Traditional health insurance reimbursement to providers (though payment is a more appropriate word) for healthcare services and products is at the root of our healthcare crisis. Our traditional fee for service system in the USA rewards hospitals and providers for doing more (and more costly) procedures to patients. Some interesting findings from a study from Harvard Medical School were that the higher the cost of surgery, the greater the likelihood of complications and the more out-of-pocket a patient with Medicare or private insurance paid, the more complications were reported. In addition, if a patient paid for the surgery fully out-of-pocket or through government-funded Medicaid, the likelihood of complications was lower. The Affordable Care Act, which introduces newer payment models including bundled payments, is creating an economic environment which is conducive to the widespread use of remote patient monitoring (RPM) for recently discharged hospital patients and those with chronic diseases. RPM will be most focused on vital signs monitoring for cardiac and pulmonary patients and diabetes monitoring. Larger opportunities abound for weight management, medication adherence, and preventive medicine.
Recent institution of Medicare payment penalties for hospital readmissions is probably the most immediate impetus for the interest by healthcare systems in RPM. Studies at Johns Hopkins University and Geisinger Medical Center are just a few which demonstrate this utility of RPM.
RPM, will, in addition, foster other offshoot benefits of its technology. Firstly, I believe it will accelerate interoperability of disparate digital monitoring technologies, EHRs and patient portals. The ability of different technologies to talk to each other and to EHRs is at the heart of potential benefits of electronic health data. Secondly, it will change the culture of healthcare to shift the focus from the provider to the patient. Data emanating from patients will de facto involve patients more than they are now in their own care. Seeing the data will educate them and facilitate self-management (to detractors of the concept of self-management, patients have been self-managing diabetes for decades). RPM will increase interest in (and hopefully use of) patient portals which will be mobile hubs of patient health records and communication. But I digress (something I usually don’t do, but RPM has so many ramifications). This will also herald an introduction into the use of mobile apps by patients, recommended by providers. The issue surrounding reimbursement for health apps in general will also be resolved as it follows the path of RPM.
Organizations adopting RPM now are those who already have value-based or bundled payment systems or who realize that determining the ROI of technology in healthcare can be complex and that the predictable prevention of penalties is a good starting place. Improving longer term outcomes of RPM certainly needs more study.
While RPM is not new, its place as a leader of technology in the new payment system healthcare space is. RPM is well-suited for bundled payment systems because it is not just a technology. It involves the creation of processes and changes in workflow around the technology, some of which are home-based and some office and hospital-based. The success of RPM depends upon physician champions who will design these processes, and devise alert self-management, provider notification and treatment algorithms. RPM, via technology, can be the door to better provider-patient communication, more meaningful office follow-up visits, and increased caregiver participation. Nothing I’ve said here is earth shattering news. I meant to bring the discussion of RPM to a practical level about why it is here, needs to be utilized now and where it fits in to existing strategies. Let’s all welcome it.