At-home remote patient monitoring as a tool to support real-time, video-enabled telehealth services has tremendous potential for better managing seniors and other patients with serious chronic conditions. “But how do we pay for it?” asks Naveen Rao, lead analyst at Chilmark Research.
In a new report, Rao walks through the “sketchy” reimbursement environment of real-time home healthcare and discusses what can be done to encourage greater use of these technologies, including biometric sensors and web/mobile apps to communicate, educate and engage chronically ill patients.
Right now, the reimbursement environment is tactical, with one-off incentives. Some state Medicaid agencies will reimburse for use of home-based technology and under Medicare physician review of remote data from the home is reimbursable for treating patients with two or more serious chronic conditions under the new Chronic Care Management code. However, industry understanding of the CCM code presently is low, Rao says. “A lot of education is still required for this to have an impact.”
Consequently, there are small pockets of progress but many providers are not relying on reimbursement. There is a good business case for reimbursement of real-time home telehealth care for the 7-8 percent of the sickest patients; for the less acute the business case is not strong enough at this time, Rao believes.
That said, the migration to value-based care is making a clear business case for remote patient monitoring adoption, he adds. “However, the challenge now is to scale RPM capabilities. Issues such as optimizing workflow for a nurse care manager, selecting the right components for sensors, patient identification and call centers are all new areas for most health systems in the context of virtual care delivery.”
In coming years, the industry could see a form of cost-sharing as children buy remote monitoring technology for their elderly parents. But with most patients having smartphones, the data is starting to shift now toward patients’ hands, so providers should reach out and make sure the right data gets shared with patients and the technology is correctly used, Rao advises. “Make sure the hubs for transmitting are turned on, devices are being used properly, and that patients are following care guidelines.”
State reimbursement policies can have a big effect on the adoption of real-time home health technology. The State of Maryland, Rao notes, moved to a global budget for hospitals—they get paid once a year in a lump sum for care provided. Many hospitals in other states, however, see real-time home monitoring as just another expense.
The biggest roadblock, however, remains the Medicare fee-for-service program. Incentives are shifting on such priorities as readmissions and hospital-acquired conditions, but it still will take three to five years for FFS telehealth reimbursement to catch on.
As for pricing models for real-time remote patient monitoring technology, right now they vary widely among vendors, Rao says. “We don’t know yet what the right price is. These are the very early days particularly for the provider market because they’re not yet used to taking on risk.”
The Chilmark report, “Migration to Connected Health Opportunities and Challenges in Remote Patient Monitoring,” costs $1,495 and is available here.
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