Remote physiologic monitoring (RPM) technology, also called remote patient monitoring, is playing a vital role during the current pandemic. It excels in connecting patients to care teams, providing real-time clinical data needed to control symptom and disease progression. As COVID-19 continues to spread, our country faces the unprecedented challenge of managing health in a safe and effective manner.
Time and resources are valuable commodities for all healthcare organizations — especially as medical professionals battle this pandemic. Clinicians adopt RPM to monitor, assess and address patients’ health, instantly receiving vitals and data from thermometers, pulse oximeters and blood pressure monitors. With real-time insights come fast response, better prioritization and triage of patients, and faster delivery of healthcare when every minute counts.
Patients no longer have to rely on their own discretion as to whether their rising temperature or shortness of breath warrant a visit to the nearest emergency room. With RPM technologies, they have confidence that they are being monitored; a change in their health status will be immediately conveyed to their care team. RPM expedites the delivery of medical care in a safe and virtual manner, as face-to-face treatment now poses too large of a risk potential in many cases. The Centers for Medicare and Medicaid Services (CMS) recently released new regulations covering these services for patients with acute conditions.
CPT Codes and RPM Adoption
The recent healthcare crisis put a spotlight on the value that tools like RPM and wearable devices in the management of patient outcomes. It was in 2019, however, that their use became more common. That is when CMS published several new RPM Current Procedural Terminology (CPT) codes. These CPT codes more clearly improve reimbursement for the work typically performed around RPM service programs. This includes issuing devices to the patient and training them on its use. It also supports electronic transmissions, monitoring clinical data, and interactively communicating with patients.
These newly released codes successfully boosted physician adoption. In Spyglass Consulting Group’s 2019 survey, 88% of healthcare providers reported either purchasing or evaluating RPM technologies. Providers have found RPM valuable in managing high-risk populations. It also led to expansion of chronic care management programs, aiding in the successful transition to value-based care models. RPM is highly effective in treating prevalent diseases, such as diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and asthma. Studies demonstrate that they play a significant role in substantially reducing readmission rates and overall costs of care.
In 2020, CMS further relaxed their RPM guidelines. Clinical staff can now perform these services under the supervising physician’s general supervision based on CMS’ incident-to guidelines. This allows care providers to work efficiently, freeing up physician time for more complex treatments and procedures. It also expands the potential business models for RPM programs, as the physician doesn’t have to be in the same physical location while the services are performed.
Medical Benefits of RPM
DocsInk uniquely positions medical professionals to successfully implement an RPM program. It simplifies the day to day use of remote patient monitoring for medical professionals by seamlessly connecting to any wearable device. Additionally, it offers customizable clinical alert notifications, facilitates templated patient surveys, streamlines interactive patient communications, and instantly bills for all professional services rendered.
We are all working to gain control over the global health crisis. Yet we must simultaneously navigate value-based care, manage chronically-ill patient populations, and provide general health coaching. That’s why we created a new solution. DocsInk’s RPM solution offers a strong ROI, improved workflow efficiencies, and the tools to achieve patient goals.
Many providers across the nation are finding that participating in Medicare’s Chronic Care Management Services (CCM) program is a natural parallel to meeting requirements defined in the Merit-based Incentive Payment System (MIPS), which was launched in October, 2017.
As the healthcare industry moves towards a value-based reimbursement model, practitioners across the nation are working to gain an understanding of what this means for their practices.
What changes will be necessary in the way patient care is delivered?
What associated reporting is required?
What are the possible impacts to clinical revenue?
What additional technology or resources are going to be needed?
On the heels of meaningful use, PQRS and value-based modifier reporting, congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which consolidated and replaced these former programs. (View our comprehensive 2020 MACRA white paper here) MACRA incentivizes medical providers to deliver high-quality care through two Quality Payment Programs (QPPs), known as MIPS and Advanced APMs. MIPS, specifically, focuses on 4 categories including:
MACRA as bi-partisan legislation, has continued to expand over the last five years. Providers are faced with the challenge of avoiding up to a -5% Medicare penalty, and alternatively explore the opportunity to successfully participate in MIPS, potentially earning a positive Medicare payment incentive. Offering DocsInk Chronic Care Management Services (CCM) is a viable option which offers both monetary and health outcome benefits.
According to U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), 5% of the population accounts for 49% of total health care expenses across the nation. AHRQ further reports that patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition. Understanding that many chronic conditions, such as heart disease, can be prevented through healthier living, care delivery continues to shift from acute episodic-based medicine to prevention and wellness.
To address this initiative, CMS introduced the CCM program in 2015, to improve patient engagement and outcomes at a lower cost for their 35 million beneficiaries being treated for multiple chronic conditions. Medicare initially reimbursed approximately $42+ per month for a minimum of 20 minutes of non-complex, non-face-to-face services, rendered to patients suffering from two or more chronic conditions. During the first 2 years of the program, Medicare concluded that CCM services were severely under-utilized, receiving claims for only 2% of their eligible beneficiaries. In an effort to encourage medical providers to incorporate CCM services into their practices, CMS has continued to release new and less stringent guidelines which are designed to increase access and reimbursement for these services. (View our2020 CCM summary here).
There are several benefits for eligible providers to offer CCM services. Beyond the opportunity to substantially increase clinical revenue, CCM also closely mirrors the goals and activities outlined by MIPS, setting the stage for successful participation in value-based care models. We can draw these parallels as they relate to each of the MIPS categories. As evidenced below, providers who offer CCM services to their chronically-ill patient population, are well positioned to successfully report in the MIPS program.
It is important to note that to be eligible for participation in MIPS and be considered an eligible clinician (EC), you must meet the necessary criteria during two available determination periods. In 2020, all EC’s are subject to a possible -5% to +5% payment adjustment. The EC’s Medicare penalty or incentive payment percentage is determined by their performance in the four MIPS domains listed below, which are then used to generate a composite score that is compared to national benchmarks.
The MIPS Quality category specifies 270+ individual quality measures from which providers must select to report metrics. A CCM program fully supports the Quality metrics necessary to maximize both minimize penalties and maximize incentive payments. Two of the optional measures are:
Develop and follow a comprehensive care plan (Quality ID #47; NQF 0326)
Perform a medication reconciliation (Quality ID# 130; NQF 0419)
Each of these tasks are required components of the CCM guidelines.
In addition, CCM programs facilitate the successful reporting on health improvements of patients with chronic conditions such as hypertension and diabetes, also included in the Quality category.
Improvement Activities (IA)
The MIPS IA category outlines 9 categories and 112 activities that are designed to improve patient outcomes. Four of the available activities are also components and/or requirements of providing CCM services including:
Chronic Care and Preventive Care Management for Empaneled Patients;
Engagement of Patients, Family, and Caregivers in Developing a Plan of Care;
Implementation of Medication Management Practice Improvements; and
Integration of Patient Coaching Practices Between Visits.
Promoting Interoperability (PI)
The MIPS PI category promotes the adoption and use of certified electronic health record (EHR) systems, by meeting specific objectives and measures. Although, CCM doesn’t directly share any measures with Promoting Interoperability, the CCM guidelines require providers to create their patient’s care plans using structured data from their certified EHR systems, which must be able to be shared with CCM patients and their respective care teams. Therefore, by meeting the CCM electronic care plan requirements, you are also complying with the applicable PI measure.
The MIPS Cost category concentrates on reducing medical expenses and over-utilization of emergency and inpatient services. Providers participating in the CCM program are shown to achieve these same goals by offering cost-effective, non-face-to-face services for their chronically ill patient population. Medical adherence is improved, transitions are streamlined, and avoidable readmissions are reduced.
Understanding how closely the initiatives of the MACRA payment reform legislation aligns with the CCM program, CCM becomes an obvious parallel to successful MIPS reporting for many providers. The added revenue generated from the CCM offering, also may help offset associated expenses that clinicians and medical groups are likely to incur while implementing a successful value-based care model.
DocsInk easily identify chronic care management (CCM) patients, to promote improved health outcomes and maximized reimbursement for non-face-to-face patient services, performed by providers and their support staff. As required by Medicare, electronic patient care plans may be created and securely shared in real-time with patients, between care team members, and across multiple organizations. All eligible CCM clinical tasks and associated time units are quickly logged and tasks are generated to ensure no patient is lost to follow-up, promoting seamless workflows. Our unique “audit-lock” feature aggregates all data input throughout the month, calculating the level of complexity based on The Center for Medicare and Medicaid Services’ (CMS) national medical decision making (MDM) guidelines, to automatically generate the highest and most accurate billing codes for CCM services performed.
DocsInk differentiates its software from the competition by simultaneously addressing the fiscal, communication, and connectivity needs of medical professionals. Delivered as Software-as-a-Service (“SaaS”), DocsInk is improving the way technology integrates with the various workflows of the healthcare industry. We provide simple, effective solutions that improve the speed, efficiency, accuracy, and options in the delivery of patient care. Beyond our technology, that is native to Mac, PC, iOS, and Android, our team is dedicated to providing customer support and a user experience that is second to none.
The healthcare industry and the patients it serves continues to navigate how to best cope with, and begin to move forward from, the challenges caused by the COVID-19 pandemic. Clinicians are working tirelessly to provide high-quality care to their patients and now, more than ever, there is a need for simple, secure, and reliable technology to connect patients to their care teams.
The Centers for Medicare and Medicaid Services (CMS), State Medicaid programs, and many major insurance payers including Blue Cross Blue Shield and United Healthcare have relaxed their existing guidelines for telehealth services, making it easier for providers to be reimbursed for their services and patients to gain access to care.
As of March 6, 2020, CMS specifically began paying physicians and other qualified non-provider professionals (QPPs) for all telehealth visits, including 80 additional codes during this public health emergency. No longer is Medicare requiring their patients to be in an HPSA (federally defined rural area) or be in an approved originating site such as another doctor’s office, federally qualified health center, hospital, etc. Patients may now receive these telehealth visits while at home and their providers can get paid just as they would if the patient was in the office. CMS has also said they will no longer be auditing to ensure that the patient was an “established patient” with the billing provider, which allows clinicians to render and bill for medical services for new patients as well.
Typically, all telehealth services are subject to CMS’ standard co-insurance and deductible amounts, leaving most Medicare patients with a balance due. As a rule, the reduction or elimination of these amounts owed by Medicare beneficiaries potentially violate the Federal Anti-Kickback Statute, the civil monetary penalty rule, and exclusion laws. In response to the COVID-19 pandemic, the Health and Human Services (HHS) Office of Inspector General (OIG) issued guidance to ensure physicians and other qualified non-provider professionals are not subject to these sanctions for reduced or eliminated beneficiary cost share amounts for telehealth or e-visits.
In addition, CMS has now recognized several new virtual check-in codes that they have categorized as communication-based technology services (CBTS). These CBTS codes include both remote evaluation of pre-recorded patient information (CPT code G2010) and virtual check-ins (CPT code G2012), each with an average allowable amount between $12 – $15.
We here at DocsInk understand the COVID-19 pandemic overshadows anything previously seen or experienced throughout the modern history of the world. We are currently faced with fears of both the known and unknown regarding this relentless disease which continues to wreak havoc on even the healthiest populations around the globe. COVID-19 has affected every individual in one way or another, causing us to rethink the way we live, work, and care for one another.
Recently, the leading topic throughout the healthcare industry has been the shift from fee-for-service to value-based care. Although lowering the costs of care and improving health outcomes are still vital goals, healthcare professionals must now focus on finding new ways to deliver medical care when treating patients face-to-face is not always safe or possible.
In light of these new and daunting challenges caused by this healthcare crisis, the Centers for Medicare and Medicaid Services (CMS) has issued an unprecedented amount of new regulatory waivers and guidelines to assist clinicians in responding to the needs of patients across our nation. Telehealth is at the forefront of preferred and recommended treatment options which involves the use of interactive electronic communications to provide clinical services to patients in lieu of in-person visits.
Telehealth is an effective alternative to brick and mortar office visits, when quick to adopt and easy to deploy. Healthcare heroes in the form of physicians and other qualified professional providers are working tirelessly to care for patients with acute and chronic conditions in the toughest of circumstances. It is critical that their technology of choice be an uncomplicated and reliable solution that streamlines their efforts and successfully connects care teams to their patients, when and where they need it most. Working in tandem with Telehealth, Remote Patient Monitoring (RPM) and Virtual Check-Ins serve as effective treatment methods for caring for patients during the COVID-19 pandemic. DocsInk, a leading healthcare communication technology application, was designed to deliver these services in a uniquely simple and secure manner.
Practices around the nation benefit from the ability to virtualize their practice in minutes using DocsInk’s One-Tap Telehealth Solution. Their patients are securely linked to providers within seconds via audio and video, without the need for downloading any software or applications. Videos may be saved as part of an electronic patient care plan, securely shared with care teams and caregivers using DocsInk’s secure messaging capabilities and imported into health information exchange systems for full continuity of care. DocsInk’s integrated appointment dashboard and scheduler, secure messaging features, and billing/charge capture functionality are major differentiators that create a seamless workflow for streamlined and reimbursable visits.
Additionally, home-based patient monitoring is a critical component of any successful Telehealth solution. DocsInk’s Remote Patient Monitoring (RPM) Solution, also known as Remote Physiological Monitoring, relays real-time patient data back to their clinicians for review. Particularly in the middle of the COVID-19 health crisis, medical providers are relying on RPM to monitor a patient’s pulmonary function, temperature, blood pressure, and other vital changes in symptoms and disease progression. The ability to easily launch a Telehealth session between provider and patient enables RPM data to become actionable. Critical medical decision making is expedited including changes to treatment plans and medication management, helping patients avoid preventable declines in their health status. CMS has recognized RPM to be such a critical component to patient care that they changed their regulations in response to COVID-19 to permanently allow patients with acute conditions to receive these services, in addition to those patients who previously covered suffering from one or more chronic conditions.
Other types of virtual care options such as automated Check-Ins and Customized Surveys provide clinicians the unique ability to monitor their patients and ultimately improve their overall health and well-being. DocsInk allows providers to determine the timing intervals for the electronic Check-Ins as well as the questions to be asked, information to be shared, and/or data to be obtained from their patients. Popular use cases include post-discharge check in’s, post-surgery questionnaires, standardized mental health scale tests, etc. These capabilities allow clinicians to mold the DocsInk technology to fit their workflows, protocols, and their patient’s needs down to a granular level.
Beyond the unparalleled functionality and ease of use, DocsInk also does not overlook the importance of data privacy. Even in light of the Office for Civil Rights (OCR) announcement that they will waive the enforcement of HIPAA Rule regulations during the COVID-19 emergency, DocsInk remains committed to patient privacy and the highest level of security standards. It is critical that both providers and patients can depend on their technology partners to protect them from personal, financial, reputation, and operational harm even now during this healthcare crisis. Worrying about the security of patient data should not be laid on the shoulders of those working so diligently to win the war against the COVID-19 pandemic. We, at DocsInk, believe securing data is our responsibility and should be the last concern of those treating the ill and those trying to get and stay well.
In short, DocsInk is unique because of our ability to securely connect patients and providers, using simple technology built for improving patient lives, streamlining practice workflows, and revenue generation. DocsInk is the only choice for HIPAA Compliant communication-based technology and virtual care, especially when time, money, and health matter.
The landscape of healthcare has dramatically changed since the onset of the COVID-19 pandemic. Brick and mortar doctor’s offices visits have in great part been replaced by e-visits via laptops and mobile devices within the comfort of patient’s homes. Stay-at-home orders and widespread quarantines have pushed the fast forward button on the increased adoption of telemedicine.
Prior to the pandemic, telemedicine was used in a much more limited capacity for lower-level services such as diabetic teaching and hospital-based specialty visits in rural areas. Although it was accepted in theory by many as a good alternative to face-to-face medical care under some circumstances, providers and patients alike were very slow to open up to this type of virtual care. Medicare only covered telemedicine visits in very limited situations and reimbursement rates from both government and private payersfor these services were very low.
In response to the rapid spread of COVID-19, the Centers for Medicare and Medicaid Services (CMS) began paying for telemedicine visits at the same rate as in-person visits and relaxed many of their rigid guidelines making virtual visits more accessible for Medicare patients. Many of the large private insurance companies quickly followed suit, which led to an onslaught of new telehealth visits the in March. The Wall Street Journal reported that CMS telemedicine visits increased from 100,000 to 300,000 per week as of March 28, with an expectation that it will continue to grow at a steady rate. According to research conducted by Frost and Sullivan consultants, total telemedicine visits have increased by 50% nationwide and could reach nearly 1 billion in total by the end of 2020.
The question that remains is what will happen when we win the COVID-19 war and the crisis is over? Although no one knows for sure how many of the new telemedicine administrative guidelines and reimbursement rates will remain in effect, it appears safe to say that virtual visits will remain a viable treatment option. Particularly in the new healthcare landscape with value-based-care at the forefront, providers and payers will continue to find value in this type of quality care which boasts new level of efficiencies and lower costs of care. Patients will continue to enjoy the comfort and convenience of receiving healthcare when and where they choose, without the worries of wait times, missed work or transportation.
On April 26, CMS administrator Seema Verma told the Wall Street Journal, “I think the genie’s out of the bottle on this one.” She continued, “I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”