Most of us thought—or at least hoped—we would be on the other side of the pandemic by now. But such as they are, we can’t predict with certainty how much longer it will last. While we wait for the much-anticipated vaccine, healthcare systems continue going above and beyond to keep patients and staff safe through precautionary social distancing processes. This is so important, especially for chronic care patients. We’ve learned that co-morbidities increase the severity of COVID-19 and also increase mortality rates.
While some health systems have returned to in-person visits, others have decided to continue offering telehealth as an option for patients. As long as telehealth continues to be reimbursed at in-person rates, that will likely continue to be the case. But how long that lasts, no one knows. Medicare has committed to continue at the higher payment until the virus is no longer deemed a public health emergency. In contrast, many private payers haven’t made a commitment beyond October or have committed only through the end of the year.
Whether payers eventually fall back to pre-pandemic rates or not, there is no denying telehealth’s value in managing our chronic care population. In one study, 41% of PCPs surveyed said patients with multiple chronic conditions should be seen three to five times a year to properly manage their health, while 32% say they should be seen six to eight times a year. But the same study found that just 9% of providers were very satisfied that they are giving their patients all the attention they need. This is where telehealth comes into play.
With the new codes for remote patient monitoring (RPM) and chronic care management (CCM) issued in the Medicare Physician Fee Schedule for 2020, ACOs can now benefit financially for using telehealth, even beyond the pandemic. And the great part of it is that care can be provided by staff other than the physician. This includes nurse practitioners, physician assistants, clinical nurse specialists, registered nurse anesthetists, registered dietitians, and other professionals. In this way, providers have time to see more patients without adding additional staff or overhead, and without adding more hours to the day. This increases access, reduces costs, and supports a more effective care plan.
The cost of noncompliance
According to the CDC, nonadherence in chronic disease management is associated with “higher rates of hospital admissions, suboptimal health outcomes, increased morbidity, and mortality.” Medication noncompliance alone is responsible for 50% of all treatment failures, 25% of all hospitalizations, 125,000 deaths annually, and up to $300 billion in increased costs.
With such an impact, we have to question why there are 35 million Medicare patients in the US who qualify for a CCM program, but only a small fraction are currently enrolled. And the number of those that qualify is likely to grow as our population ages. Today, nearly 80% of older adults have at least one chronic condition, with 77% having at least two. Overall, more than 36% of those on Medicare have four or more chronic conditions. The conditions this population are likely to suffer from—heart disease, cancer, diabetes, and stroke—are some of the most costly, acute episodes of care. Add COVID-19 to the equation, and the scenario becomes seven times more severe—and deadly.
Nearly a third of seniors in the US, or 13.8 million, live alone, a number that is expected to grow. Remote patient monitoring and chronic care management are critical for caring for this vulnerable population.
Finding the time and resources to collect, monitor, and manage critical health data for chronic care populations is challenging but essential in making appropriate clinical care decisions and keeping costs down. Instead of thinking about whether telehealth will continue to be reimbursed at the higher rates, health systems should consider the longer-term financial advantages of making telehealth a permanent part of a comprehensive CCM and RPM program. Improved outcomes, reduced costs, and enhanced patient satisfaction all have an impact on the bottom line.
A comprehensive chronic care management program, fueled by telehealth and remote patient monitoring, creates more cohesive care coordination of care between ACOs, providers, patients, and at-risk populations. Even Seema Verma, administrator of the CMS, sees the value in retaining the current telehealth reimbursement changes. In an article published by the NY Times, Verma is quoted, “Reversing course would be a mistake.”
The good news is that most of the heavy lift of implementing telehealth has been done, thanks to the pandemic. And patients, for the most part, have embraced it. In fact, 84% of patients surveyed say they would choose a provider who offers telemedicine over one who does not. Letting this opportunity slip by is sure to cause regret—and greater effort—down the road. Now is the time to develop a long-term strategy for telehealth, CCM, and RPM to improve outcomes, reduce the cost of care, enhance patient satisfaction, and address the needs of patients living with chronic disease.