RPM means remote patient monitoring and
will be here to stay under the Affordable Care Act (ACA). Initially
this started with heart patients, but it will expand. And yes,
diabetes is on the list of types of patients that will be remotely
followed. Now why would they do this, considering that few type 2
diabetes patients receive education on managing their diabetes? Not
only that, but without the personnel available to educate people with
diabetes, how can they expect patients with type 2 diabetes to feel
anything but contempt for remote patient monitoring.
I expect to see something appear in the
American Diabetes Association (ADA) website as early as this summer
hinting at the possible monitoring to be done and when it will start.
Then, I am guessing that the ADA 2014 guidelines will have much more
to say about this. If not this summer, then announcements will
happen by the summer of 2014 and will be part of the ADA 2015
guidelines. It is coming and of this, I have no doubt.
This press release says a lot about RPM
for five major chronic illnesses that will grow by 6-fold by 2017.
This is because the ACA will be pushing hospitals and physicians to
stop the revolving door treatments by hospitals. In 2012, clinicians
reviewed remote patient monitoring data for about 227,000 patients
with congestive heart failure (CHF), chronic obstructive pulmonary
disease, diabetes, hypertension, and mental illness. The
figures include a number of other patients with asthma, coronary
artery disease, and hemophilia.
CHF patients were almost half of PRM in
2012. In 2017, diabetes will overtake CHF and the monitoring will
grow by 67.5 percent from 2012 to 2017. The next fastest group of
RPM will be patients with mental illness. Demand for this monitoring
comes from patients and private insurers, which seek to reduce costly
hospitalizations. All of these trends build on an even larger one, an
aging population beset with chronic conditions.
The ACA will bring financial incentive
into play to promote RPM and this will mean rewards for physicians
and hospitals that comply. In addition to sharing payment for an
episode of care, they will earn a bonus, or take a pay cut, depending
whether they come under or exceed a cost target. With the financial
incentives and penalties that the ACA can and will enforce, hospitals
and physicians will have money reasons to physically monitor
patients. Then there are those providers that want to remotely
patient monitor at home for improved care whether there are monetary
rewards or not.
The one factor not included in this
article if the role of the Food and Drug Administration and how fast
they will be approving these remote monitoring devices. This
could be the flaw in the current thinking, but this should not delay
progress for long as CMS and most insurance payers are on board and
looking to the benefits this will provide.
Currently, the task of reviewing RPM
data falls to nurses at third party triage and call centers services.
They then alert the relevant physician to flagged changes.
Currently, under the existing fee-for-service reimbursement, there is
no incentive to take remote medical data that will not result in a
billable office visit. Under the ACA, there will be many financial
incentives for physicians to change their way of doing business
including penalties.
Presently, remote-monitoring systems
are relegated to call centers, but this will change as pressure is
put in place for the electronic health records (EHR) to be capable of
tracking this data. Yes, the manufacturers of EHR systems are
balking; however, congressional pressure is being applied quite
liberally to force them to make their systems more responsive to
receiving RPM data and working together (interoperability) to
correspond with competing EHR systems. This can only be positive as
the Health and Human Services and Centers for Medicare and Medicaid
are applying pressure saying their systems will not meet useful
standards, as they exist. The pressure is to make all systems
“telehealth-ready.”
No comments:
Post a Comment