As a nation, we are getting sicker. Today, 117 million adults have one or more chronic health conditions and more that 25% have at least two . With the aging of our population, the situation will become even more dire. Seventy-seven percent of people age 65 or older have at least two chronic conditions. Besides the cost to patients in terms of health, chronic conditions cost the nation’s economy. An estimated 80% of the $3.6 trillion in annual healthcare spend is due to chronic conditions.
Clearly, there is an increasing need by healthcare providers to address the chronically ill population in order to aid in the reduction of hospitalizations, readmissions, lengths of stay, and costs. But physicians are hard-pressed to find resources to help monitor, collect, and manage data in a way that provides the level of insight needed for making more informed clinical care decisions. Finding, paying for, and maintaining the IT and infrastructure to support these activities brings even greater hardship. Further, until 2020, Medicare had not paid physicians for these services. It’s no wonder things have escalated so far. But that’s changing.
This past November, the Centers for Medicare and Medicaid Services (CMS) issued their final proposed rules for services furnished under the Medicare Physician Fee Schedule for 2020, including provisions for remote patient monitoring (RPM) as well as increased coverage for chronic care management (CCM). Under the new rules, general supervision is allowed for RPM, meaning third-party clinical partners can now provide RPM services to practices similar to the general supervision rules associated with CCM.
What do providers have to gain?
Physicians, practice groups, ACOs, hospitals, and healthcare systems can now leverage third-party vendors to help provide their patients with remote patient monitoring. At the same time, providers add what could be significant revenue every month through new RPM incentives. In addition to immediate additional income, improved patient outcomes will be inevitable, which means increased payer reimbursement, enhanced patient satisfaction, and greater long-term financial viability.
Combining RPM with CCM can increase patient compliance through daily monitoring of patients’ vitals. To be most effective, RPM programs should include daily medication monitoring and reminders. This can help reduce misdiagnoses and eliminate most medication problems. The data collected on each patient through daily monitoring and regular monthly contact aids in the ability to address concerns and anticipate illnesses sooner. In this way, providers increase access to care and decrease cost of delivery.
A success story
RPM provides increased value for both patients and their families. It is estimated that more than 14 million people over the age of 65 in the US live alone. Many times, these patients depend on their grown children to help them manage their healthcare needs. Gyalia Ruthledge knows the challenges first hand. Both of Ruthledge’s parents suffer from serious chronic conditions. Her father is on dialysis, has hypertension, is post-open heart surgery, and walks very little. Her mother has heart failure, kidney failure, and a pacemaker (100% replaced).
“Keeping up with them on a daily basis, yet trying to keep them as independent as possible, has proved to be a difficult task,” Ruthledge said. “I was having to trust my parents to communicate with me when something was wrong or when they didn’t feel good, which was not working very well.” Ruthledge found herself worrying and having to physically check in on them. Even then, there were things that slipped past her and one of the them would end up in the hospital. “One time mom ended up in the hospital with congestive heart failure simply because she forget to weigh herself and didn’t tell me when she was short of breath.” Other times, Ruthledge’s mother would have issues with low oxygen saturation but was asymptomatic so Ruthledge had to continually check her oxygen levels just to be safe.
Ruthledge was excited when she learned that her parents’ physician had partnered with NavCare, a leading provider of RPM and CCM services. Remote monitoring devices were soon incorporated into her parent’s care program, which included an app for Ruthledge so she could monitor her parents remotely right along with the doctor. “The knowledge that there is a consistent monitoring system in place for blood pressure, weight, pulse oximetry and knowing someone else was checking on them took a huge burden off me.” Ruthledge said. “I can now simply log onto the app, look at mom’s weight and pulse ox, adjust her diet and diuretics accordingly, or contact her Cardiologist if necessary.” In the four months since being on RPM, Ruthledge’s mother has not been in the hospital or ED.
A better approach
Through care management programs such as CCM and TCM, care coordinators are able to better engage and communicate with patients. The addition of RPM provides the insightful data care coordinators need to be even more effective with each patient interaction.
Utilizing its clinically staffed care center, NavCare provides CCM and RPM, as well as transitional care management and other care management services. To learn more visit NavCare.com or call 844.804.1740.
 CMS-Connect 2018
2] Clinical Health Coach 2018
 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and Reports/NationalHealthExpendData/NationalHealthAccountsHistorical
 Administration on Aging