Healthcare providers, patients, and all of us in general, hear the terms every day – telehealth, virtual care, remote care. The talk intensified even more in the depths of COVID-19, and for good reason. Patients and providers alike benefit from Virtual Care Services (VCS), so much so that the industry is changing fundamentally, and quickly.
Medicare (CMS) helped spur the movement by creating reimbursement programs that help practices improve patient outcomes as well as their own profitability, all crafted within the last several years. One of the most basic – and practical – of these is Remote Patient Monitoring (RPM), which allows patients to take and transmit their vitals from home, saving a trip to the doctor’s office, providing more insight into their health and freeing up that doctor’s schedule for more complex procedures.
What’s not to like? Everyone benefits from the program. In support, CMS has created and expanded upon a wide range of CPT codes specifically for RPM and other VCS services. Yet the program hasn’t yet achieved the sort of utilization that many analysts would have expected to see. A recent comprehensive study from Definitive Healthcare, in fact, states that, at most, 25 percent of U.S. practices currently utilize RPM.
Applying typical rates of enrollment to that figure, it’s fair to say that no more than 10 percent of eligible patients (covered by Medicare and/or private insurers) currently make use of the service. Remember, there are over 60 million Americans on Medicare! Millions of others over 65 use private insurance as well.
So, what’s the holdup? Aren’t programs like RPM the patient-facing future of healthcare? The American Medical Association certainly thinks so, publishing this guide to help providers set up and maintain a remote care regimen. The U.S. Department of Health and Human Services created this resource, broken down by specialty, for the same purpose.
Such authoritative voices are speaking out from both convenience and necessity;: they realize in many ways the care industry iIs as competitive as any other, and practices who offer VCS programs to patients, particularly those with mobility or access issues, create an advantage for themselves.
Yet there are perceived drawbacks to RPM, and the Definitive Healthcare report cites a handful of them. Are they valid? Is RPM too good, or too costly, or too burdensome to be true? We’ll discuss these concerns, and how HealthXL® addresses each uniquely.
Issue No. 1: Data security and accuracy
Providers are constantly faced with HIPAA compliance concerns as it is. Would remote care imperil PHI (Protected Health Information) just for the sake of saving a patient a few trips to the practice? And can patients be counted on to accurately – and consistently – record their own vitals data?
HealthXL®’s solution: Our proprietary software platform, iCare by HealthXL, uses Amazon Web Services (AWS) cloud technology to safeguard patient data, from transmission (using 256-bit encryption) to storage (using Amazon’s S3 storage services) to access within iCare (minimizing storage space and limiting data visibility based on user credentials). You can gorge yourself on nerd talk if you like – and here’s a good primer on AWS if you’re so inclined – but all you really need to know here is we use technology that’s continually evolving to keep your patient data secure.
What’s more, we are required by HIPAA regulations to sign a business associate agreement (BAA) with every client for whom we provide Virtual Care Services, including RPM, to ensure complete protection of their PHI. It’s not a responsibility we take lightly!
As for the accuracy of the data itself, our licensed Care Coordinators walk patients through the process of setting up their devices (blood pressure cuffs, pulse oximeters, etc.), helping ensure confidence and consistency in recording readings. If something requires the program’s attention, we send it on immediately. Otherwise, the workflow rolls along with no necessary intervention from the provider.
Issue No. 2: Fee-for Service payment structure
Understanding the finances of remote care can be worrisome as well – namely, how complicated is the process of billing Medicare and/or private payers? And how can practices be confident they’re meeting all the care-related requirements involved in billing in the first place?
HealthXL®’s solution: While CPT codes give the billing process some structure (CMS wants to make things easier, after all), we track all compliance items, from patient enrollment to device ordering and delivery, as well as monthly servicing, including documenting that sufficient patient readings and phone interaction have been achieved.
Accordingly, HealthXL® delivers providers a fully documented and compliant list of services provided when it’s time to invoice Medicare and other insurers. And, critically, we maintain all compliance checks and data in the event of periodic, standard CMS audits.
Issue No. 3: Staff training and infrastructure requirements
Overworked, understaffed providers typically assume a new process, by definition, means overhead in the form of man-hours and expenses. Why would RPM be any different? Even if they outsource the service, won’t it take time and effort to get it started and keep it up?
HealthXL®’s solution: In a word, no. We handle all elements of the program, under the provider’s general supervision. Once we have access to the practice’s EMR (Electronic Medical Records) system, we work hand in hand with the provider to identify the patients that will benefit from the program – based on the CMS criteria, treatment needs and insurance – and contact them. If they elect to enter the program, we document their consent, send them the appropriate devices, get them up and running, and overall make sure they understand and are comfortable complying each month.
And there’s no need for new equipment within the practice, such as computers or servers, because everything “lives” at our end. Physicians can access patient information whenever they like, of course, a simple process because we update their EMRs automatically – safely and securely.
Issue No. 4: Does it make sense financially?
There are geographical variances in what CMS allows for remote care services billing, and some providers have expressed concern that these differences can lessen the motivation to start such programs. And Medicaid currently allows for only 34 states to bill for RPM. So, are there some areas where RPM simply isn’t practical?
HealthXL®’s solution: In reality, geography is often a prime motivation for using RPM, since many patients in more rural areas are greatly aided by fewer trips to the doctor. And reimbursement rates are adjusted by geography, as evidenced by CMS’ Physician Fee Schedule.
We have clients in both highly urban and rural locations, and everywhere in between across the country, and they’ve never mentioned reimbursement rates as a reason to not offer the program. Ultimately, if it makes sense for a broad number of their patients, the providers weigh the increased care value first.
Issue No. 5: Patient technology barriers
Some providers – and sometimes patients themselves – worry about connectivity issues based on their location. What if wi-fi isn’t available at the patient’s home? And isn’t it a leap of faith to assume that all patients (typically seniors) will even be willing and able to use the devices?
HealthXL®’s solution: Our devices, provided by LiveCare, use Link+ auto-pair technology to record and transmit readings data, needing only a cellular connection – and wi-fi, where available, works just as well. Meanwhile, our Care Coordinators, as always, interact regularly with patients, making sure their devices are being used correctly and are transmitting reliably.
One theme you should notice throughout this discussion is that HealthXL® handles all the detailed, time-consuming work involved in creating and administering a successful, sustainable and compliant Remote Patient Monitoring program, no matter the size or scope of a practice.
RPM’s usefulness and sustainability was confirmed during COVID-19 and is, essentially, a use it or lose it proposition: if you’re already using remote services begun by necessity during the pandemic, why not expand the process and improve your monthly cash flow along the way? All we need is EMR access, then we get you up and running by overseeing patient enrollment and going from there.
Contact us to find out more about HealthXL®’s innovative, turnkey solutions for Remote Patient Monitoring and other Virtual Care Services.