COVID-19 has shown that our healthcare system needs to be equipped to monitor, manage, and treat patients outside the clinical care setting. During this unprecedented time, hospitals and health systems can no longer afford to deprioritize virtual health services – and technologies.
Revenue gaps, personnel shortages, and capacity issues are nothing new for many health systems. And, COVID-19 has without a doubt exacerbated these issues, in some cases, to unmanageable levels for providers. Hospitals are reporting losing between $80M and $800M per month. New York academic medical centers have stated losses up to $450M a month since the start of COVID-19 due to sharply rising personnel costs with “dramatic losses in revenue.”
The primary driver of revenue loss are the canceled or delayed procedures like elective surgeries or standing in-person visits. While many cancelations are driven by the health system or provider, patients are also canceling proactively out of fear of COVID-19 exposure. Evidation’s COVID-19 impact recent study indicated about 33% of patients reported they have abstained from or canceled a scheduled appointment within the last two weeks.
In addition to alarming revenue shortages, hospital administrators are trying to manage the lack of beds and personnel to support those who are critically ill. While providers themselves, the people on the frontlines of care delivery in this pandemic, are facing sharp rises in burnout and declining mental health. A JAMA study conducted in China during the coronavirus pandemic found over 50 percent of health care workers had symptoms of depression while nearly 45 percent reported symptoms of anxiety and over 70 percent felt distressed.
A support system for challenges provider face during and after COVID-19
Virtual care is providing short-term and long-term opportunities for providers of all sizes to address these critical challenges. From large health systems to single-physician clinics, virtual care is creating sustainable streams of revenue, alleviating capacity issues, helping overburdened care personnel, and, most importantly, supporting patients with proactive care. As health systems are working quickly to redirect and reinstitute care programs and treatments for their patients, these technology-driven solutions are providing the ability for providers to continue to see and serve patients.
Remote patient monitoring (RPM) services and telehealth visits are becoming vital during COVID-19 to care delivery efforts. Recognizing this, CMS, OCR, and the FCC have thrown their weight behind creating quick pathways to deployment and reimbursement. Through an emergency declaration and continued CMS expansion of coverage for telehealth services, virtual visits, e-visits, and RPM services, it is easier for providers to implement and use these virtual care services without previous restrictions, such as modality.
The relationship between telehealth and remote patient monitoring
Telehealth services have been and continue to be quickly deployed to replace in-person appointments. With waivers in place and some reimbursement temporarily furnished at the same rate as in-person services, these programs are providing a lifeboat to providers and patients in need of operational, financial, and clinical support. Even outside of the COVID-19 response, telehealth serves as a strong replacement for in-person services. Whereas, remote patient monitoring serves as a strong extension and augmentation to in-person and/or telehealth services – enhancing clinical insights between office or virtual visits and provide a more longitudinal care model.
Remote patient monitoring enables providers to continuously monitor and manage their patients, with either acute or chronic conditions, in-between clinical visits. Continuous monitoring programs and connected devices allow providers to not only monitor patients’ progress with treatments and understand daily biometrics (e.g., blood pressure, blood glucose, etc.), but they also drive detailed conversations between patients and providers that initiate lifestyle and behavior changes. These programs have demonstrated improvements in outcomes, treatment adherence, and meaningful goal adjustments. Using RPM, providers can observe and intervene based on trends in patients’ readings. This allows them to intervene before an adverse health event occurs or a hospitalization is needed.
Patient-provider conversations and interventions using patient-generated health data to address outcomes, adherence, goals, and trends can be conducted via telephonic conversations and can be billed concurrently with RPM services (CPT code 99457) using HCPCS code G2012. The virtual check-in code reimburses for 5-10 audio-only evaluations of patients. Hospitals or health clinics that do not have the infrastructure for telehealth can offer virtual check-ins with primary care doctors, specialists, and physical therapists as an alternative.
Using the patient’s data and observing the progression or worsening of trends, a provider may determine a person with diabetes, for example, may require additional visits to address their condition. RPM, in conjunction with telehealth, enables providers to create intermittent encounters – that goes every three-to-six month – to support the patient in his, her, or their goals, outcomes, and treatments.
Together, RPM and telehealth services can help providers better manage patients, address the ongoing capacity issues and personnel shortage, and can keep patients out of the hospital – reducing potential exposure to COVID-19.
Take James, for example, a person with type 2 diabetes, James has an in-person visit scheduled every three months with his doctor. Due to COVID-19, James isn’t able to go into his doctor’s office and is now utilizing telehealth for his visits. Because he’s self-quarantining, James hasn’t been able to exercise as much as he was previously; he’s become depressed, isn’t managing his nutrition as well, and his sleep is worsening. James continues to add weight, and his blood pressure and blood glucose levels are rising week-over-week. Through remote patient monitoring, James’ RN observes these trends and intervenes before his condition worsens or requires a hospitalization.
Creating revenue through remote patient monitoring
For physicians at small clinics or hospitals whose in-person visits were canceled, RPM can help them keep their doors open and continue to support their families and teams. With financial reimbursement available for remote monitoring, providers can use CPT Code 99457 to bill for remote patient monitoring services and 99453 for patient education and set-up. These two codes allow for quick deployment and scaling of remote monitoring programs by providing the financial structure for physicians and qualified medical professionals to be reimbursed for their time spent on patient care.
CPT code 99453 is a one-time practice expense reimbursing for the setup and patient education on the use of RPM equipment. Many health systems are incorporating code 99453 into their post-discharge process for COVID-19 patients. Outside of the COVID-19 response, health systems are incorporating this process into quarterly appointments with patients – providing them with the devices, set up, training, and education on site before they return home.
CPT code 99457 is a direct monthly expense for the remote monitoring of physiologic data as part of the patient’s treatment management services – for at least 20 mins per month. Additionally, if a provider spends more than 20 minutes on RPM services for a patient in a given month, he, she or they can bill for additional 20-minute increments with CPT code 99458. These services include the review of data and related charts, messaging and conversing with patients as part of the program, etc. CMS has temporarily waved the associated co-pay for these services as a way to provide unrestricted access to patients – regardless of affordability.
The future of virtual care in a post-COVID-19 world
Our hearts continue to be with the patients and their families who are battling COVID-19, the providers on the frontlines that continue to make daily sacrifices, and the first responders, essential personnel at grocery stores, gas stations, providing sanitation services, and so many more.
At Validic, our goal is to continue to serve these people with technology that makes care delivery better, more affordable, and more accessible. By keeping people that do not need emergency medical attention out of hospitals and health clinics, telehealth and remote patient monitoring can help reduce the spread of COVID-19 and ensure limited healthcare resources are put towards the most critical and urgent needs. Virtual care services are needed now and in a post-COVID world to radically improve patient care and outcomes, provider burnout and shortages, and worsening capacity issues.
For more information on Validic’s COVID-19 response, please visit https://www.covidmonitoring.com/ or learn more about Validic’s remote patient monitoring solution at https://validic.com/solutions/impact/.
- Telehealth Visits: Multimedia communications that includes, at a minimum, audio and visual equipment permitting two-way, real-time interactive communication between a provider and a patient. Can be used for new or established patients.
- Virtual Check-Ins: A brief (5-10 minutes) communication technology-based services – can be audio-only such as via telephone or other telecommunications device – to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.
- E-Visits: Asynchronous, brief communication between a patient and their provider to discuss a health concern, through an online, digital E&M, such as a patient portal.
- Remote Patient Monitoring: Asynchronous, physiologic monitoring of patients during a calendar month, in which data is transmitted, reviewed, and managed by the patient and/or caregiver.
* definitions provided by Crowell & Moring
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