In the reimbursement partner Q&A series, we share knowledge and expertise from HRS partners across the country who have pursued reimbursement through CMS or private pay programs. Below, Eden Health Regional Telehealth Manager, Travis Tomulty, shares his insights into Eden Health's development of a private pay program for remote patient monitoring and telehealth services. 


1. When your organization began the process of telehealth reimbursement, how did you decide whether to pursue reimbursement through CMS, commercial partnerships, or other avenues?

We began our telehealth program long before CMS had options for reimbursement, so reimbursement for the program focused primarily on establishing a return on investment (ROI). For a remote patient monitoring (RPM) and telehealth program, ROI relies on reducing rehospitalizations, preservation of clinician time and resources, as well as increasing patient satisfaction. For Eden Health, increasing patient satisfaction was paramount to our program’s ROI – satisfaction with the telehealth program raised our HHCAPHS scores, resulting in an increased census and better patient outcomes.

After the initial pilot program, and reviewing the pilot results, we quickly pivoted to offer a private pay program to Eden patients. The private pay program extends RPM and telehealth services to patients who are no longer eligible for home health, but who would still benefit from daily monitoring and chronic disease management. This also extends our reach into the community, helping us further increase census and build strong, lasting relationships with patients and their families.

2. When establishing a private pay program, most agencies struggle with setting a price point for services. Was this your experience at Eden Health? What metrics did you focus on? 

Cost to the patient was at the forefront of our minds as we worked to build the private pay program. You want to set a price point that is fair to the consumer–your patients but also compensates your agency and accounts for the additional workload placed on your staff. When determining price, we worked with HRS to analyze and calculate staffing costs for monitoring and installation, patients’ insurance coverage and equipment cost, including hardware, software, and shipping.

3. Can you tell us more about the structure of your private pay program and how you identify eligible patients?

The program is focused on supporting patients who require or would benefit significantly from long-term monitoring. We review patients’ vital signs, symptoms and medication adherence in preparation for discharge. We look at the progress each patient has made in their self-management, identifying patients with unstable vitals and symptoms as well as patients that would prefer to continue receiving that additional layer of support.

Many Eden Health patients will opt to enroll in the private pay program because they view the tablet and monitoring as a way to keep them honest and engaged; but we’ve had the most success identifying patients working with our partners. Cardiologists, pulmonologists, and cardio-pulmonologists who have instructed or recommended the service to their patients after seeing the benefits.

4. CMS announced the Acute Hospital Care at Home Program to assist with the most recent COVID-19 surge. Is your organization planning to participate in this program?

We are not quite ready to participate in the new program. We are partnered with several SNFs with rounding MDs, but our next step in obtaining reimbursement will be to establish partnerships with physicians to supervise our telehealth census and submit billing. We’re looking forward to pursuing reimbursement through CMS in 2021, not only for recent COVID-19 programs but for RPM services more broadly.

How to Implement a Private Pay Program