage and go to a much better state of health,” she says.
Back at Columbia Health, Pope is looking toward long-term sustainability. He wants a chronic care management program that will eventually keep watch over patients no matter how long they’ve been out of the hospital.
“Most [RPM] programs are really designed strictly for cutting down the 30-day readmissions, which we get penalized for,” he says. “That’s nice, but it’s better patient care if we can keep them out of the hospital altogether.”