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Can Remote Patient Monitoring help my ESRD patients?

Martin Shapiro, MD
Jul 6, 2020 8:24:19 AM

Renal Disease patient population leads hospital admissions among chronic diseases. Utilizing Remote Patient Monitoring (RPM) can improve outcomes for Early Stage Renal Disease (ESRD)

In 2016, chronic kidney disease care and end stage renal disease (ESRD) care in Medicare cost over $79 billion and $35 billion respectively, or 20% of overall healthcare expenditures. With the highest risk of hospitalization, ESRD patients are being admitted more often than conditions of heart failure, pulmonary disease and cancer. However, given advances in telemedicine technology and remote monitoring tools, providers now have increased abilities to manage ESRD and intervene before hospital admissions. Recognizing this opportunity, CMS has expanded access to Medicare telehealth services to better support patients and the physicians providing care. In this article, we will discuss how to use virtual visits and remote monitoring to improve outcomes of patients and the billing for these encounters.

Remote Patient Monitoring (RPM) Empowers Continuity of Care: 

  • Blood Pressure: Home blood pressure devices allow for a consistent measurement of disease severity and allows for accurate therapeutic intervention. One of the challenges on managing blood pressure is having a measurement reflective of the patients current health status rather than a standalone clinic office that may be affected by factors such as whitecoat hypertension. However, home blood pressure monitoring has been shown to be able to provide a more accurate picture through daily patient measured values yielding a more prognostic assessment of their kidney disease. Optimize.health provides an intuitive, easy to use dashboard allowing for visualization and prioritization of patients demonstrating the most at-risk blood pressure measurements and the ability to view the trends and individual measurements of this patient over time to inform therapeutic management.
  • Weight Scales: Similar to heart failure, ESRD patients can also use daily weight measurements through at home scales to use as a proxy for fluid overload.  When a practice is able to see these readings through an RPM program  they can help patients  avoid hospitalization. Using a telehealth weight measurement device has also been shown to improve patient satisfaction.

Virtual Visits improve patient experience and prevent adverse healthcare events:

  • Telehealth: Enabling telehealth visits removes barriers to access of care for patients, increasing satisfaction and patient independence by decreasing the hassle of travel and allowing for flexibility of scheduling. In addition, a higher touch of communication and management allows for avoidance of complications and prevention of admissions, especially when informed with monitoring data described above.

 

How Virtual Visits and Remote Monitoring Also Expand Revenue Streams:

  • RPM Billable Services Compensate Your Practice for Reviewing Physiological Health Metrics: Providers have the opportunity to be compensated for providing enhanced care to their patients through remote monitoring. The provider is then able to be reimbursed for services including initial setup, patient education, supplying devices, and time spent on remote monitoring services through CPT Codes (99453-99458). The optimize.health platform automates the collection of this information, allowing for easy billing and auditing which gives your staff valuable time to focus on caring for patients.
  • CMS Expands Telehealth Coverage in light of COVID-19: The highlights of the three main types of Medicare virtual services are discussed below with more comprehensive information available at CMS
    • Medicare Telehealth Visits: Starting March 6, 2020 for the duration of the COVID-19 Public Health Emergency, these visits will be considered and paid at the same rate as in-person visits. Visits can be conducted at any healthcare facility or the physician’s home and no prior relationships between the patient and physician will be audited by the HHS during the public health emergency.
    • Virtual Check-Ins: For established patient and physician relationships, virtual check-ins can be billed through HCPCS codes G2012 and G2010.
      • “HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
      • “HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.
      • E-Visits: For established patient and physician relationships, doctors can bill for non-face-to-face patient initiated communications through online portals.
        1. “99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes”
        2. “99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes”
        3. “99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.”

Dr. Martin Shapiro, MD
By rpm.expert: Martin Shapiro, MD, MBA
Martin is a Family Medicine Resident at UCSF with a passion for health technology and care delivery innovation. Prior to his work with optimize.health, Martin received his MBA from USC and a Bachelors of Science in mechanical engineering from Yale.
 

 


Sources:

 "v2 CH9 Healthcare Expenditures for Persons with ESRD." https://www.usrds.org/2018/view/v2_09.aspx. Accessed 8 Apr. 2020.

 "Predicting risk of hospital and emergency department use for ...." 14 Nov. 2014, https://www.ncbi.nlm.nih.gov/pubmed/25391559. Accessed 8 Apr. 2020.

 "Medicare Telemedicine Health Care Provider Fact Sheet - CMS." 17 Mar. 2020, https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Accessed 8 Apr. 2020.

 "Practical Use of Home Blood Pressure Monitoring in Chronic ...." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164080/. Accessed 8 Apr. 2020.

 "Satisfaction and Improvements in Peritoneal Dialysis ... - NCBI." 1 Mar. 2017, https://www.ncbi.nlm.nih.gov/pubmed/28246673. Accessed 8 Apr. 2020.

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