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Keith Loria is a contributing writer to Medical Economics.
Devices take some of the pressure off a healthcare system coping with COVID-19.
Remote patient monitoring, once the province of early adopters and healthcare’s gadget geeks, has become mainstream during the COVID-19 pandemic. Hospitals are using remote monitoring to reduce spending on personal protective equipment and free up beds for patients with COVID-19. Many clinicians appreciate that this technology allows them to keep tabs on patients in continuous real time instead of periodically at checkups. There are also pluses for patients.
“There are many aspects of patient care delivery and monitoring that can now be successfully accomplished outside of the traditional healthcare setting,” says Donna Morrow, vice president of clinical operations at Noteworth, a digital health company headquartered in Hoboken, New Jersey. “This is providing peace of mind to the patient and reducing exposure.”
Eric Rock, founder and CEO of Vivify Health, says the immediate future of remote patient monitoring will rest on its scalability and the level of information it provides.
“Instead of asking the exact same biometric measurement questions of someone every day, [remote patient monitoring] will engage the patient with more meaningful content that is tailored and adaptive to patients’ responses,” he says. “The tool will have its own rules and logic built in and will ask a sequence of questions much [as] a nurse would. Intelligent content has been shown to facilitate patient engagement, which positively [affects] outcomes.”
FDA regulations help
That may all be true, but there’s also the grittier reality that the future of remote patient monitoring, as with so much else in healthcare, depends on federal government regulation and reimbursement, especially Medicare reimbursement. Part of the reason for the crescendo of remote patient monitoring is an FDA decision in March 2020 to relax its regulation and a subsequent guidance in October that expanded upon the policy.
“In the context of the COVID-19 public health emergency,” the FDA guidance states, “the leveraging of current noninvasive patient monitoring technology will help eliminate unnecessary patient contact and ease the burden on hospitals, other healthcare facilities and healthcare professionals [who] are experiencing increased demand due to the COVID-19 pandemic as it relates to diagnosis and treatment of patients with COVID-19 and ensuring other patients who require monitoring for conditions unrelated to COVID-19 can be monitored outside of healthcare facilities.”
Philip Golz, vice president, commercial, at Spire Health, which sells remote patient monitoring technology for chronic respiratory disease, says changes in the 2021 Medicare physician fee schedule finalized by CMS at the beginning of December 2020 also will bolster remote monitoring.
“In particular, [it is helped by the requirement] that the technology used for [remote patient monitoring] is capable of transmitting data automatically and at least 16 days per month,” he says. “The new changes aim to ensure the technologies provide meaningful data and are patient-friendly.”
Clinicians see the benefits
Remote patient monitoring is part and parcel of the COVID-19-inspired shift to telehealth. Anish Sebastian, CEO and co-founder of Babyscripts, a virtual maternity care company in Washington, D.C., says that before the pandemic, telehealth was an option that set a practice apart from the competition. Now it’s standard-issue healthcare. “Because of COVID-19, providers really had no choice but to let go of their concerns about telehealth and implement virtual solutions for their patients,” he says. “Before, (remote patient monitoring) was being tested out and piloted primarily with low-risk patients, but COVID-19 drove providers to offer it for all risk profiles, sometimes supplemented with in-person visits.”
Now that clinicians have seen the benefits of remote patient monitoring, they are much more comfortable weaving it into their practices, he says.
“It’s especially important for health systems that are feeling the financial strain of the pandemic to offer these enhancements to patients, and we’re seeing new reimbursement codes and payer reimbursement mechanisms that are making it easier for practices to use (the technology),” Sebastian says.
Prior to the public health emergency, Medicare coverage of remote patient monitoring services was limited to patients with one or more chronic conditions. However, as patients were being encouraged to stay at home, the need for remote monitoring to treat patients with acute, time-limited conditions (such as COVID-19) became all the more critical. Confirmed in the 2021 Final Rule, CMS clarifies that providers may furnish RPM to collect/analyze physiological data from patients with acute and chronic conditions.
It’s also attractive to patients who worry about possible exposure to the virus during an in-person visit. “With the availability of remote patient monitoring, [Noteworth] is allowing providers to keep patients out of the hospital and physician office settings,” Morrow says. “This is especially important for the at-risk population. And with the changes enacted by CMS to open the patient population that could utilize remote patient monitoring, this expanded to the acute conditions as well. This opened up greater engagement and accountability for the patient and the care team.”
Robin Hill, chief clinical officer of Vivify Health, notes that leveraging remote patient monitoring quickly has enabled clinicians to keep an eye on their patients without going into the home. “Because of the social isolation, using our solution to provide that human touch virtually helped support our patients holistically,” she says. “Our solution has also helped decompress some pressure on health systems that were at capacity with the influx of [patients with] COVID-19 by being able to remotely screen and/or monitor patients and/or employees [for the virus].”
Tomas C. Walker, vice president of clinical affairs at Dexcom, a San Diego-based maker of continuous glucose monitoring systems, says changing standards of care in the current COVID-19 environment led to rapid development in monitoring technologies.
“One of the clinicians we work with told us that the hospital staff and administrators grasped the value and the potential of remote monitoring and care and that they will never go back,” Walker says. “I think we can safely state that the genie is out of the bottle on this one. Remote care and telehealth have been given a huge opportunity with COVID-19, and we are seeing the benefits of a lot of previously unnoticed work.”
Well-suited for diabetes care
Although remote patient monitoring isn’t confined to any particular demographic, it may be especially valuable when it comes to caring for elderly people. About 1 in 4 seniors lives alone. Even before the pandemic, access to in-person care was far from a sure bet. Social distancing requirements because of COVID-19 make in-person care even more difficult, so remote patient monitoring is extremely important in this group.
Walker says that remote patient monitoring is a hot topic right now, with data from continuous glucose monitoring playing a central role. His company has integrated data from Bluetooth-connected insulin pens into its reports. “Clinicians who may be used to looking at insulin pump printouts where you can see insulin dosing and meal boluses now get that same feature (virtually) with continuous glucose monitoring.
Remote monitoring is bringing together data produced by insulin pumps, glucose meters, smart pens and other devices that people who have diabetes depend on, says Diana Isaacs, Pharm.D., continuous glucose monitoring program coordinator for the Cleveland Clinic Diabetes Center.
“There are now more sophisticated mobile apps that can connect with these devices and automatically upload data to a portal so data can be viewed in nearly real time,” she says. “Also, many of the systems can be set up to flag for things (such as) hyperglycemia and hypoglycemia. There are also smart scales and blood pressure cuffs. Many apps can integrate with Apple’s Health app to view other things, too, (such as) heart rate, (daily number of) steps and sleep quality.”
Maternal health has seen a big jump in remote patient monitoring, with companies such as Babyscripts taking the lead. “Pregnant moms are more anxious than the typical population (about risking) exposure to COVID-19 by coming into the office,” Sebastian observes. “They’re also the perfect age for using technology in their healthcare, making them an ideal demographic for remote monitoring.”
Still, partly because remote patient monitoring is relatively new to the healthcare field, there are problems that need to be sorted out, not the least of which is payment. “The reimbursement through insurance companies is inconsistent,” Isaacs says. “Fortunately, the coverage is improving, but not all plans reimburse yet, and copays can vary.”
Isaacs also noted that the number of remote monitor systems has proliferated. “We don’t yet have the perfect system that can work with all devices and directly send data to the electronic medical record,” she says.
Sebastian says incorporating remote monitoring — and the data it produces — into the workflow of clinicians is a concern: “If workflow is not simple, intuitive and well-integrated, [remote patient monitoring] is going to fail.”
Some of the biggest worries about remote monitoring have been privacy and security. They haven’t gone away, even if the pandemic has shifted attention away from them.
“As with everything health-related, data privacy and security are also going to be concerns,” Sebastian says. “Even with the COVID-19 surge, providers are still wary of handling sensitive information through technology because of the potential for security breaches.”
Golz notes that remote patient monitoring is still considered new by many. He sees more innovation in the offing. “We believe that, as it evolves, [remote patient monitoring] will become more robust as the monitoring technology improves, the evidence supporting its use develops and the ability to share data across systems increases,” he says. “Changes [such as] those described in the 2021 physician fee schedule continue to drive the industry toward offering technology that is easy for patients to use and provides clinical value.”
Sebastian thinks there will be remote patient monitoring in every person’s home in the next 10 to 15 years, maybe sooner.
“Insurers are starting to see the benefits and are finding mechanisms for reimbursement outside the normal CPT and billing codes,” he says. “With financial barriers removed by the payer, providers are going to make [remote patient monitoring] a standard enhancement to the delivery of care.”
Physician shortages have made asynchronous methods of care delivery an imperative. For patients who are facing barriers of access — social or geographic — a remote connection to the provider is even more important for continuity of care. That’s why Walker sees remote patient monitoring as a robust part of future healthcare for both inpatient and outpatient care.
“Now that (clinicians) have had the opportunity to engage in this, we are seeing the full potential of remote monitoring and distant care,” says Walker. Just as remote learning became an option in education, remote care has become an option in healthcare, says Walker. “Patients and clinicians have been thinking about this for a long time, and now that they are engaged in this practice, it is not going away.”
Keith Loria, a frequent contributor to Managed Healthcare Executive®, is a freelance writer in the Washington, D.C., area.