Friday, July 29, 2022

Summer Bootcamp: Remote patient monitoring economics

Editor's note: The information is this story was taken from a recent Medical Economics Bootcamp session. You can find the full video of the session here.


INTRODUCTION


In 2019 and 2020, the Centers for Medicare & Medicaid Services created new reimbursement codes for providers to monitor and manage patient care remotely. Patients wear small monitoring devices connected to an app on a smartphone that sends data to the physician. Monitoring patients remotely can generate over $150 per patient per month. Remote patient monitoring (RPM) has been shown to improve outcomes for patients while much of the work is done by clinical staff, and it doesn’t require an excessive amount of time from the physician. With inflation hitting record highs and payers focusing more on positive patient outcomes, RPM is the perfect way to both boost revenue and improve patient outcomes. Not every patient is eligible for remote monitoring, but those with a diagnosis of obesity, diabetes or chronic pain usually are, along with patients who require pre- or postsurgical management. Now is the perfect time to see whether RPM makes economic sense for your practice.


LEARNING OBJECTIVES

  • Understand the available codes for RPM and the proper way to use them.
  • Learn about the benefits of RPM for both physicians and their patients.
  • Gain a full appreciation for the reimbursement/revenue potential of a successful RPM program.

MEET THE PANELIST



Shari Kappell, CPCO, CPPM, CPC

How remote patient monitoring can boost your practice revenue and improve patient outcomes

In a time when inflation is rising, medical practices must look at every way possible to boost revenue. When you can accomplish that with existing patients in a way that also improves their outcomes, you have a solution that is helping both patient and practice health. Remote patient monitoring (RPM) provides exactly that. “(RPM) is a revenue stream that is remarkably untapped, despite how CMS (Centers for Medicare & Medicaid Services) backs it,” Shari Kappell, CPCO, CPPM, CPC, implementation and billing manager at CoachCare, says.

RPM is when a patient uses a wireless device that’s able to upload data in real time to a health care provider so they can track and monitor their condition from their practice. The data are relayed using a mobile app.

The old way of seeing a patient was to start with an in-office visit, then schedule a follow-up appointment for months later. That might be all you see of them unless something major occurs. If it does, now you’re either seeing them in the emergency department or as an inpatient if they have severe issues that haven’t been checked in months. With RPM, the person is transmitting their vitals and information in real time. Staffers are assisting with daily monitoring, which might save a trip to the hospital because a physician can intervene faster.

“RPM has a lot of great benefits for the provider,” Kappell says. “You can improve your patient care (and) connectivity with patients, and it’s flexible and efficient. You can monitor your patients before their health conditions get out of control, which is one of the huge benefits of having a (RPM) program.”

Another bonus is that once the physician orders RPM, a junior staffer can monitor the data and only involve the doctor when necessary. “Patients feel like there is more of a connection with their doctor, even though they are not actually speaking to the provider face-to-face,” Kappell says. “Having that connectivity to your provider and your care team is promoting that next level of care for patients. Accountability is driving patients to have better outcomes by having them become more active participants in their health care decisions.”

For example, one CoachCare study on patients who are obese found 86% more weight loss at the patient level for those using RPM compared with those who were not, and those using RPM stayed on the obesity program 30% longer.

Most patients are eligible for RPM, and although those with chronic conditions are often the best candidates, acute patients can also benefit. An RPM patient will need to have had a face-to-face visit over the past 12 months, with telehealth visits also qualifying.

“It’s really based on insurance coverage, to get a basic understanding of where coverage is for your key payers, but for the most part, insurances are covering RPM,” Kappell says.

If staffing is tight or already overburdened, the monitoring function can be outsourced. Kappell says all devices must be FDA approved, so consumer products such as Apple watches are not eligible for use in a RPM program.

As CMS and other payers move to more value-based care contracts, RPM is the perfect tool for physicians. “It’s intervening prior to a medical catastrophe,” Kappell says. “It’s low cost to patients (and is) creating consistent revenue streams for providers. It greatly reduces the chances of patients having to go undiagnosed for months by giving real-time data to providers in their care teams.”


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The unexpected drivers of patient retention


As healthcare providers, we care about our patients. And we put a lot of time and effort into offering the best patient experience possible. But often, more than good bedside manner is needed. In today’s ever-changing clinical environment that spans in-person to virtual appointments, it's important to understand the nuanced factors driving patient satisfaction.

To deliver a great patient experience, providers need to understand patient perceptions, expectations, and preferences when it comes to receiving care. After reviewing some recent patient feedback, I believe there are some essential elements that define patient-perceived success—such as the likelihood of the patient returning to the clinic and even recommending the practice to others. The great news is that there are simple fixes any provider can make in their practice to attract more patients, retain them for longer, and help them achieve optimal outcomes.
The nuances of patient communication

Communication from the provider is one of the biggest factors contributing to patient-perceived success. Patient communication should be viewed as an ongoing process, not simply a one-time exchange. Yet, a recent survey by WebPT showed that only 30% of patients report receiving regular communications between appointments. Additionally, 52% of physical therapy patients felt that their at-home exercises would have been more successful with greater communication between appointments.

To deliver optimal communication, healthcare providers must pay attention to how—and when—patients receive communication. Digital delivery can make this process much more manageable. For example, rehab therapy providers can send their patients home exercises digitally instead of in paper format, thereby adding another touchpoint to the patient experience. Based on our survey, there's room for improvement in leveraging digital communication. In fact, the report showed that only 33% reported receiving their exercises in a digital format, yet 83% of patients who received their exercises digitally reported success in their care.
Beware of communication bias



It’s also important to be aware of communication biases in relation to how you are communicating across all patient groups. One of the most surprising insights found in the PT Patient Experience Report is that there is a genuine and significant difference in the frequency of communication across different age groups. There is a linear relationship between a patient’s age and the likelihood of receiving communication, with younger patients much more likely to receive frequent check-ins than older patients. This can also be seen when comparing athletic ability, with most athletic patients much more likely to receive communication than the least athletic patients.
Set clear expectations from the start

In the physical therapy industry—like many other healthcare disciplines—it seems that providers often link treatment “success” solely to outcomes measures. However, when we factor in the patient’s perspective, the definition of success changes.

To set clear expectations with patients, it’s important to set up a thorough plan of care for each patient from the beginning of their treatment process. This includes anticipating the number of appointments needed throughout the care journey and adjusting the volume of appointments as required. Calibrating a patient’s plan of care as needed to adjust to their ability and availability will significantly affect the patient’s perceived success.

Any effort spent in communicating clear expectations is worth the work, since patients who feel that their healthcare provider outlined clear expectations are more likely to report a higher level of satisfaction. The PT Patient Experience Report showed that 86% of patients who had clear expectations said they would recommend their treatment, and 74% said they’d repeat their treatment.
The need for mobile-friendly options

Today’s patients often get the question: “Paper or digital?” but simply asking the question isn’t enough—we need to actually listen to their answers. Understanding patient preferences around traditional versus digital communication goes hand-in-hand with patient success and retention.

In our report, the majority of patients across all age groups reported a preference for patient-centered tech to help them quickly and easily on-board, at their convenience. For example, 81% of patients prefer digital appointment reminders, with text being the #1 method. The only age-related difference found was a slight delivery difference, with patients under age 45 more likely to want to use a patient app while patients over age 45 more likely to prefer an online option.

A recent study by Pew Research showed that tech adoption among those 65 and older is increasing—so clinicians can be confident in offering digital solutions to patients of all ages. According to their research, the percentage of those 65 and older who own a smartphone has risen from 13% to 61% in the last decade. In the same timeframe, the percentage of those 65 and older who own a tablet has increased from 6% in 2012 to a whopping 44% today. Of course, COVID-19 played a role in accelerating the shift to online healthcare offerings, with many everyday functions rapidly transitioning to digital processes. It’s important to note that this change happened across all age groups.

Clearly, healthcare providers shouldn’t assume patient preferences based on age, athletic ability, or other factors. Solutions like digital appointment reminders, filling out intake forms online, online scheduling, and digital payment options should be available to patients across all age groups. Mobile-friendly services help patients feel that their needs are being met, thus increasing the likelihood of retention.

Since patient satisfaction is linked to retention, most providers are eager to level up wherever needed. Based on our findings, it’s clear that a great patient experience includes clear expectations, stellar communication, and an individualized experience. This combination is a surefire prescription to keep patients satisfied—and keep ‘em coming back.


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Thursday, July 28, 2022

Making omnichannel work for health care

Today, most healthcare organizations across the country are connecting to their patients and customers in both the physical and digital world. The pandemic dramatically accelerated the addition of digital channels of care, but consumer demand is also a major driver for convenient and valuable ways to access care. After all, when so many people can work from home and do much of their shopping and banking online, why not online visits with the family pediatrician?

In healthcare’s rush to meet consumers and patients where they are, the response has been fragmented. Now, healthcare organizations must make the leap from providing siloed channels of care to putting the consumer in the driver’s seat, with access to a seamless, integrated experience whenever and wherever they need it. A fully integrated model of care will provide omnichannel access that is readily available regardless of which physical or digital “door” a consumer enters or which provider they are interacting with. These new models require utilization of all channels of care—including remote patient monitoring, mobile health and at-home care—without sacrificing the personal connection of individual care.

Are you there yet? If so, you are ahead of the curve. If not, you’re among the majority of organizations that need to make this leap. We work with healthcare organizations across the country to help them make a strategic move to omnichannel, knowing that it will increasingly influence the buying decisions and loyalty of patients and their families.

Here are four ways you can shift your thinking about omnichannel now–and practical steps for making it a success.

Omnichannel is a way to deliver care and drive innovation.

American healthcare is unique in many ways. Although criticized on the value-to-cost ratio, it’s a system that opens every door to innovation. When we think about how to use that strength, we should consider how to smoothly incorporate innovative new channels and sunset inefficient or underutilized channels of care. In the last decade, the healthcare ecosystem added many new channels, including apps, virtual care, remote patient monitoring, in-pharmacy care and home care, to name a few. As a result, consumers have more options than ever, but confusion about which channel to access that increases as care delivery becomes more fractured than ever.

We recommend a few practical steps to improve consumer options, reduce confusion and create an integrated care experience:Connect any channel investments back to your overall omnichannel strategy before deciding to build or buy. Traditional brick-and-mortar investments typically require a full business case with scrutiny backed by market research and an anticipated timeline for profitability. While new channel development, particularly in the digital space, might not be as costly and often allows for a pilot implementation, it’s important to apply the same thoughtful analysis to channel development and value creation before you build or buy. Measuring value over time will let you know if an investment is worth expanding to other markets and populations.
Implement new channels of care with the same rigor and attention given to traditional channels of care. Many healthcare organizations raced to stand up telehealth in the midst of the pandemic, did little to improve it over time, and then walked away from it when in-office visits resumed. The result isn’t a problem of telehealth as a channel; it’s that the channel never received the time and attention to be truly integrated into the care model. Any new channel should be driven by the requirements in a business case and thoughtfully integrated with existing channels. The way you implement a new channel will make or break the way your providers and consumers adopt, experience and value it.
Be just as thoughtful in sunsetting old models as in implementing new ones. Constantly adding new channels but never replacing the old ones can lead to inefficiencies. With all the alternative channels in most health systems, outdated and redundant channels of delivery (think fax machines and paper) lead to inefficiencies, higher costs, and a fractured experience for consumers and providers alike.

Omnichannel influences buying decisions and patient loyalty.

Are you thinking about your omnichannel strategy as a path to consumer loyalty?



Traditionally, healthcare consumers might have been loyal to an individual provider, but not necessarily a brand. That has changed over the last decade with the rise of network agreements, consolidation and a growing emphasis on brand marketing. As consumers increasingly seek out omnichannel delivery of healthcare services, gaining their loyalty requires a comprehensive delivery strategy that anticipates and delivers care when and where they want and need it. Without this critical alignment, healthcare organizations risk revenue leakage and erode the investments they’ve made in building a direct-to-consumer brand over the last decade.

To anticipate and deliver care when and where consumers want and need it, ask—and answer—these key questions:What does data tell you? Building consumer loyalty takes a deep understanding of customers’ wants and needs. While healthcare has always been rich in data, few organizations invest in gleaning it for the purpose of delighting their customers. Now, new entrants in healthcare delivery—from startups to large retailers—are using data to increase consumer loyalty through marketing and experience. Traditional healthcare organizations stand to lose market share unless they begin to invest in this area, too.
Who is your customer? Many healthcare organizations made the move to put the patient at the center of everything from care delivery to building design and workflows. But fewer have made the leap to unpacking the meaning of “patient,” “consumer” and “customer” terminology. It may seem straightforward to define your patients. But as you invest to diversify your revenue streams, your list of “customers” is likely to grow and change. A shared understanding of these terminologies—who they are, what they mean to your organization, how they relate to each other—is essential to developing an omnichannel strategy that will reach them.
What is their journey? Mature organizations have a deep understanding of their consumers and their opportunities to grow market share. They may have mapped the consumer journey as a way of looking at the experience. But do those maps actually drive strategic investments, such as the opening and closing of channels of care? A journey map must be more than an aspiration on the wall. It must be iterative – almost agile – to provide continuous benefit. Consumer-obsessed organizations are constantly refreshing their journey maps and bringing them to life as they anticipate and act on consumers’ wants and needs.

Leveraging omnichannel will accelerate your value-based care strategy.

Healthcare must be inclusive across multiple delivery channels. The type of care, and the way patients access it—whether digitally or in-person—must be accessible to all patient populations, regardless of socioeconomic status. Value-based care requires health systems, payers and providers to establish an environment that supports all patients across the care continuum, including primary and specialty care. This calls for systems that not only create access to care, but that also support patients in using technology to gain that access.

We see three critical components to accelerating a value-based care strategy:Make it easy for patients to access care across multiple delivery channels. Create systems that enable patients to access care the way they want to receive it. Be thoughtful in creating benefits, programs and systems for your patient population. Develop a marketing and communications strategy that empowers all patients to navigate the complexity of the healthcare system to meet their individual needs. Ensure that patients understand their care-delivery options and provide continued support along the patient journey—particularly when things get complicated. Consider benefit design and develop programs to support patients where they are.
Make it easy for patients and providers to leverage technology for care delivery. Create an environment that makes it easy to access technology for care for all communities—especially underprivileged ones. Be thoughtful about creating and marketing solutions for patients who may not have access to all care delivery options. Provide technology support, whether it’s a technology-support phone line or iPad home delivery for provider video visits. Make sure that access to technology is not a limiting factor in your care delivery model.
Design an omnichannel system that accelerates your population health strategy. Value-based care requires easy access to care and easy delivery of care across multiple channels. As you think about driving quality outcomes, managing the cost of care, and improving patient and provider experiences, omnichannel should be top of mind for designing and executing on a value-based care strategy. Without understanding how patients and providers want to engage in care through customer segmentation and without the ability to deliver on that customer demand, there are significant limits to achieving the objectives of value-based care.

Omnichannel is a catalyst for value-based care and healthcare organizations should invest now.

Omnichannel is key to providing a holistic patient and family experience.

Consumer experience requires a holistic and seamless “front end” of usability, connectedness, look and feel. Providing an exceptional front-end experience calls for a back-end consolidation of data, with seamless access to it. A digital front door is critical to an omnichannel experience that includes patient identity management, patient experience platforms, and an in-depth analysis of the patient population to drive adoption.A few rules of the road for moving fully into the holistic omnichannel world:
Provide a consistent patient experience, easy navigation, and a modern look and feel to engage healthcare consumers—in person, over the phone, via email, messaging or on digital platforms (telehealth or patient portals). This requires patient information to be consolidated and available to everyone supporting the omnichannel experience. To manage an infinite number of use cases and patient journeys, omnichannel providers should define the patient and family experience as a set of common activities performed across channels and provide a seamless experience.
Emphasize a high level of digital patient management. The patient portal has long been viewed as the bedrock of patient-engagement technology. But while accessibility may be high, adoption is actually quite low. Research shows that over 90 percent of organizations offer patient portal access, but most hospitals see a patient adoption rate of less than 25 percent.Omnichannel providers should focus on patients’ adoption of portal and mobile applications and on-demand patient and family education. The ability to access patient data in a central place will be an important learning curve for many, providing access to online appointment scheduling, online billing, prescription refill requests, data updates, messaging, lab and radiology results reviews, and more. Omnichannel providers need to understand the demographics of their patient population in order to determine which demographic(s) will be their initial target.
Focus on patient information consolidation and availability. Because multiple providers are often engaged in the omnichannel experience, fragmented medical data (scheduling, orders, records, billing) is an inherent problem due to disparate and unconnected EHR systems. This often creates a negative patient and family experience and poses an omnichannel adoption risk. This fragmentation can even create patient safety risks caused by duplicate procedures, failure to get care, or medication errors. Disconnected clinical and non-clinical systems may exist even within the four walls of a single provider—a problem that can be costly, disruptive and time-consuming to fix. Again, omnichannel means focusing on patient information consolidation and availability. They should design patient and family experiences that address the challenge by leveraging their current technology capabilities and footprint while building a roadmap to make improvements.
Prioritize data interoperability, standards, security and compliance.Healthcare providers are required to provide patients with access to their health information when they need it most—and in a way they can best use it. Omnichannel providers should leverage the CMS Interoperability and Patient Access final rule to achieve information consolidation and availability. They should adopt common standards (i.e., Health Level 7 [HL7] Fast Healthcare Interoperability Resources [FHIR]) as the foundational standard to support data exchange via secure application programming interfaces (APIs). Regulatory compliance, data security and data protection are top priorities. If not executed well, digital patient engagement may pose a risk of HIPAA violation. Information releases and consent processes must be followed to include tracking events that will require access restriction (i.e., parent of a minor and adolescent).Adolescent patients need to be engaged in transitioning to their own digital health experience.

The bottom line

While healthcare organizations offer more channels of care than ever, most have yet to make the leap into providing an experience that enables consumers to enter through any channel and receive the care and services they want and need. Taking cues from other industries, healthcare providers must design and execute a clear, cohesive omnichannel strategy that drives consumer loyalty, integrates back-end-technology for a seamless experience, incorporates new channels while sunsetting inefficient or underused ones, and serves both individual consumers and population health goals.

For more Insights on omnichannel success, read about developing a long-term telehealth strategy at https://www.pointb.com/case-studies/developing-a-long-term-telehealth-strategy/. Learn more about building a digital front door at https://www.pointb.com/insights/sustain-and-extend-care-delivery-during-crisis-and-beyond-keys-to-building-your-digital-front-door/. And get new Insight into reducing clinician burnout and increasing workforce engagement at https://www.pointb.com/insights/clinical-workforce-engagement-reducing-clinician-burnout/.


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