From the March 2011 issue of HealthCare Business News magazine


Compensation & change
Tech aspects aside, the lack of standardized reimbursement is a major roadblock to the adoption of RPM technologies across health systems.

Although some state Medicaid plans recognize remote monitoring, the Centers for Medicare and Medicaid Services is not fully onboard with the solutions. “CMS has a history of being a passive insurer: a provider does something, files a claim and it pays the claim,” says Gary Capistrant, senior director of public policy with the American Telemedicine Association. “It has not really used its market power to improve health care delivery or payment methods — certainly not to the extent that it could.”
In Europe, RPM interest is currently driven mostly by cardiologists and some “more forward looking” insurers, says Philips’ Bromberg.

Skeptics say more evidence proving RPM’s efficacy in reducing costs and improving quality is needed before reimbursement policies can be established. But the evidence in favor of RPM is mounting.

In 2003, the world’s first large-scale, randomized prospective trial observing CHF patients found that telemonitoring reduced the number of days spent in a hospital by 26 percent and reduced overall costs by 10 percent, when compared to nurse telephone support.

This month, the preliminary results of the Whole System Demonstrator program in the United Kingdom, the world’s largest telehealth randomized trial to date, will be released. More than 6,000 participants were enrolled in the two-year study that sought to pinpoint the value of RPM technologies.

In the United States, a number of smaller studies are currently underway, including efforts by government agencies. In late January, the U.S. Department of Agriculture allocated more than $34.7 million to fund 45 telemedicine projects being developed to increase access to health care in rural areas.

Additional research may sway payers toward establishing reimbursement codes for remote monitoring, but some say tying adoption with payment is off-target. “Is reimbursement an issue? It’s an issue that a lot of people talk about,” says Care Innovations’ Cherry. “I’d like to see us talk more about the impact to our bottom line when we do a better job of identifying problems with patients early and keeping them out of those high-cost settings, rather than being so focused on not adopting this until the physician gets reimbursed.”

Another obstacle in the way of widespread adoption is the clinical culture’s focus on interventional rather than preventative care. “Not only does the incentive system not line up with this, providers are not being paid for keeping patients out of the hospital, but for treating them in the hospital. That’s how they’ve been trained,” says Philips’ Bromberg. “It’s going to require time and a new generation of physicians and clinicians to come into the health care arena with the mindset that preventing is better than treating.”

March 2011 Magazine

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