Dr. Steven Gerst: Changes in American Healthcare Require a Delivery Format Capable of Reaching a Larger, More Diverse Community of Patients

Dr. Steven R. Gerst is a leading authority in Health Informatics who has dedicated much of his career to analyzing the latest breakthroughs in medical technology and the healthcare industry. He advocates the use of Telemedicine and Remote Patient Monitoring (RPM) to accommodate the contemporary health requirements.

Dr. Steven R. Gerst

RPM allows for the immediate capture of data from a patient experiencing medical issues through a direct, real-time connection to a physician's and hospital's electronic medical record system. Patients with chronic illnesses who would greatly benefit from full-time monitoring make up approximately 71 percent of the general population and 86 percent of Medicare recipients (1). Bluetooth-Cellular and web-enabled devices based in the home and through mobile technologies may provide patients with 24-hour access to healthcare providers.

Steven R. GerstThere could be over $300 billion in annual cost savings for implementing RPM, Chronic Care Management, mobile behavior health modification applications and telemedicine systems into the healthcare regimens for those suffering from chronic illnesses. 

Nearly $1 trillion is spent every year on managing patients diagnosed with one or more of the 23 chronic illnesses reimbursed by Medicare and Medicaid. Providers may be reimbursed between $43.10 and $141 per patient per month for use of virtual monitoring under the CMS' Chronic Care Management Codes under CPT codes 99490, and the New Complex Condition Care Management Codes 99487 and 99489 for between 20 minutes and 60 minutes of care (2). In addition, post hospital discharge under Transitional Care Management Codes 99495 and 99496 (3) pay between $160 and $230 for post-discharge follow-up care which may now be furnished via a telehealth visit. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter. 

Experimental projects promoting Medicare objectives have also been granted reimbursement authority by Congress through the Secretary of Health and Human Services as Section 1115 of the Social Security Act allows hospitals to apply for waivers to implement telemedicine programs in some states.

Chronic disease accounts for approximately 1/3 of total U.S. healthcare expenditures. About half of all American Adults (117 million have one or more chronic disease; 25 percent have 2 or more (4). Diseases such as heart conditions, chronic obstructive pulmonary disease (COPD), asthma, and diabetes account for the largest portion of these expenditures and, therefore, demonstrate the greatest potential for telemedicine practices to improve patient outcomes, lower adverse events, and reduce patient costs.

The result of a year-long RPM study discovered patients with a diagnosis of heart failure utilizing at-home telemedicine saved approximately $8,375 for the year's health expenditures. In addition to monetary savings, patients involved in the study experienced a net reduction of 34 percent of acute heart failure admissions and an overall patient satisfaction rate of 94 percent.

3 new innovations may save an estimated total of $305 billion (according to a report developed by Goldman Sachs) (5):

  • $100 billion from telemedicine
  • $200 billion from RPM, and 
  • Tremendous savings from integrated behavior modification applications to address smoking cessation, obesity management, and other lifestyle changes which can be implemented.

Steven R. Gerst: Obstacles remain when promoting nation-wide adoption of telemedicine practices.  

The report developed by Goldman Sachs estimates commercially available options to provide telemedicine services and technology may generate $32.5 billion per year in commercial opportunities to integrate into regular healthcare services. Yet, there are still a few challenges to overcome for the wider implementation of telehealth, RPM and Chronic Care Management: 

  • Wireless healthcare must undergo significant upgrades to protect privacy at a HIPAA compliant status 
  • Some physicians remain unconvinced with the viability of telemedicine with currently available technology 
  • Some argue securing reimbursement is essential to the viability of digital health business models while others find this counter to connected health goals

In addition, automated revenue cycle management systems need to be developed in conjunction with the electronic medical record companies and billing systems to electronically capture and bill CMS for the CCM and TCM codes as part of daily workflow. Despite the hurdles, the same report relays the progress made toward the future of digital health. The FDA has approved over 100 digital health applications and provides guidelines for regulation and approval for digital health services. Technological developers are hard at work creating seamless interfaces for users of all levels of smart technology competency. 

Steven R. GerstRPM currently in practice focuses on high-cost chronic illnesses like congestive heart failure (CHF), COPD, hypertension, and diabetes. 

Some of the most expensive and common chronic diseases are excellent candidates for remote health management. Helpful tools which have been cleared by the FDA include 510K Bluetooth-connected devices to cellular systems such as weight scales, glucometers, thermometers, pulse oximeters, spirometers, and 2 lead EKG sensors. 

When Bluetooth and WiFi dual-band devices are automatically paired to a 3G/4G (and soon, 5G narrowband) hubs, the possibilities for real-time data transmission to a doctor's EMR permit customizable healthcare to best treat the specific disease manifestations of each individual patient. The costs of financing and time are greatly reduced as this technological advancement may lower the medically unnecessary hospital 30-day readmissions. Over 2,600 hospitals were penalized by CMS during 2015 up to 3 percent of the Medicare reimbursement totaling over $428 million.

During the recent American Telemedicine Association and HIMSS meetings, several hospitals and payors testing RPM systems have indicated drastically reduced numbers of readmissions (47 percent), admissions (45 percent) and ER visits (27 percent). Among the tools used were connected pulse oximeters, scales, and blood pressure cuffs for a group of remotely monitored patients experiencing pulmonary obstructive disease. 

The same conferences displayed monitoring devices designed to be consumer-friendly for patients and caregivers. The use of these "plug n' play" technologies broaden the opportunities for health IT vendors to improve the livelihood and cost of care for patients. Such solutions are highly recommended for the Accountable Care Organizations, MSOs, and insurances with at-risk populations in Medicare Advantage plans, commercial, and certain Medicaid plans. 

Developments in telemedicine continue to grow for the betterment of health services to populations in remote areas and/or with various financial constraints. Where the technology is available, the work performed in the U.S. could revolutionize the healthcare industry eventually broadening the availability of healthcare worldwide.

To learn more about the growth in remote health and home monitoring, visit  www.stevenrgerst.com

(1) CDC. As found at: Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Aug. 16, 2016. 

(2 ) Department of Health and Human Services, Center for Medicare & Medicaid. As found at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagementServicesChanges2017.pdf

(3) Department of Health and Human Services, Center for Medicare & Medicaid. As Found at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf.

(4) Centers for Disease Control and Prevention. "Chronic Diseases: The Leading Causes of Death and Disability in the United States." As found at: https://www.cdc.gov/chronicdisease/overview/index.htm.

(5) Goldman Sachs Equity Research. June 29, 2015. David H. Roman and Kyle D. Conlee: "The Digital Revolution comes to US Healthcare." As found at: http://www.scbio.org/resources/Documents/Internet%20of%20Things%20-%20Volume%205%20-%20The%20Digital%20Revolution%20comes%20to%20US%20HC%20-%20Jun%2029,%202015%5B1%5D.pdf

To learn more about the growth in remote health and home monitoring, visit www.stevenrgerst.com.

Source: Steven R. Gerst