A practicing healthcare attorney offers advice and perspective on the potential role of remote patient monitoring in the care of patients with cardiovascular disease.
Evolving technology is altering the way healthcare is delivered, and remote patient monitoring (RPM) is leading a transformation in primary and specialty care settings.
Cardiology was one of the first specialties to incorporate RPM with the introduction of connected cardiac implants. Now, the particularities of the specialty—coupled with the increased need and demand for virtual care solutions in the COVID-19 era—make cardiology practices particularly well-positioned to reap the short- and long-term benefits associated with the progression of RPM services, technology, and regulation.
Despite the specialty's early adoption of RPM, the concept remains unfamiliar to some. RPM is a covered service that leverages digital technologies and electronic monitoring to encourage patients to become more active participants in their health while enabling practitioners to collect vital patient data between in-office visits. Within cardiology, RPM has several significant patient applications, most notably management of hypertension, medication titration and management, weight for congestive heart failure, and weight for obesity.
A few statistics from the Centers for Disease Control and Prevention (CDC) show why there is increasing demand and need for RPM within cardiology. It is estimated that nearly 1 out of 2 U.S. adults has hypertension, with most of these adults failing to have their hypertension under control. Estimates also suggest that upwards up 6.1 million people in the United States have atrial fibrillation (AF) — a figure that will rise as the population ages. Finally, CDC estimates indicate that more than 42% of the American population was considered obese in 2017–2018, which is up from about 31% in 1999–2000.
The demographics of cardiology patients are the demographics that stand to benefit the most from RPM. They are generally older patients with chronic conditions that can exacerbate without easily self-identifiable symptoms until a health crisis.
Additionally, the above-noted disease states often require medication changes based upon the data that can be easily captured via RPM devices. This adds convenience for patients and cardiology practices without the need for unnecessary office visits, which is especially important as the threat of COVID-19 remains.
While we still have a lot to learn about the direct effects of RPM on patients with heart failure, the American Heart Association notes there has been evidence suggesting that RPM lowers the risk of heart failure hospital admissions and mortality. RPM can greatly increase the quality of life for such patients and help detect trouble much sooner. According to the American Heart Association, "Recent clinical guidelines strongly recommend the use of RPM for AF detection in both stroke and non-stroke patients."
The American Heart Association also states, "Research has shown RPM can reduce systolic blood pressure and diastolic blood pressure significantly compared to usual care and self-monitoring alone."
Since the volume of patients requiring care is continually increasing, delivering care for everyone who needs it can be overwhelming, even for the most efficient practitioners. RPM can be an easy solution to this time-management conundrum that also improves outcomes and increases patient accountability in their own health.
Now that we have established a general understanding of RPM and its applications within cardiology, let's briefly explore further how cardiologists and their practices benefit from delivering RPM. Two of the most significant benefits highlighted by cardiologists with RPM programs is that RPM helps streamline care and improve their aforementioned time management. Tracking of vital patient data is easier and reduces the number of in-office visits for some patients, permitting cardiologists to support a significant patient base while reducing stress associated with burnout.
RPM helps increase the likelihood of identifying and addressing an oncoming health crisis while also providing practitioners with a better understanding of patient lifestyle and triggers that can help dictate educated changes to a treatment plan. Despite its virtual nature, RPM is a high-touch patient engagement strategy that often strengthens practitioner relationships with their patients.
Finally, RPM is a financially lucrative Medicare care management program. RPM is an effective way of adding supplemental, non-visit revenue, which is beneficial since reimbursement remains under pressure.
First let's dispel a common myth: It has been argued that older patients are not likely to be receptive to RPM since it's a technology-based service, but early feedback is showing promising results. More and more older Americans are using technology to stay connected to friends and family. The Pew Research Center notes that 91% of U.S. adults 65 and over own a cellphone, with more than half owning a smartphone. The technology used for RPM isn't much different than what these patients are already accustomed to.
Once patients understand how RPM technology works, the benefits are numerous. Patients participate more in their health, which typically improves outcomes and reduces costs. RPM helps remove or at least reduce barriers to care, such as transportation, geographic location, climate, and financial hardship thanks to the reduction in number of in-office visits and possibly emergency room visits. Patients have better access to their health information and can recognize trends that encourage them to take action concerning their health sooner. RPM can also help practitioners make informed decisions that reduce a patient's number of medications or lead to more effective prescribing decisions.
Cardiovascular disease costs our healthcare system more than any other disease category. Medicare and other insurance payers have expanded coverage for the remote monitoring of cardiovascular conditions to encourage adoption of RPM not just to improve patient health but also with the goal of lowering hospital admission rates and their associated costs. Medicare has been on the forefront of the push for RPM, incentivizing its use with an average provider reimbursement of about $120 per month (and up to $210) per qualified patient for 2020.
Since RPM devices are gaining in popularity, the race is on for health technology companies to bring new and improved devices to the market. Like any new investment, practices can expect some upfront cost in implementing a new RPM program for their practice.
Then there is the matter of deciding what devices to provide to your patients. Looking beyond the specific types (e.g., blood pressure cuff, weight scale), you will need to decide how you want your devices to transmit patient health data to your practice: over a cellular network or via Bluetooth technology. Cellular RPM devices collect and transmit data automatically over mobile networks without the need for configuration or setup. Bluetooth devices transmit data over short-range wireless connections to devices that can connect to the internet. There are pros and cons to both.
A few important questions you will want to answer to help guide your decision: Do many of your patients live in rural settings? Do your patients have access to the internet, or do they rely on cellular connection? Do your patients have access to a connected device like a cellphone or tablet? Are your patients technically inclined to keep a device paired with a smartphone?
It's important to note that, in August, the Centers for Medicare & Medicaid Services released its 2021 Medicare physician fee schedule proposed rule, which includes many proposed changes to RPM. These are worth understanding before launching a program.
To summarize, there are several reasons why cardiology is the specialty that likely benefits most from RPM. They are as follows:
With patients largely embracing virtual care—either by choice or necessity due to COVID-19 risks and fears—and payers supporting it, this is a great time for cardiologists to launch an RPM program. Growth of RPM has surged in the short term as more patients are exposed to telehealth during this public health crisis and appreciate its convenience and other benefits and in the long term as the age of the patient population increases and health insurers emphasize preventive care to lower costs. Now it's up to practices to meet this demand.