On a higher level, telemedicine tools exist that are dramatically changing the paradigm for some of the most complex, high-cost conditions. DoseDr, a mobile chronic care management application, is one example. Developed to send medication reminders and physician-reviewed instructions to patients in real time, patient-reported data is aggregated and regularly analyzed by the telemedicine physicians. In the case of diabetes, patients enter their blood sugar levels into the application and receive the correct insulin dose to take, enhancing patient-provider communication, while improving A1c levels and patient engagement.

In two separate pilot studies, uncontrolled A1c levels greater than 9 percent were reduced to 6.4 in just three months – an achievement that often takes years to achieve through traditional office visits. While technology was critical to achieving this outcome, the full strategy required not only the right tools, but the people and workflow systems that support interconnectivity between the patient and provider.


The Challenge
Charges for remote patient monitoring represent a move toward real industry change that supports proactive and ongoing care management for better population health. Yet there is potential risk that this move will ultimately generate more charges, increasing the cost of care without changing outcomes.

Simply put, three things can go wrong.

1. First, some providers might collect and view patient data and then do nothing actionable with it. Remote monitoring implies that an opportunity exists to make a positive change, and that interventions are taken on behalf of the patient. Because this implication is not narrowly defined, the reality of human nature is that the code could be abused. The result is more waste and greater costs. To improve the outlook, the industry needs a call to uphold professional excellence and policies to audit the code’s use.

2. Second, providers may have good intentions to do right by CPT 99091 but may not focus on the right data. Managing the highest cost conditions – those with multiple comorbiditiess – requires the right tools and a focused approach to interventions that really matter. For instance: hypertension outcomes rely on ambulatory blood pressure monitoring; insulin-dependent diabetes outcomes rely on glucose assessments; and congestive heart failure outcomes rely on blood pressure and weight. Providers need to consider chronic diseases where treatment decisions can be reliably made by provider monitoring of user-generated data.

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