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Medicare’s new rules created a $30 billion market overnight.
The senior population in the United States, those with Medicare coverage, have the highest risk for mortality when infected with COVID-19. 73% of those hospitalized for the virus have a preexisting condition and COVID-19 kills 13% of patients 80 and older.
The COVID-19 pandemic has clearly accelerated already recognized trends, like telemedicine and remote patient monitoring (RPM). The latter will profoundly change the amount and type of data physicians can access to improve some of our most expensive and dangerous conditions, like heart failure.
As an industry, the goal is to connect everyone who needs RPM to accessible technology solutions, for every level of technological understanding: we still need to connect sophisticated technology to users who often still have “12:00AM” blinking on their VCR. New companies are solving for this gap by providing connected devices that automatically pull information from the home into the doctor’s office.
Allowing transparency into home events allows real data to be collected without patients missing the big clue that would normally help physicians in their care. For example, missing weight gain during heart failure is catastrophic. If alerted early, physicians can prescribe dietary changes or an extra Lasix and an office visit. The alternative is an expensive emergency room visit or hospital readmission. Congestive Heart Failure (CHF) is one of the top five most expensive diagnosis-related groups (DRG).
Medicare spending amounted to $731 billion in 2018 — a whopping 15% of total federal spending — and is projected to average 7.9% annual growth over the course of the next decade, the fastest rate among major healthcare insurers. In 2019, Medicare’s Board of Trustees issued a “funding warning” to Congress and the President for their second consecutive year, reflecting their concern over the ability to cover growing costs in the future. Adding to the strain, aging Baby Boomers will grow Medicare enrollment from 59 million to more than 73 million in a decade.
As a nation, we’re facing a challenge we’ve never seen before: a growing senior population, explosive Medicare spending, and the sickest generation we’ve ever had in the history of the United States. COVID-19 has made this challenge more urgent than ever as seniors are disproportionately affected by this pandemic.
How are we solving for the sickest generation in history during a global pandemic?
Seniors are sick, have limited financial resources, and significant technology barriers, making them the most susceptible population to the COVID-19 virus. Medical practitioners should have the information they need to identify patients who may have contracted COVID-19 by tracking common symptoms through remote patient monitoring and caring for patients through telemedicine.
Preventative medicine — seeing patients early and often to curb costs and prevent expensive emergency visits while improving patient outcomes — has long been touted as the holy grail solution. The Medicare program has long sought ways to incentivize doctors to provide proactive, ongoing care in lieu of the episodic treatment that dominates in today’s fee-for-service model.
Remote patient monitoring will profoundly change the data physicians are able to access to improve the outcomes of some of our nation’s most dangerous and costly conditions, like heart failure. These long-standing conditions in our senior population are what many have been calling the pandemic underlying the COVID-19 pandemic: obesity, diabetes, heart disease — these all contribute to the death toll this virus has taken on our senior population. And, we still need to connect technology to users who may not understand how to set up or use it. New companies are conquering this obstacle with connected devices that automatically pull information from the home into the doctor’s office through remote patient monitoring solutions.
In January 2019, Medicare took a big step towards this goal by announcing reimbursement for “Remote Patient Monitoring.” Under the program, doctors are compensated for remotely reviewing patients’ physiological data as captured by a third-party monitoring device. In January 2020, they expanded the program even further, adding additional reimbursement to enable practitioners to bill for more time spent reviewing data and broadening the pool of practice staff who can perform Remote Patient Monitoring tasks.
Remote Patient Monitoring is clearly a long term Medicare investment, and it’s proven to be successful in reducing emergency room visits by up to 92% and readmission rates by up to 40%. Emergency room visits can be traumatic for patients and expensive for insurers, and they don’t address the underlying and everyday data of chronic conditions. The goal of geriatric care is to prevent catastrophic events for seniors and Remote Patient Monitoring can do that.
How does Remote Patient Monitoring work?
The idea is simple: doctors identify high-risk patients within their practice and distribute connected medical devices to them. The devices capture physiological data (e.g. blood pressure) about the patients and send it securely to the doctor on a periodic basis. This enables doctors and their staff to be able to monitor and engage with patients in between office visits, and keep them from needing more, expensive care later.
Here’s how Remote Patient Monitoring works for practitioners:
1. Identify and enroll your patients
2. Patients receive and use the Remote Patient Monitoring device
3. Review patient data to provide better care
4. Get paid
Here’s how Remote Patient Monitoring works for patients:
1. Your doctor enrolls you in the program
2. You receive a Remote Patient Monitoring device
3. You use the device as directed by your doctor
So, who wins?
If done right, taxpayers, doctors, and patients.
Remote patient monitoring facilitates preventative care of patients and the cost savings in treating these patients before their conditions are exacerbated is massive.
If Remote Patient Monitoring can help doctors help seniors remain or become healthy, doctors’, patients’, and Medicare’s bottom line win.
Medicare is putting serious money behind it. Doctors using the Remote Patient Monitoring platform, 100Plus, get paid approximately $720 per patient per year for reviewing patients’ data. For the average primary care physician (PCP) with 800 Medicare patients, this represents approximately $500,000 in additional revenue per year. To put this in context, the average PCP makes $223,000, so they can nearly triple their income by remotely monitoring seniors.
Patients can experience a higher quality of life, less out of pocket costs, and longer life-expectancy.
COVID-19 is accelerating and increasing the use of remote patient monitoring and Medicare has put guidelines in place to enable permanent use for seniors. As physicians increasingly utilize and gain confidence in this new model, their patients will begin to expect this standard of care, irrespective of provider. Those providers who choose remote patient monitoring and telemedicine now will have an advantage moving into the future.
If done right, everyone wins, including taxpayers, doctors, and most importantly, senior patients. This is a new era of modern, technology-enabled preventative healthcare for seniors.
Ryan Howard is the founder and CEO of 100Plus.