In this episode, we are joined by Deborah Fisher, Chief Operating Officer at NavCare, to discuss how hospital revenue can be increased through the use of remote patient monitoring.
Highlights of this episode include:
- Background on NavCare and their evolution from a home health company to a post-acute care company.
- Details on remote patient monitoring and how it works.
- How using remote patient monitoring of the chronically ill can increase revenue.
- What role does remote patient monitoring play during the coronavirus pandemic?
- How has remote patient monitoring impacted Medicare reimbursements?
- How healthcare organizations can initiate a remote patient monitoring program
- And more…
Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. Today I’m joined by Deborah Fisher, Chief Operating Officer at NavCare, who will share her thoughts on how hospital revenue can be increased through the use of remote patient monitoring. Deborah has worked as a nurse in a variety of settings, including inpatient, home health, and hospice. She is now in operational leadership at NavCare. Deborah, welcome to the show.
Deborah Fisher: Thank you, Mike. And thank you for me.
Mike: Why don’t you start out by telling us a bit about NavCare and what you do there?
Deborah: Okay. So NavCare, actually, is a care management company. We really evolved out of a home health company, home health, hospice, and private duty. That post-acute care space is what we were in prior to that. We sold off a little bit of our business and then really moved into the care management space right around the same time that CMS was releasing those chronic care management codes. And so we really have been, and still continue to be, a post-acute care company. And what I do here is I am the Operations Manager for NavCare, really helping to see– as it is a clinical product, really helping to see that we are managing and helping our providers manage their patients, who either have had an acute care illness or are chronically ill and dealing with some of those chronic illnesses.
Mike: Deborah, when we talk about remote patient monitoring, practically, what does that mean and how does it work?
Deborah: Okay. So in 20– actually, in late 2018, CMS unbundled a code which allowed providers to bill for remote patient monitoring. And as they described remote patient monitoring, really what it is looking at digital technology, collecting data from a patient, and then transmitting that data electronically, obviously, securely as well, to a provider in a different location. Taking the benefits of using technology to get better insight on patients and what they’re doing. And so in 2018/2019, Medicare released some codes that allow primary care providers, and especially providers, to begin billing for remote patient monitoring. So in 2018, they released a few codes. 2019, they released some additional codes. And then in 2020, they’ve even enhanced more to give us more options not only for primary care providers but for specialty providers as well to bill for these remote patient monitoring activities.
Mike: Deborah, COVID-19 has put financial hardships on physicians, physician groups in hospitals nationwide as utilization has dropped significantly, how can using remote patient monitoring for the chronically ill in the patient population increase revenue?
Deborah: Yeah. I think we’re all, I think, kind of still swirling a little bit with this COVID-19 trying to figure out who we are what we’re doing. But I think one of the pieces of remote patient monitoring that has really come to the forefront is the ability to stay connected with patients. So I think when we think about remote patient monitoring prior to COVID, I think it was, “Yeah, that might be a nice-to-do.” But now post-COVID, it is truly almost a necessity. It really helps those providers keep an eyes point on what’s going on with those patients, really getting insight into those patients, especially as you think about most providers, as we’re thinking about COVID, and we’re sheltering in place, and you’re not going to your providers more often. And still these patients are still dealing with chronic illness like diabetes, heart failure. And so how do we still keep our eyes on what’s going on with those patients without necessarily bringing them into the four walls and exposing them? Well, there’s an opportunity for remote patient monitoring. So I think that’s one excellent opportunity for remote patient monitoring. I think the other, when we think about revenue and the loss of revenue, again, as providers are really kind of keeping those patients away from the office, sheltering them at home, that means that they’re not coming into the office, that means that I’m not getting revenue because of those visits. And I think with remote patient monitoring, it allows you to get that non-face-to-face revenue and really helping to, like I said before, not only keep an eye on what’s going on with that patient, but now here’s an opportunity for me, still, to get some kind of payment, some kind of revenue from those patients as well. So I think it’s twofold in that piece of it.
Mike: Most COVID-19 deaths have been attributed to the elderly. What role does remote patient monitoring play in keeping those seniors safe?
Deborah: Well, I think what we’ve seen in our industry over the last several months is definitely a rise in interest in remote patient monitoring from several different vendors, even folks that hadn’t really thought about remote patient monitoring. But again, as we think about these seniors being isolated in their homes, remote patient monitoring gives you visibility into what’s going on in that senior’s home. And even as we think about our facilities as well, we have a hospice that we have on service right now. And for them, their hospice nurses had been used to going into facilities. Now with COVID, not only are they not allowed to come in the facilities but neither are those patients, family members as well. So again, having that remote patient monitoring gives you an insight into what’s going on. We can deposit that equipment to that patient, but that patient will take those vitals on a daily basis. Those providers are getting those daily data points and able to make decisions on that patient. And so I know one of the things that came out of a New York study was that oxygen saturation, that was one key indicator of a decline in status for a lot of our elderly patients, especially those who have either been exposed to COVID or may have been dealing with COVID. With remote patient monitoring, you can give that patient a pulse ox, which monitors that O2 saturation. And then you can trend that, and you can see if there’s a decline going on and then have an interaction or intervention to improve the health of that patient. I think with remote patient monitoring, really that has been in terms of– now only am I getting data, but now I can act on that data in a lot more timely fashion. I don’t have to rely on that patient to convey that information to me. I’m seeing that on a daily basis coming in and coming over.
Also, with the remote patient monitoring, which I think is beneficial for our seniors, it’s helping them stay engaged in a part of their health and their activity and not so isolated. One of the things that we’ve seen as we’re doing more of the telephonic outreach on these patients with remote patient monitoring, we hear from the patients a lot. We hear and we see depression. We see the sense of isolation. And with this remote patient monitor, it allows us to keep connected with that patient, to engage them in their health on a daily basis. We also send the messages through the remote patient monitoring device just as a check-in. We also send what we call a terrific Tuesday message out to them. We’re just giving them a health tip. So it’s keeping them engaged and involved so they don’t feel isolated. And also helping them just to manage those chronic conditions as we think about, they’re not seeing their physician as often, so how do we make sure we stay in contact with them? So I think as we look at our elderly population, and we think about the impact that COVID has made, truly the isolation piece of it, and I would say also monitoring those vitals on a day-by-day basis and providing timely interventions that can really alter and change and improve their health outcomes.
Mike: Can you talk about the impact of Medicare’s reimbursement of remote patient monitoring from the perspective of patients, caregivers, and providers?
Deborah: Sure. I’m really excited to see that Medicare really has provided a lot of support to our primary care providers on the remote patient monitoring piece. Like I mentioned before, in 2018, they unbundled a CPT code which allowed the providers to bill for remote patient monitoring, but there was some restrictions around there and some challenges around there. In 2019, when they release additional codes, it really, really helps supporting the primary care providers. They released three additional codes in 2019. Still, I would say some reservations with those codes and the primary care providers using them because one of the issues with that was that it required direct supervision, which really put a lot of– I would say taxed a lot of the primary care providers and specialty providers to make sure that those services were provided by someone inside of their office. With the beauty of it in 2020, when Medicare released the regulations for the physician fee schedule, they opened it up to say that not only did we add an additional code, but it also allowed those codes to be in the care and services to be provided by general supervision, which allows a third-party company like ourselves to come in and support those primary care providers. So I think Medicare is really seeing not only the evolution of the benefits of remote patient monitoring, but they’re putting dollars behind it because they know at the end of the day, it’s a taxing job for primary care provider to wrap their arms around the large populations that many of them have. Some primary care providers have 1,500 to 2,000 patients on their panel. It’s hard to keep your pulse on what’s going on with each of those, especially those who are dealing with those chronic conditions. Well, Medicare really has, I would say, stepped up and helped to support those primary care providers by giving them resources and giving them reimbursement opportunities to not only gain information but also be paid for that as well. So I think from that perspective, it’s been great for our providers. I think when you think about patients and caregivers– I had one, one patient, to share a story, who we put on the remote patient monitoring system. And his first comment was, “I feel a sense of peace and relief that somebody is watching these on a day-by-day basis.” Because you think about– many patients, they may take their blood pressure, they may take their blood sugar, but knowing that those numbers mean one thing, knowing that someone clinically every day is looking at those numbers and following the trends of those numbers is something different, and it gives them a sense of peace of mind to know that I take my vitals, and I send it in via this Bluetooth connectivity. I don’t have to do too much. I send that in, and lo and behold, if it’s outside of those parameters, someone’s going to call and follow up with me. That’s where that sense of peace, I think, comes from the patient as well as those family members as well. Because oftentimes, again, we’re thinking about in COVID world which we’re adapting to now, many of our seniors are confined or isolated. Now family members have an opportunity to at least know that if they’re on remote patient monitoring, someone’s monitoring those vitals. And with our particular system, we do have an app that allows that loved one, actually to see those vitals as well. So they know what’s going on with their loved one. So I think there’s a lot of benefits around the whole remote patient monitoring, not only from a Medicare stand point but also from the caregiver standpoint as well.
Mike: How can a health care organization get started with a remote patient monitoring program?
Deborah: I think a couple of things with that. One is really looking at the technology component of it. I would say that ease of use is probably the key driver in selecting your RPM provider. I think the other piece of it is deciding if that facility or that healthcare organization can manage this on their own, or do they need support from an outside vendor like ourselves? And I think that’s a couple of questions that they need to ask themselves. Do they have the bandwidth to not only get the equipment, manage the equipment, but also manage and monitor those daily insights or vitals that are coming in? So those are a couple of things, I would say, that healthcare organizations really need to think about as they’re thinking about starting a remote patient monitoring program. I think the other piece is what population do you want to monitor? Where do you feel like there’s the biggest benefit? I know we recently worked with an organization who has a lot of cardiac patients, and we are seeing some positive trends in terms of decreasing rehospitalization for that population. And so I would suggest that a healthcare organization really think about where do they feel like they have the biggest opportunity? Where do they feel like they would need to have a little more closely monitoring and managing of patients? I think those are two key things.
Mike: Deborah, if someone wanted to learn more about NavCare, where can they go?
Deborah: We are located on www.navcare.com. And again, we provide really the full gamut of remote patient monitoring services. Not only do we have the equipment piece of it, but we also back that with a clinical care team that provides services 24 hours a day, 7 days a week. We’re excited that our product that we use is very simplistic. It’s really truly a plug and play. And we are really a turnkey operation. So if someone is interested, they can certainly seek us out on the website navcare.com, and we would be more than happy to do a demo and show them the equipment as well.
Mike: Deborah Fisher, thank you so much for stopping by the podcast today and sharing your thoughts on the future of remote patient monitoring.
Deborah: Thank you so much for inviting me, and I enjoyed your couple of podcasts that I’ve listened to. So thank you for allowing me to participate.