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September 2020

Telehealth News: Research & News Recap

Interest in remote patient monitoring (RPM) and its positive impact continues to grow as providers see the benefits of adding telehealth to their workflow. This has led to increased and extensive research on telehealth as well as changes to government policies. Explore recent research on the efficacy of telehealth and understand new rulings from the Center of Medicare and Medicaid Services (CMS) in HRS’ September 2020 Research & News Recap.

Part I. Research Findings - Remote Patient Monitoring and Telehealth

In this section three studies conducted on various RPM and telehealth topics are analyzed. Real quantitative and qualitative data from telehealth patients was collected, studied, and conclusions were drawn in the studies included below. The results point to the positive impacts of RPM in healthcare and the growth potential of telehealth.

Article 1

Clinical Care, Research, and Telehealth Services in the Era of Social Distancing to Mitigate COVID 19

What was studied?

The COVID-19 pandemic has undoubtedly affected patients living with all types of illnesses. It has especially effected patients with HIV and those who are immunocompromised needing daily management and care. In this 2020 review, Sean D. Young and John Schneider looked at how integrating technologies such as telemedicine, social media, chatbots, and wearables can hel[ deliver care to immunocompromised patients, specifically those living with HIV.

Research findings

Partnering everyday healthcare management with telehealth and wearables opens a wealth of benefits and results for  providers. Remote patient monitoring programs give patients and clinicians peace of mind while also ensuring patients are able to receive the same level of high quality care.

Current uses & benefits of wearables:

  • Vital signs measured include temperature, respiratory, oxygen saturation, & heart rate
  • Bluetooth compatibility - alerts clinicians of potentially life-altering dips / spikes in vitals
  • Offers patients peace of mind taking control of their health in the comfort of their home

Current uses & benefits of telehealth:

  • Same easy-to-use technology of an in-person medical environment
  • Real-time data sent through physician portals
  • Allows adherence to social distancing standards, limiting contraction & spread of illness
  • Patients are taking better care and are more engaged in their health

Why do these findings matter?

Due to COVID-19, healthcare providers have had to adapt and develop plans to ensure their patients are still able to receive quality treatment and proper care management. Introducing technology to their patients’ care plans has opened better care routines, improved access to treatments and follow-ups and has given patients, providers and caregivers peace of mind with at-home care. Wearables, video chat, health monitoring apps like Fitbit, chatbots, and other telehealth modalities improve access to care, and increase patient engagement in their health.

Access the full article, here.

Date Published: May 2020

Young, Sean D., Schneider, John. (2020, May 21). Clinical Care, Research, and Telehealth Services in the Era of Social Distancing to Mitigate COVID 19. Retrieved September 1, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241061/

Article 2

Emotion sharing in remote patient monitoring of patients with chronic kidney disease

What was studied?

In a 4-year study from January 1, 2015 – June 1, 2018, researchers collected data from 156 patients participating in home hemodialysis (HHD) in an RPM setting. Patients were introduced to emoticons and sentiment sharing as a new function of the RPM app to input their feelings and emotions of HHD treatment sessions. Results were collected from a total of 31,159 dialysis sessions; 4,087 of those sessions recorded are considered technically troubled dialysis (TTD).

Home Hemodialysis RPM
The RPM system contained the following three main components:
  • Mobile application for data input including:
    1. personal messages (sentiments) and emotions
    2. weight, blood pressure, ultra-filtration volumes, blood flows, venous & arterial pressures, and session times
  • Cloud database for data storage
  • Web dashboard for healthcare professionals to monitor and send feedback

Introduction of emoticon and sentiment features

At the end of each hemodialysis session, patients were asked to input their emotion status to the app (as a general indication of how they are feeling) by way of a sliding scale with a corresponding emoticon or by typing in their sentiment. In order to allow health professionals to quickly identify patients that are in need of care, the dashboard interface organized the patients based on the three most recent emoticons submitted for their dialysis sessions. The emoticons are ranked using a 5-point scale: 0 = Very Happy, 1 = Happy, 2 = Neutral, 3 = Unhappy and 4 = Very Unhappy.

Research findings

78% of patients actively sent in emoticons of their emotions while 94% had written 1 or more session notes (there was overlap of patients utilizing both forms of communication). HHD patients using the RPM system tended to show and report positive emotions after their session, even when the HHD session by itself may have been technically troubled. When analyzed against the occurrence of TTD, results showed that negative emotions were significantly associated with TTD and could potentially be a predictor to prolonged periods of TTD.

Healthcare providers were able to utilize the emoticon and sentiment data to further understand how a patient was feeling emotionally versus physically. It offered insight into whether an HHD session is preferred, or the best care management option, for that particular patient. Healthcare professionals were able to adjust patient needs as necessary.

Why do these findings matter?

Ensuring a patient is happy and engaged with their healthcare management plan is essential to a better quality of life. Adding functions that measure emotions during home hemodialysis sessions gives clinicians a better look into the patient’s care management plan; adjustments can be made as necessary, or it could be determined that the patient is better off with an in-person dialysis session rather than at home.

Access the full article, here.

Date Published: October 2019

Huang, R., Liu, N., Nicado, M., Mikaheal, M., Baldacchino, T., Albeos, A., Petoumenos, K., Sud, K., Kim, J.. Emotion sharing in remote patient monitoring of patients with chronic kidney disease. Published 2019 Oct 21. doi: 10.1093/jamia/ocz183

Article 3

Remote Patient Monitoring for the Detection of COPD Exacerbations

What was studied?

As COPD progresses, exacerbations occur more frequently and are associated with a worse prognosis and higher healthcare expenditure. Researchers found that studying certain metrics associated with COPD such as forced vital capacity (FVC), FEV1 and peak expiratory flow (PEF), would become extremely useful when accompanied with remote patient monitoring (RPM). Daily physical activity, symptoms, and treatments were also studied.

Patient Group:

A group of seventeen subjects with a median age of 69.7 years, with moderate to severe COPD received RPM tools. With over 2,618 patient-days (just over 7 patient-years) of monitoring, researchers obtained daily symptom scores, treatment adherence, self-reported activity levels, daily spirometry, inspiratory capacity, and oxygenation. Data points were used to identify predictors of exacerbations.

Previous remote monitoring studies in COPD patients demonstrated the reliability of daily spirometry performed at home. Certain metrics like FVC, FEV1 and PEF have been known to decrease during exacerbations.

Process and daily routine:

  • Physiological values measured included: FEV1, FVC, PEF, IC and pulse oximetry (SpO2).
  • Questionnaire on daily symptoms: cough, dyspnea, wheezing, sputum volume and purulence, daily physical activity, and daily medication.
  • Monthly telephone contact with a researcher from UCLA – they obtained data from the questionnaire, medication changes, and any self-reported exacerbation events which may have caused physician visits, ED visits and hospitalizations.

Research findings

The patient group was found to be on average older, predominantly female, with moderate COPD. The mean age was 71.1 years. Other findings include: FEV1 was 1.54 L (56.8%) of predicted, FVC was 3.04 L (86.8%) of predicted, FEV1/FVC of 46.3%. Most of the subjects were found to be highly symptomatic according to the GOLD 2017 grading and are categorized as having mildly to moderately compromised health status.

Why do these findings matter?

There are significant risk factors that can be life altering; these factors can be identified throughout the care management process to decrease the chance of exacerbations and/or readmission. Taking time to better understand when metrics like FEV and FVC, physical activity levels, and what happens in between the use of bronchodilators and inhalers, is key to creating a care management plan to reduce the amount of COPD exacerbations and how to prevent them.

With the use of RPM such as the ones studied and mentioned above, patients have the ability to take better control of their care management and reduce the worry of symptom exacerbations and readmission. If remote monitoring of COPD patients does gain popularity in the future, one potential benefit would be to enable the development of clearer guidelines for the introduction of these medications.

Access the full article, here.

Date Published: September 2020

Cooper, Christopher B., Worawan, S., Arnold, Michael T., Neufeld, Eric V., Taylor, M., Xiaoyan, W., Dolezal, B. (2020, September 5). Retrieved September 01, 2020, from https://www.dovepress.com/remote-patient-monitoring-for-the-detection-of-copd-exacerbations-peer-reviewed-article-COPD

Part II. Reimbursement Updates

Throughout the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) have made changes to their policies in order to make telehealth more accessible across the country. As we continue to move forward, new federal policies and state laws have been proposed to continue expanding reimbursement for telehealth and RPM services. Below, you can review recent reimbursement changes as well as insights from our reimbursement team.

Reimbursement Updates

CMS Proposes Expanding Telehealth Reimbursement After COVID-19

On August 4, the Center for Medicare and Medicaid Services released its proposed 2021 Physician Fee Schedule. The proposed rules provide clarifications and restrictions across numerous telehealth and RPM services, prompting those across the healthcare industry to take note and respond. Below, you can review highlights from the proposed rule as it relates to telehealth and RPM services:

  • New vs. Existing Patients: During the COVID pandemic, given the public health emergency declarations, many organizations were able to shift care and immediately enroll new patients in telehealth programs. This enabled providers to immediately extend care and remote monitoring to COVID patients. However, this adjust has now been extended in the proposed rule.
  • Interactive Communication: CMS has further clarified interactive communication between clinicians and patients, specifically as it refers to CPT code 99457. Not only does the code require collecting and analyzing data, but 20 minutes of conversation between clinicians and patients via phone of video communication
  • Set-up and Supply: CPT codes 99453 and 99454 previously covered initial patient set-up and supply of devices. CMS clarified is the 2021 proposal that each of these codes can be used only once within a 30-day period, preventing clinicians from using the codes multiple times for each monitoring device set-up for patient use i.e. blood pressure cuff, scale, pulse oximeter.

You can read more about the proposed 2021 Physician Fee Schedule, here. You can also review the full proposal and submit comments until October through CMS.

Access the full article, here.

Date Published: September 1, 2020

Wicklund, Eric. “CMS Proposes Significant Changes to Remote Patient Monitoring Coverage” MHealthIntelligence, MHealthIntelligence, 1 Sept. 2020, https://mhealthintelligence.com/news/cms-proposes-significant-changes-to-remote-patient-monitoring-coverage.