Data and Telemedicine: MACRA, MIPS, and Your Data

MACRA, The Medicare Access, and CHIP Reauthorization Act of 2015 changed the way that Medicare rewards clinicians for value over volume.  It supports multiple quality programs under the new Merit-Based Incentive Payments System (MIPS)
and gives bonus payments for participation in eligible alternative payment models (APMs).  In general, it moves payment from a fee-for-service payment model to a value-based system that encourages quality and more efficient/effective patient care.  This system also is tailor-made for the incorporation of telemedicine into a value-based payment system.  Each year, we move closer to a value-based system and away from a fee for service system.  How can you dip your toe in the water of a value-based system to try it out? The Center for Medicare/Medicaid Services (CMS) gave us the answer as of January 2018.

Medicine doctor working with modern tablet computer and virtual

CPT code 99091:  Remote Patient Monitoring allows patient-collected physiologic health data that is digitally stored and/or transmitted by the patient to be securely sent to the provider.  This involves patient-collected heart rate, blood pressure, weight, glucose readings, CPAP usage, EKG readings, and pulse oximetry readings to be shared directly with the provider for monthly review.  This must be transmitted using a HIPAA-compliant, secure system like Housecall Telemedicine and cannot be transmitted by insecure mechanisms like email or text. It pays an average of $59 per patient per month nationally. Not only has remote patient monitoring been shown to improve outcomes and access to care, it also has been shown to improve cost-effectiveness and reduce hospital readmission rates.  This study from 2015 showed in COPD and CHF patients that 30-day readmission rates were reduced 50% and showed a 13-19% reduction in 180-day readmission rates. This finding was made even more impressive given that the study population consisted of underserved patients and included many who had no insurance.  Indeed there are numerous studies that show telemedicine, remote patient monitoring, and transitional care programs along with care management programs can drastically reduce 30-day readmission rates by as much as 50%.

Remote Patient Monitoring can also be used with Chronic Care Management (CCM) services (CPT codes 99490 and 99487).  These codes were introduced in 2015 to compensate providers for the routine care of complex chronic conditions that providers have delivered for years without compensation.  CCM Patients must have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, and chronic conditions that place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline.  This includes (but is not limited to) conditions such as Alzheimer’s disease and related dementia, Arthritis (osteoarthritis and rheumatoid), Asthma, Atrial fibrillation, Autism spectrum disorders, Cancer, Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Depression, Diabetes,  Hypertension and infectious diseases such as HIV/AIDS.   CCM requires at least a visit in-person yearly that can be billed separately.  It also requires a formal care plan for each individual patient that is reviewed and revised as needed.  CMS even loosened its prior restriction on telemedicine to allow Chronic Care Management Care Planning to be done directly with the patient by a care manager via an unrestricted telemedicine conference (CPT G0506) as of January 1, 2018.

Chronic Care Management for “non-complex” cases (CPT 99490) pays an average of $49 monthly nationally.

Chronic Care Management for “complex” cases (CPT 99487) pays an average of $86 monthly.

Chronic Care Management Care Planning (CPT G0506) pays an average of $59 monthly and can be done via telemedicine between a care coordinator and the patient.

Remote Patient Monitoring (CPT 99091) pays an average of $59 monthly.

A complex patient enrolled in both CCM and RPM generates an average revenue of $204 per patient per month or $2448 per patient per year to a practice.  This is in addition to in-person visits with the provider that are charged separately.

Reimbursement Update on Remote Patient Monitoring, and Chronic Care Management Codes for 2018

CMS Fact Sheet on Chronic Care Management Services

Frequently Asked Questions About Chronic Care Management

Housecall Telemedicine is a data platform that allows you to connect patient data to a direct telemedicine visit.  From the very beginning of the company, the idea of connecting patient-collected personalized data to a provider has been “THE IDEA” behind the company.  That idea was fairly out there in 2014.  Now in 2018, it is becoming mainstream.  Now that the CMS has come around with recent CPT codes that support the data connection between patient and provider, the expansion of telemedicine has clearly begun.  Good ideas from the CHRONIC ACT that were recently incorporated into law with the latest budget act passed in February 2018,  make the use of telemedicine in Medicare patients even easier.  These new rules expand the use of telemedicine in end-stage renal patients, and for tele-stroke.  It also greatly expands the use of telemedicine for use in Medicare Advantage plans and ACOs.  The use of the Next Generation ACO telehealth waiver allows ACOs to waive the geographic restriction for telemedicine use in Medicare and allows the patient to be anywhere to make a telemedicine connection to a provider.  The use of telemedicine for Chronic Care Management care planning in an unrestricted fashion continues to expand the use of telemedicine and provides improved access to care for our patients and that care is more consistently delivered.  It seems like CMS finally Cares Enough To Care and has finally begun to really answer the question Why Telemedicine?


Care Enough To Care

Screen Shot 2018-03-12 at 4.57.03 PM“I can teach you medicine, but I cannot teach you to care” was a frequent saying from a mentor during my residency training.  Empathy, the ability to understand and share the feelings of another, is perhaps the most critical component in a doctor.  It is also one that is sometimes missing today in many healthcare workers.   I would venture that a lack of empathy is not just less in healthcare, but in our society in general.  Do you care enough to care?

Could a greater miracle take place than for us to look through each other’s eyes for an instant?

– Henry David Thoreau

Empathy is not just a good thing in abstraction but it translates to better business and better patient outcomes.  In a study of orthopedic patients, 65% of patient satisfaction was attributed to empathy,  the largest factor found in the study.  Satisfaction was not significantly affected by wait time for an appointment, wait time in the office, time with the surgeon, resident/fellow involvement, whether or not patients were seeking a second opinion, health literacy, or treatment choice.  Empathy was far more important.  The study showed that physician empathy was the best opportunity to improve the patient experience.  Research has shown empathy and compassion to be associated with better adherence to medications, decreased malpractice cases, fewer mistakes, in addition to increased patient satisfaction.  This translates to better overall patient outcomes, fewer hospital readmissions and an improved bottom line for hospitals.

This video is from the Cleveland Clinic from a few years ago but it makes a very important point.  If you could stand in someone else’s shoes; hear what they hear; see what they see; feel what they feel; Would you treat them differently?

56% of physicians said they lacked the time to be empathic, and 29% reported burn-out as the primary reason for their difficulty in being empathic.  One criticism of telemedicine is the lack of an in-person personal connection to the patient.  But empathy is a skill that can be utilized even through a remote connection.  Telemedicine allows the provider to time-shift a patient encounter to a time and setting of their choosing.  It changes their practice in a way that the provider has more time to show that they care.

Check out the new Housecall version and sign up today!   It is available on desktop computer, iOS, and Android platforms  Ask us about how we can help your bottom line while delivering state of the art healthcare for your patients.