beyond telehealth - wild apricot
TRANSCRIPT
Beyond Telehealth: Expanding Patient Care and Generating New
Revenue With Remote Patient Monitoring
Sponsored By:
Meet the Presenter
Jake LevyPresident, Health Tech Associates LLC
Jake is a serial entrepreneur and thought-
leader with 25+ years of healthcare technology
innovation. His passion for enabling better
care at home for patients has been a career-
long focus. He has pioneered software in
many areas of homecare and hospice with a
particular focus on telehealth and remote care.
Jake works with healthcare providers and
physicians across the continuum care in
Acute, Post-Acute, Long-Term and Outpatient
care settings to enable technologies to
improve patient outcome.
Telehealth in a COVID World
• On April 23rd CMS released a toolkit for states to accelerate the adoption of telehealth
• $250B in healthcare spend could shift to telehealth
• Level of telehealth adoption is up from 11% in 2019 to 46% of consumers
• 64% of providers are more comfortable with telehealth since COVID
• 23 states now cover the use of Remote Patient Monitoring
$250B
What is RPM?
“Remote Patient Monitoring is the use of
technology to measure a patient’s physiologic
parameters at home.”
Delivering Timely Care into the Home
Feedback
Communication
Education
Compliance
Self-Care
Safety
What Does RPM Offer?
Real-TimeData
Vitals
Surveys &Med
RemindersPatient
Education
VideoAudioChat
CaregiverEngagement
Alert & ComplianceMonitoring
5 Steps To Start Your RPM Program
Step 1: Understanding Reimbursement
Step 2: Evaluate Patient Population
Step 3: Identify Staffing Requirements
Step 4: Select an RPM System
Step 5: Measure KPIs for Success
Step 1: Evaluate Reimbursement
CPT 99453: $21 one-time setup
CPT 99454: $68 / month for devices
CPT 99457: $54 / month for 20 mins monitoring
CPT 99458: $43 / month for +20 mins monitoring
* National average based on CMS physician fee schedule(https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx)
Total: $165/month*Factor in 20% Medicare Co-Pay
Plus potential revenue for CCM, TCM, BHI
CPT CODES IN DETAIL
Step 1: Evaluate Reimbursement
CPT CODE CMS REG WHAT TO KNOW99453 “Remote monitoring of physiologic parameter(s) (e.g, weight,
blood pressure, pulse oximetry, respiratory flow rate), initial;
set-up and patient education on use of equipment.”
One-time reimbursement for the work associated with
onboarding a new patient, setting up the equipment and
educating the patient on using the equipment. The average
national Medicare payment for these services is $19.46.
99454 “Device(s) supply with daily recording(s) or programmed
alert(s) transmission, each 30 days.”
Reimbursement for providing the patient with a RPM device
for a 30-day period. Requires minimum of 16 days of readings
per period. Note that 99454 can be billed each 30 days.
Devices must be FDA listed. The average national Medicare
payment for these services is $64.15.
99457 “Remote physiologic monitoring treatment management
services, 20 minutes or more of clinical staff/physician/other
qualified healthcare professional time in a calendar month
requiring interactive communication with the
patient/caregiver during the month.”
Reimburse for clinical staff time that contributes toward
monitoring and interactive communication which includes
video, phone, text and email in a calendar month. Does not
require face-toface exam. The average national Medicare
payment for these services is $51.54
99458 “Remote physiologic monitoring treatment management
services by clinical staff/physician/other qualified healthcare
professional that exceeds first 20 minutes in a calendar month
requiring interactive communication with the
patient/caregiver during the month.”
As of January 2020, care providers can bill an additional 20
mins each month for monitoring
RPM at an estimated $43.
99091 Collection and interpretation of physiologic data (e.g., ECG,
blood pressure, glucose monitoring) digitally stored and/or
transmitted by the patient and/or caregiver to the physician
or other qualified health care professional, qualified by
education, training, licensure/regulation (when applicable)
requiring a minimum of 30 minutes of time, each 30 days.
Introduced in 2002, is limited only to “physicians and qualified
health care professionals” and does not expressly allow the
RPM service to be delivered by clinical staff (e.g., RNs, medical
assistants, etc.). Requires at least 1 face to face exam annually.
The average national Medicare payment for these services is
$58.38.
Step 1: CMS Reimbursement
$-
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
50 PATIENTS 150 PATIENTS 300 PATIENTS
NEW RPM REVENUE (LESS SYSTEM COST)
Step 2: Evaluate Patient Population
56% of all Americans over 65 have 2 or more chronic diseases
• Focus on higher risk patients
• Other factors affecting program eligibility:
- Cognition
- Age
- Willingness to Participate
- Caregiver Support
Step 3: Staffing Requirements
Remote Patient MONITORING (99457/8)
• Examine current supportive clinical staff
• Direct communication with patients
• 2020 Third-Party Monitoring Option
• Don’t Confuse RPM with PERS
Step 4: Selecting an RPM System
Lots of Moving Parts
• Engagement for Patients
• Staff Efficiency
• Ability to Grow with Your Practice
• Turn-Key Solution
Step 4: Selecting an RPM System
Patient Engagement
• Coach Patient to Improve Utilization
• Provide Education to Modify Behavior
• Multiple Levels of Engagement
• Include Caregivers and Family Members
Step 4: Selecting an RPM System
Patient Engagement
1. 2.
3. 4.
Reminder to take Vitals
Pain Scale
Medication Survey
Patient Education
Step 4: Selecting an RPM System
Ease of Use for Staff
• Workflow and Decision – Risk Stratification
• Efficiency of Converting Monitoring Time to
Billable Events
• Highly Mobile – Smartphone Enabled
• Minimal IT Burden
• Ability to Integrate with EMR
Ease of Use for Staff
Step 4: Selecting an RPM System
Step 4: Selecting an RPM System
Ability to Grow With Your Practice
• Scalability of Software
• Configurability & Expansion of Content
• Multiple Deployment Options for Patients
• Ability to Work with Multiple Devices
Step 4: Selecting an RPM System
Ability to Grow With Your Practice
Step 4: Selecting an RPM System
Turn-Key Solution
• Devices: Tablets, Smartphones, BYOD, IoT
• Sensors: Monitors & Wearables
• Software: Clinical, Inventory, Tracking
• HIPAA Security: Samsung Knox, AWS, Microsoft Azure
• Communications: 4G Cellular & WiFi
• Logistics: Kitting, Patient Deployment, Refurbishment
Step 5: Measuring KPIs for Success
Moving from Getting Started
• Patient Utilization & Compliance
• Reduced Readmissions
• ED Avoidance
• More Favorable Patient Survey
• Increase in MIPS scores
• Level of Reimbursement
Summary
Success requires careful planning & solutions developed
specifically for your senior chronic care patients
Engage Patients
Improve Compliance
Change Behavior
