ACA Will Help Spark Boom in RPM

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RPM means remote patient monitoring andwill be here to stay under the Affordable Care Act (ACA). Initiallythis started with heart patients, but it will expand. And yes,diabetes is on the list of types of patients that will be remotelyfollowed. Now why would they do this, considering that few type 2diabetes patients receive education on managing their diabetes? Notonly that, but without the personnel available to educate people withdiabetes, how can they expect patients with type 2 diabetes to feelanything but contempt for remote patient monitoring.
I expect to see something appear in theAmerican Diabetes Association (ADA) website as early as this summerhinting at the possible monitoring to be done and when it will start. Then, I am guessing that the ADA 2014 guidelines will have much moreto say about this. If not this summer, then announcements willhappen by the summer of 2014 and will be part of the ADA 2015guidelines. It is coming and of this, I have no doubt.
This press release says a lot about RPMfor five major chronic illnesses that will grow by 6-fold by 2017. This is because the ACA will be pushing hospitals and physicians tostop the revolving door treatments by hospitals. In 2012, cliniciansreviewed remote patient monitoring data for about 227,000 patientswith congestive heart failure (CHF), chronic obstructive pulmonarydisease, diabetes, hypertension, and mental illness. Thefigures include a number of other patients with asthma, coronaryartery disease, and hemophilia.
CHF patients were almost half of PRM in2012. In 2017, diabetes will overtake CHF and the monitoring willgrow by 67.5 percent from 2012 to 2017. The next fastest group ofRPM will be patients with mental illness. Demand for this monitoringcomes from patients and private insurers, which seek to reduce costlyhospitalizations. All of these trends build on an even larger one, anaging population beset with chronic conditions.
The ACA will bring financial incentiveinto play to promote RPM and this will mean rewards for physiciansand hospitals that comply. In addition to sharing payment for anepisode of care, they will earn a bonus, or take a pay cut, dependingwhether they come under or exceed a cost target. With the financialincentives and penalties that the ACA can and will enforce, hospitalsand physicians will have money reasons to physically monitorpatients. Then there are those providers that want to remotelypatient monitor at home for improved care whether there are monetaryrewards or not.
The one factor not included in thisarticle if the role of the Food and Drug Administration and how fastthey will be approving these remote monitoring devices. Thiscould be the flaw in the current thinking, but this should not delayprogress for long as CMS and most insurance payers are on board andlooking to the benefits this will provide.
Currently, the task of reviewing RPMdata falls to nurses at third party triage and call centers services. They then alert the relevant physician to flagged changes. Currently, under the existing fee-for-service reimbursement, there isno incentive to take remote medical data that will not result in abillable office visit. Under the ACA, there will be many financialincentives for physicians to change their way of doing businessincluding penalties.
Presently, remote-monitoring systemsare relegated to call centers, but this will change as pressure isput in place for the electronic health records (EHR) to be capable oftracking this data. Yes, the manufacturers of EHR systems arebalking; however, congressional pressure is being applied quiteliberally to force them to make their systems more responsive toreceiving RPM data and working together (interoperability) tocorrespond with competing EHR systems. This can only be positive asthe Health and Human Services and Centers for Medicare and Medicaidare applying pressure saying their systems will not meet usefulstandards, as they exist. The pressure is to make all systems“telehealth-ready.”