How do we care for people at
high medical risk who live alone?
Mollie is 84 years old, has diabetes and hypertension, and lives alone in a two story home. She is afraid that she could fall on her stairs and nobody would know she needs help. She is also not going to her doctor's office for checkups for fear of being infected by the new coronavirus. Molly wants a way to stay in touch with her doctor and care team, and to let her family know how she is doing. She wants help to notify them if she falls, gets sick and doesn't get out of bed, or gets confused and doesn't eat or take her medicines.
Mollie's primary care provider has seen a steep drop-off in visits from patients like Mollie, and is moving to provide telemedicine services to manage patients with chronic care needs, and to maintain revenue to keep clinic staff employed.
EmPowerYu's core sensor set provides reimbursable Remote Patient Monitoring (RPM) by giving care providers a numerical and visual summary of Mollie's daily life activities, and device readings when she takes them. A healthcare provider can then ensure that a chronic care patient like Mollie is monitored for ability to live independently and follow a care plan. Notifications and alerts can be scheduled and sent to the provider to support care decisions, and to triage the patient to the right place for care when an intervention is needed.
Dementia care - people who do not remember instructions can be monitored without any effort on their part.
Low energy or low interest patients - people who don't feel well enough to respond to surveys, or take medical device readings, have daily life metrics taken automatically.
Complex chronic conditions - people who need help tracking and organizing data before clinical visits, or who have high susceptibility to environmental conditions, like circulating diseases or poor air quality, can have a longitudinal record of home data provided to their clinician.
Removing the requirement for participation in data collection generates a complete dataset for as long as the system is in place. Passive monitoring solves the problem of data gaps when patients lose interest in wearable devices, and don't charge or wear them.
Eldercare and frailty monitoring - people who want to age in place but are at the edge of their ability to self-care, and who are at risk for hospital-acquired conditions need real time oversight.
Older adults are susceptible to hearing loss (nearly 2 out of 3 people over age 70), and impaired vision (13% over age 65), which limits their ability to engage with most technologies.
Social Determinants of Health (SDOH) - discover food insecurity, and reduce bias by comparing each person to his / her / their own baseline rather than to a population that may not represent them.
Immunocompromised patients - people with cancer, rheumatoid arthritis, diabetes, multiple sclerosis, and celiac disease, etc, can stay home with oversight, reducing exposure to circulating diseases.
Nonambulatory patients - people who are homebound or require significant help to leave the home can stay in place.
Low technology settings - people who do not use smartphones or have access to broadband cannot use the common telehealth tools, and their providers therefore do not have any data other than often inaccurate self-reporting. EmPowerYu provides complete data using cellular connections.
Rural care - patients and providers need access to digital technology to keep local relationships strong and provide revenue to clinics, while reducing patient burdens related to data gathering and transportation.
Post-acute care - providers get immediate insight into the ability of the patient to self-care after returning home from the hospital, and to get metrics for outcomes like return of function.
Cancer treatment - people living alone and undergoing chemotherapy, and for whom small obstacles to daily living loom large, need automated oversight that will inform caregivers of functional status and recovery rates.
Primary care, Lifestyle Medicine, and Care Management practices - integrated care and chronic care teams will benefit from a holistic view of patients that promotes care management and coordination.
Counseling and Health Coaching - patients and clinicians, including therapists, can discuss specific patterns of daily life that impact the patient's wellbeing. Examples include spikes in blood pressure after eating away from home, sleep pattern stability, distribution of activity over the day and night, etc.
Outcomes monitoring - Patients who can't clearly communicate the effect of treatment to doctors or clinical trials need help creating a description that clinicians can use. Quantifying home patterns supplies analytics with the data needed to discover trends and results that the patient may not be able to recognize or describe.
Remote Patient Management (RPM) codes include the equipment, data transfer fees, and provider time for interpretation of data and images related to the patient. Providers can retain up to $120 per patient per month while providing their patients with the ongoing service. CPT codes 99453, 99454, 99457, 99458, 99473, 99474, are examples of applicable RPM codes.
Chronic Care Management (CCM) codes are for services of at least 20 minutes from any clinical staff member for people with two or more chronic conditions. Reimbursement of up to $118 per patient per month is possible with CPT codes 99487, 99489, 99490, 99491, and G2058. 99491can be billed for Physician's Assistants working from home.
Principal Care Management (PCM) codes are used for patients with one high risk condition, and can be used by a specialist at the same time a primary care provider is billing for chronic care management. Applicable codes are G2064, G2065, worth up to $54 per patient per month.
RPM codes can be charged at the same time as CCM and PCM codes, and RPM can be the basis for coordinating care between local providers and telehealth specialists using current data about the patient.
Telephone (landline) calls with established patients can use codes 99441, 99442, and 99443, depending on time spent on medical discussion.
eVisits (patient calls the clinic to discuss medical care) are worth up to $51, and include codes 99421, 99422, 99423, G2061, G2062, G2063.
Transitional Care Management - codes are for contact with patients within 2 days of discharge. Code 99495 covers moderately complex patients and bills at $166, and code 99496 covers highly complex patients and bills at $237.
For specific details on reimbursement in individual locations, see the National Consortium of Telehealth Resources Center, whose federal funding makes assistance generally free of charge. https://www.telehealthresourcecenter,org/