CMS proposal defines ‘remote patient monitoring,’ encourages use in home health | July 23, 2018|Vol. 44, Issue 29

Agencies may soon be allowed to list remote patient monitoring on their cost reports as an allowable administrative cost.

In the 2019 proposed PPS rule, CMS explains that defining remote patient monitoring in regulation for the Medicare home health benefit and making such cost allowable on cost reports will encourage more agencies to use the technology. CMS is soliciting comments regarding this proposed change until Aug. 31. “These costs would then be factored into the costs per visit,” CMS states in the proposed rule. “Factoring the costs associated with remote patient monitoring into the costs per visit has important implications for assessing home health costs relevant to payment, including [agency] Medicare margin calculations.”

It’s important to move toward remote monitoring being an allowable expense for agencies, says Joy Cameron, vice president of policy and innovation at ElevatingHOME. “Whether agencies have been using the technology and it allows them to do more, or it allows agencies to implement remote monitoring for the first time, it’s only benefitting patients.”

Agencies won’t receive a direct reimbursement for remote monitoring costs under the proposed rule, but allowing remote patient monitoring to be listed on cost reports will show a more accurate representation of a company’s cost of care, experts say.

Agency leaders contend that with a more accurate representation of costs, the government will better see how much they spend to provide care, possibly resulting in more funding in the future. Because agencies haven’t previously been able to include remote patient monitoring on their cost reports, “they felt they were significantly understating the cost of providing care,” says Karen Thomas, president of CMS making this change “is really setting the tone for home health agencies to be more innovative in producing better patient outcomes,” Thomas says

What is remote patient monitoring?

In the proposed rule, CMS seeks to define remote patient monitoring under the home health benefit as “the collection of physiologic data (for example, ECG,blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver” to the agency. Remote patient monitoring isn’t considered a home health visit for purposes of eligibility or payment. Conversely, telehealth services are more in-depth and used to substitute in-person visits. Telehealth is not included in CMS’ proposed rule.

Within the proposed rule, CMS provides an example of how remote monitoring could be integrated into home health episodes of care. At one agency, CMS says,certain patients with chronic conditions received tablets pre-loaded with software enabling patients to take and transmit their vital signs daily. The data is then monitored and analyzed by an outside service, which contacts the agency about changes or abnormalities.

Monitoring may prevent rehospitalization

In the proposed rule, CMS boasted about the effectiveness of remote monitoring, saying it could increase efficiency and allow agencies to more quickly identify and react to changes in a patient’s condition. CMS says studies show remote monitoring of chronic diseases has the potential to significantly improve patients’ quality of life and independence while minimizing costs and preventing complications.

“We believe remote patient monitoring could be beneficial in augmenting the home health services outlined in the patient’s plan of care, without replicating or replacing home health visits,” the proposed rule states. CMS cites a 2014 study in the Journal of Cardiac Failure that shows a post-acute transitional telemonitoring program for underserved heart failure patients showed a “22% difference in 30-day readmission rates.”

In addition, CMS notes, “a systematic review of evidence collected by the Agency for Healthcare Research and Quality (AHRQ) revealed that remote patient monitoring of chronic cardiac and respiratory conditions resulted in lower mortality, improved quality of life and reductions in hospital admissions.” Trinity Home Health Services, of Livonia, Mich., is among the agencies that have had rehospitalization rates and ER visits decrease significantly as a result of remote monitoring, says Kim Johnson, manager of the agency’s virtual care center. “Health care is changing constantly, and remote monitoring allows us to bridge the gap between distance and time and our patients are seeing better outcomes because of it,” Johnson says.

Get nurses, clinicians on board early

Despite the benefits of remote patient monitoring for some providers, there are skeptics. Often, clinicians are hesitant to implement the technology because they fear an increased workload and difficulties in deploying the equipment in patients’ homes, Thomas says.

Sometimes clinicians simply fear change, Thomas says, but concerns can typically be eased by promoting the positives. It’s crucial to show clinicians statistics about how remote monitoring reduced workload and improved efficiency. It’s also important to address any concerns or issues head-on early, as opposed to taking a “wait-and-see” approach. Also, be sure to relay benefits patients will see, Cameron adds. For example, because remote monitoring services allow patients to record their own vitals, it will likely reduce the number of visits clinicians make to their homes, in turn lessening daily interruptions for patients. Less intrusion leads to happier and more compliant patients, and this could lead to better HHCAHPS results for agencies, Cameron says.

Do this when investigating solutions

Get references. When speaking with vendors about remote monitoring technology ask for names and numbers of agency clients you can speak with, advises Arlene Maxim, a home health expert based in Troy, Mich. Ask those clients about the quality of technical support they receive from the vendor, Maxim says. Also ask about the buy-in those agencies have received about the technology from staff and patients.

Investigate whether it makes sense to use a multifaceted telehealth solution. Some solutions only look at things such as patients’ vital signs, for example, while others help with psychosocial needs, Maxim says. For example, one vendor helps elderly patients avoid being lonely by having them mentor students.

Speak with your top referral sources about their preferences. Some referral sources might prefer a specific vendor or technology.

Show nurses the technology. Rather than simply speaking about the remote monitoring technology, allow nurses to see and use it themselves to increase buy-in, Johnson says. Be sure to listen to their feedback so they know their opinions matter.

Identify your goals before purchasing equipment.

An agency looking to implement remote monitoring technology should first determine its goal — whether it is to reduce hospitalizations or work with a patient with certain illnesses, Thomas says. Then, purchase equipment that best fulfills those needs.


Home Health Line July 23, 2018

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