You Took the First Step, Now What?
Let's start with all those nice senior citizens home bound and afraid to come to your office. Don't wait for them to have a stroke, heart attack or other emergency. Get them on remote patient monitoring.
Step 2. You need a Telemedicine platform that includes RPM coding, billing support, links the device readings, allows for messages and surveys, displays Alerts, allows scheduled calls, has a to do function, records nutrition and even has an activities for daily living function. That's VitalCare.
Step 3. Find a reliable source for bluetooth monitoring devices such as a blood pressure cuff, pulse oximeter and weight scale which handles about 90% of your chronic patients. Again the answer is VitalCare because their devices are paired easily to the tablet or smartphone.
Step 4. Decide if you have the staff time to monitor the patient's signs and make the monthly phone calls. Or have an outside chronic care management agency provide the support. Have them do it on a split of the reimbursement. Like the service we work with does.
Step 5. Your vendor representatives should be on top of the market and changes. They should have the latest technologies to help keep you on top of the game. That's Telemedical Partners!.
You are half way there. Right now, Telemedicine is helping solve the basic communication with your patients. But there is so much more you can do. We are here to help you get started and taking care of your RPM business from soup to nuts. We provide a truly turnkey solution. Give us a call today! 800-940-7113
Alerts for Respiratory Decompensation
In wake of the current COVID-19 pandemic, increased emphasis has been placed on remote monitoring of high-risk patients who have contracted the COVID-19 virus, both at home and in-clinic. Due to the nature of the virus infecting the alveoli in the lungs, monitoring of respiratory parameters—specifically respiration rate and respiratory tidal volumes-- can be a valuable tool in identifying early warning signs of respiratory decompensation. Organizations like the FDA and FCC have launched initiatives to incentivize and, in some cases, pay for telemedicine remote monitoring programs implemented by health care providers.
Respiratory Wave Forms and Reports
In an effort to help combat issues brought on by the current pandemic, toSense Inc. has made slight modifications to its core, FDA-cleared technology; the CoVa Monitoring System 2. Using its impedance-based technology, the system is able to display uniquely high-quality waveforms depicting highly accurate values of respiration rate.
Additionally, the monitoring cycle is being modified to accommodate longer battery life, giving physicians the ability to monitor patients continuously for periods of up to 8-12 hours. Automatically generated reports and a simple threshold-based alert system have been built in to the system’s gateway to notify clinicians and caregivers of negative trends in respiratory parameters.
Reports are generated frequently and can be sent to the clinician automatically. Early detection of symptoms allows clinicians and other health care professionals access to extremely valuable information, and gives them time to intervene and determine the correct next steps for treatment.
For more information on the modified CoVaä Monitoring System 2 for remote monitoring of COVID-19 patients and their respiratory parameters, please contact: Jim Shumate at Telemedical Partners.
Recommendations from Washington State
Note: We lifted this from the web without permission. But we don't think they will mind if we reprint it here.
The Washington State Department of Health recommends that all employers put COVID-19 screening protocols in place. You can help prevent the spread of COVID-19 in your facility by screening employees and visitors on a daily basis.
The screening protocol outlined below is based on the following:
• A review of screening protocols from multiple agencies
• Recommendations by the CDC
• A literature review of the most common signs and symptoms of COVID-19
COVID-19 screening protocol: What to do Screen everyone who enters your facility, including:
• All employees before the start of each work shift
• All visitors
COVID-19 Screening Protocol
Ask the following questions when you screen employees and visitors:
“YES or NO, since your last day of work, or since your last visit to this facility, have you had any of the following:”
*If an employee or visitor answers YES to any of the screening questions, immediately activate your agency’s emergency protocol for COVID-19. The designated screener should consider:
• A review of the screening results
• Recommendations for possible exclusion of the employee or visitor from the facility
• Recommendations for medical follow-up
From The Washington State Health Department March 21, 2020
When we work with our new clients, there are certain questions that always come up. These are the questions left unanswered prevent you from starting remote patient monitoring. Let's review them here.
We are too busy already...
We have yet to meet a practice where the staff is not fully occupied often to the point of burnout. The key to RPM is to view it as a new profit center. One person, perhaps a part-time PA, is given responsibility for the program. They research the "charts" for the right patients. Then contact them about joining this exciting new outreach program. Next schedule them for an appointment where the PA explains the details, introduces the VitalCare app, sets up the monitoring devices and trains the patient. The PA also uses the VitalCare administration dashboard to monitor the patients contacting them when Alerts appear or when other To Dos pop up. The PA also sends messages, surveys, questionnaires and makes the monthly support phone call. The same PA downloads the support for reimbursement and watches over the entire program.
No more time consuming extra work!!
Does RPM reimbursement work?
Medical practices and home health agencies are being reimbursed by CMS and depending upon your state, private insurance and Medicaid. One stipulation is that the device are used at least 50% of the days of a month, which we interpret as 16 times. All time spent by you and your staff is automatically recorded and documented in VitalCare. Your video and audio calls are covered separately if the patient is not on RPM. Again this is done through VitalCare so you have a real time record.
Do I have to give the devices to the patient?
CPT Code 99454 requires that the practice supply the monitoring devices. VitalTech supplies (sells) FDA cleared, Bluetooth monitoring devices that easily pair to the VitalCare app. Your practice can loan devices but do not have to give them away for free. We suggest the patient sign a form (we provide one) that they are borrowing the devices. If they drop out of the program they must return them in good working order or else they own the device(s).
What about device inventory?
When you schedule the RPM appointment, we can have the devices drop shipped to your office or the patient. If to the patient, they need to bring the devices in for their RPM appointment. So you do not carry inventory and only order after you have confirmed the appointment. Keep in mind that RPM requires a separate appointment and you cannot do this at the AWV or other visit.
What about the cost of devices and VitalCare?
If you supply the weight scale, patients are will find this the easiest device to us and are more likely to use it daily meeting the threshold. If you are managing their nutrition (the VitalCare app supports this quite nicely) and the plan is to help control their diabetes, hypertension and other conditions that way, the scale may be the only device you need. The first month your practice is reimbursed for training (CPT 99453) and data (CPT 99454) totaling $81.21 (before regional adjustments). The VitalCare Weight Scale is $74.99. So you break even the first month.
VitalCare is invoiced monthly for the total licenses in use that month. So you are paying for them the month after again helping cash flow.
And keep in mind, RPM is now a heavily weighted factor in your MIPS.
CDC Provides Updates Daily at 4pm
NOTE as of 2/13/2020 we are suspending making updates to this blog as information on COVID-19 is widely available.
CDC is providing clinical guidance for patients with confirmed cases of Novel Coronavirus (COVID-19). Patients typically are at the hospital having been admitted for pneumonia symptoms. Persons Under Investigation (PUI) are now broken out from confirmed cases. PUI's are under evaluation using the procedures developed for SARS and MERS.
CDC recommends physicians obtain a travel history for persons with fever and acute respiratory symptoms.
CDC is no longer reporting testing cases because states are doing it themselves (as of March 2)
As of March 10, 2020
Total Cases 938
Total Deaths 29
States Reporting 39
Of the 80 Total Cases:
Travel Related 92
Person to Person 75
Under investigation 771
These numbers started January 21, 2020.
Some businesses have issued instructions to their employees to stay home if they are running a fever above 100.4 or greater.
A physician practice may want to offer employees or patients who call in with fever, flu-like or pneumonia symptoms the option of a remote video appointment. Isolating the patient at home may help reduce the odds of spreading any respiratory virus, possibly including Novel Coronavirus. Certainly keeping suspected cases out of the office environment makes sense. The practice may want to check its employees daily.
CoVa Achieved 84% Reduction in CHF Re-admissions
Just hard to believe. But it is true.
One home monitoring product properly used in the clinical study reduced CHF hospital re-admissions by 84% over a 6 month period. That is the CoVa Monitoring Device from toSense .
FDA cleared, CoVa measures fluid build up using Thoracic Electrical Bio-impedance (TEB.) CoVa measures Stroke Volume, Heart Rate, Heart Rate Variability, Cardiac Output, Respiration Rate and single lead ECG. TEB is reimbursed under CPT Code 93701.
The CoVa necklace design is easy for the patient to use once trained by a clinician. Dexterity challenged patients may have their caregiver or home health nurse take measurements.
Clinicians can use the bluetooth active CoVa in office for CHF patient quick readings and ECG waveform on the clinician tablet (gateway.) This can be done as part of the normal workup. The 2 electrodes are easy to snap in the CoVa necklace and remove when finished.
What about your numbers?
Clinical studies typically are run with greater care than you may find in your general CHF population using CoVa at home. But let's assume that 84% isn't achievable in your practice. What about half that? Or a quarter of it? What would a 20% reduction in CHF hospital readmissions mean to you? To the patients saved from another trip to the ER?
Your ACO Can Save at Least $12 Million
We don't have to tell you what this means to an ACO. But we will. If the typical CHF hospitalization costs $21,000, and your CHF population is 10%, what does a 20% reduction look like to you?
Read more on this website or watch our demonstration video.
Contact us about a trial in your practice / Medicare Advantage / or ACO.