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.
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:
Current uses & benefits of telehealth:
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/
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 RPMIntroduction 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.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
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:
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.
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:
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.