Educational Webinar: Leveraging Remote Patient Monitoring

Good afternoon everyone, I'm pleased to welcome you to today's webinar event brought to you by McKesson Medical Surgical. Our presenter today is Remetric Health. They'll be presenting helping physicians leverage remote patient monitoring. And our speakers for today are Rebecca Russell and Chelsea Ritchie. I'm gonna give you just a moment to review our disclaimer slide and while you're doing that, I'll tell you a little bit more about Rebecca and Chelsea. Rebecca has more than 10 years of experience in the remote patient monitoring space and more than 16 years in the health care industry. She offers a wealth of knowledge and extensive practice in helping physician groups, hospitals and home health agencies improve patient outcomes satisfaction and engagement Chelsea has spent the last eight years helping physicians deliver much needed medical care to communities across the country. She has extensive, extensive knowledge of the health care industry and understands the challenges that physicians face in today's health care environment once again, thank you all for joining us today for our presentation, helping physicians leverage remote patient monitoring and without further ado I would like to introduce you to Rebecca Russell and Chelsea Ritchie. Great, thank you. Thank you so much Brandon and thank you for helping us put this webinar together and Mary Beth as well. Thank you to McKesson corporate too for hosting this webinar. Um but an extra special thank you to everybody out there in the audience today. Uh we know how valuable your time is and we really appreciate you taking some time out to spend with us today to learn about remote patient monitoring and how you can leverage it effectively. um I'll start off by just providing a basic background, quick background on who we are and then we'll just jump right in. Um so we are located in Allentown Pennsylvania and we um have been providing remote patient monitoring programs and services now for the last 13 years. Um the owner of this company started it um over 13 years ago now his daughter at the time had very your lung disease um and out of frustration um and um just being worried all the time when she would wheeze or be short of breath um and not knowing what was going on inside her airways. Um He created the first ever at the time. Personal spomer to be used in the home Um And so with that we quickly learned that there was a need to monitor lung function for people who have had uh a lung transplant or cystic fibrosis. And we worked with a lot of the major hospital systems and still do today um in the lung transplant or cystic fibrosis departments Um Over the years we we grew um we uh added additional remote patient monitoring devices to our existing platform, Their devices like a weight scale or a blood pressure monitor, uh glucometer, pulse, oxter um to be able to work with and help a lot of other patients that especially have chronic disease um today and especially over the last two years working with min we um have been focusing a lot and working very much with physician groups whether large or on physician practices, um health systems. We've had the pleasure to work with a lot of community health centers in the last two years as well. And then home health agencies have been something we've been working with for years as they were early adopters to remote patient monitoring. So our learning objectives for today. We're gonna go over five basic topics. Um number one, what is driving remote patient monitoring? So there's a lot of buzz out there right now. Um and everybody in the audience probably has some curiosity, or maybe has some questions about remote patient monitoring because maybe you heard about it through McCain or your peers or um you know, maybe you read an article or have numerous uh R PM vendors. knocking at your door and trying to get some time with you to talk to you about their program. So um we're gonna go over like why that buzz is the way that it is today and what's driving it. Um We'll also talk about the incentives from payers to providers. So we'll address Medicare reimbursement. Uh Medicaid commercial payers. um throughout this webinar just sort of as a a general sense we want to provide you with real world expectations. You know there's a lot of different opinions and there's a lot of things out there and there's sort of the best possible scenario financially speaking with remote patient monitoring because there are wonderful reimbursements for it. Um But we want to give you a real world idea and expectation of what the program is all about and what you can can expect financially and clinically. Um We'll also talk about overcoming barriers. So some of these barriers are perceived, um others are absolutely real, they're real challenges. So we'll talk through those and sort of how to address some of those challenges. Um and then we're going to answer some of the most frequently asked questions. So um and this is really sort of what sparked um providing this web. are there's so many questions that we get on a daily basis from physicians or customers, or a lot of the reps that are out in the field and their doctors are asking questions about the program and there's sort of a common theme, we hear some of the questions that are the same that come up a lot. And so we're going to try to address those for you, kind of Sprinkle those questions through as as we go through these couple slides here Ok so one of the questions that we get is um is remote patient monitoring primarily used to enhance uh virtual visits. And the answer is no um predominantly that's not necessarily how it's used. So um with a virtual visit it absolutely can be enhanced with remote patient monitoring. So if you're doing a virtual visit with a patient a telehealth visit and that patient happens to have a remote patient monitor device may be a blood pressure monitor at home. Um You know maybe this patient has um a cardiovascular disease um And now you can say oh let's take your blood pressure. You know that makes perfect sense. And so that works really well for that video visit. But that is really not the sole purpose of R. Pm. Remote patient monitoring. So I would say 99% of you know our customers that we work with or when customers come with us They don't decide to bring on a remote patient monitoring program necessarily to enhance their video visits. They do it to be able to have insight into those patients. Um Daily lives the the health of those patients on a daily basis. Um And it's not the physician or the practice to have to be monitoring these patients on a daily basis and I'll kind of get into that in a little bit. But this is not a program that should put an additional burden on the practice at all, should do the opposite. Um So what is R PM? Um So, you know, more scientifically speaking more clinically speaking, R PM stands for remote physiological monitoring. So it's, you know, monitoring patients at home with a medical device that's monitoring their biometrics. So Um in this picture here you can see a patient with a blood pressure monitor on their arm Um And so that patient would then you know put it on their arm. They would hit the button on that screen of that blood pressure monitor. And then that's all they have to do. We start inflating we'll take their blood pressure provide their reading. And then she can just take that cough off of her arm and get up and you know walk away and go about her day because that medical device will have automatically and wirelessly sent the data either to a HIPA compliant web portal or perhaps the physician's E. HR. Somewhere where the clinical staff can monitor that data on a daily basis and also look at trends so they can compare how they're doing today or you know how they've been doing over time. um I like to just kind of give a basic example. So if you um you know, picture one of your patients, perhaps, maybe it's a woman in her late seventies. Um Maybe she has a cardiovascular disease um and maybe she has an appointment with her doctor with you in um you know, the end of the month, but maybe it's the beginning of the month and she starts to feel um short of breath one day. Um But she thinks, you know, I'm just getting older, it's no big deal. Um Or maybe she wakes up in the morning and her feet are really swollen and she thinks to herself, appointment with my doctor at the end of the month I'm just gonna let him know then. Well a lot of times what happens is that patient progresses and then gets worse and then you know before she makes it and to see her primary care as an example she ends up in the hospital. Whereas if that patient were on a remote patient monitoring program and maybe her feet are swollen because she's retaining fluid and she's gained you know £3 of Night the system would alert the nurse that that has happened and then the nurse can reach out to the patient and address it before it gets worse. Or maybe her blood uh oxygen saturation is declining and that's why she's so short of breath Again, the system picks up on that alerts the nurse, the nurse can reach out and triage as necessary. So that's really what remote patient monitoring is and sort of how it's used. So what is driving remote patient monitoring? Um So first of all chronic disease um the CDC according to the CDC, there are 60% of americans that have at least one chronic disease and 40% have more than 12 or more. Um So despite the, you know Billion trillions of dollars that are spent every year to try to combat and better manage uh patients with chronic disease. It's still one of the biggest drivers um of cost as well as it takes 75% of um all of the deaths in the United States, 75% of them are because of chronic disease Um So chronic conditions are a huge issue. We also have a strong need of course to reduce the cost of care. Um This is something that has been rising for decades and it continues to do so. Um We have a US health care staffing shortage right now, I've heard it called the the great resignation. Um And I've also heard that it has hit primary care the hardest. And so, you know, when covid came along, it provided such challenging times in health care. Um I think people that are still in health care today, it really shows just the overall dedication to patient care and the resilience because you've had to face a massive p PE shortages, extremely challenging work environments. Um and just been on the front line of providing patient care at a time when it is scariest in us history. Um And so people who are still in the health care field, it deserves so much credit. um that takes me to Covid. So covid just exacerbated all of these issues that we have and that we see in health care today um and then we also have um patient demand. So there's a number of um patients out there and statistics will show and we'll talk a little bit about this, but patients are taking more of an active role in their health um and in a lot of cases they're they do want a program, like a remote patient monitoring program and so while Covid sort of forced our hand into doing uh video telehealth and remote patient monitoring because of the fact that that was the best way to care for patients without the risk of um infection. Um it also sort of opens a a lot of eyes to, wow this is really an effective way forward um with or without a pandemic at large. And then um in this sort of perfect store. And we also have expanding reimbursements. And those reimbursements have been expanding um since 2018 which we'll talk through um and we'll get more into the reimbursements that they're at a very good place right now. Ok, so provider trends, this is, we get this question a lot, you know, maybe we're talking to somebody a practice in, you know, Kentucky as an example and they want to know, oh are the doctors that are in my town or my location? Are they using remote patient monitoring? Um And so in a lot of cases remote patient monitoring is being used by a number of physicians. So One of the recent sur um surveys that was conducted by Rhythm Management Group and Sage Growth Partners. This is in January of 2022. Um it was a survey of 100 providers, administrators and executives. About two thirds of the respondents were from independent practices and then the other third was from hospital owned or affiliated practices. 57% of those organizations said they were already using remote patient monitoring. And then out of the segment that wasn't using remote patient monitoring, half of them said that they intend to use it within the next uh two years. um the american Medical Association. Um This is a a survey that they've been doing sort of yearly. Um and so in um September of 2022, they did a survey with 1300 physicians. And out of those 1000 1393% of them said that they did feel that remote patient monitoring was advantageous. Um what's interesting is that they also did this survey in 2021 and 85. Percent of the doctors at that time said that they thought it was beneficial. So we have 85% in 2021 we've got 93% in 2022. I'm excited to see what 2023 brings with this survey just because we're almost at an unanimous um point in time here with everybody understanding the benefits or at least believing that there are benefits of the program. All right, so patient trends um we talked about patient demand. Um so these are some strong statistics but um and this is going back to June 2020 Sony um did a survey and it was over 2000 patient or people and 90% of those patients. said they believed that they could better um monitor themselves with the device at home. Um especially those who had chronic conditions. And over half of the patients. S survey said that they would potentially switch from one provider to the next if they offered a device that met that chronic disease. Uh M Si International um did a survey they call it the american perception of remote patient monitoring in their health of May of 2021. And they found 80% of consumers saying that they were in favor of remote patient monitoring especially for monitoring chronic disease. so what are the benefits um to providers and to patients? So This is something that has been proven and I'll share some data but over and over again to and for years over time um significantly decrease hospital readmissions to improve overall quality of care to provide better satisfaction to patients. Um increasing treatment compliance is huge. We see this all the time Um So with our program um we have um a team of nurses that monitor the patient's biometrics on a daily basis and a lot of times if they get an alert um Maybe that patient's blood pressure is is is high as an example, they reach out to the patient um and they have the patient retest to make sure they're using the device accurately. and to confirm the result. And so they reach out, they confirm the result is high and they typically ask the patient did you take your medications today as prescribed? And so many times you know a patient will say oh well you know I didn't get to pick up my prescription. Uh Um You know or I can't afford my prescription this month. Um Or you know I felt good today. I don't think I need my pres my medication today. Um So we hear a lot of this sort of noncompliance and we see it in the results of their biometrics. Um And so it's a wonderful thing because it helps kind of our nurses sort of stay on top of those patients. But it'll also allows the patients to see the direct effects if I don't take my medication. This is what's happening inside of me. Even if they can't you know, they're not feeling that bad that day. Um So that's a big one. Um It also is a way to um help you better manage patients with chronic disease. Um And then it's a way to drive revenue a brand new revenue stream through some of these reimbursements that are available. Um so in terms of uh demonstrated clinical impact um there was a study in 2017. This one was by banner health. Um it was a study looking at the system's most complex patients um so that these patients had five or more chronic diseases and what they saw was a 75% reduction in readmissions, which is massive. Um a 50% reduction in hospital admissions and a 34% reduction in overall cost of care What I love about this is the V. P. Of patient care said um changing or catching small changes in weight or blood pressure can offer a pathway for immediate intervention limiting the high cost associated with the hospital stay while allowing patients to stay at home. Partners health care in 2006 and this is going you know, way back um enrolled more than 1200 patients into the R. Pm program reduced readmissions by 51% and saved over $10 million. And then U. P. Mc because a lot of times we'll talk about this but um they ask about you know patient compliance or my patients going to stay on this program. Are they even gonna be willing to to do it to try it? Um And so U. P. Mc had over 1500 patients enrolled in their program. They had a 90% compliance rate as well as a 90% patient satisfaction rate. And they say that patients on the R PM program are 76% less likely to be admitted to the hospital. all right. And then just two more studies um just because these are some of the newer studies. Um So uh in Jama just this last february um this was during covid and they were using a uh pulse oximeter. Um but they had 87 fewer hospitalizations and reduced death by 77%. And then the o health study is extremely motivating for me to see because this was in the Medicaid population. So the majority of the studies that are out there, there's a ton of them but a lot of them are in that Medicare population because most chronic diseases fall within that, you know that Medicare population but certainly not all. Um So in this study they had patients who had either hypertension or type two diabetes. Um There was over 4000 patients in this program. So it was big. Um And within three months they were able to get half 50% of their hypertensive patients to go and um 60% of their type two diabetes patients to go. Um and then they continued on the program. They reviewed the results again in 18 after they had been on the program for 18 months and they continued to see improvements. Um so I just think that this is really moving the needle um especially for the Medicaid population to be able to utilize remote patient monitoring Ok, so let's get into incentives for payers. I'm gonna pass the ball to uh Chelsea in just a second. I just want to review the evolution of remote patient monitoring in terms of reimbursement. So as I mentioned in 2018, that was the first time we saw a reimbursement for R PM. Uh R PM according to Medicare used to fall underneath uh telehealth Servicess but they took it out from underneath telehealth. They put it in its own category in 2018 and created a reimbursement. So it was the first time there was one reimbursement for remote patient monitoring. The following year 2019, they brought on three more reimbursement codes. Now we have a total of four. So it was a decent amount of reimbursement at that time. But there was there was one problem. The problem was is that the program needed to be um under the physician's direct supervision, meaning that the program needed to be completely managed entirely underneath or within that practice. And so what happened all the time is that, you know, the physician or the CEO or whomever at the company would say, you know, let's do this program. It makes great financial sense. It makes perfect clinical sense. Um And then they would assign one of the nurses in the office to just manage the program and get it started. Um And these people are so busy all the time that they don't have time to be, you know, seeing patients in person but also managing the patients that are at home um patient wouldn't be compliant. They're on the phone with them playing phone tag in between seeing patients that just didn't work. Um Just because you know, they had no experience. And it wasn't even really so much not knowing how to manage a program. Just not enough time in a day So, C MS recognized that that was a huge challenge and a huge burden. Um And so in a barrier I should say. Um And in 2020 they they removed that barrier. So in 2020 they allowed remote patient monitoring to be conducted under the physician's general supervision. And so for us for metric at that time, that's when we said, ok, this is the time to develop our clinical services. And so we brought on a number of nurses to be able to manage that program. on behalf of that office on a daily basis and that way that practice doesn't have to face that burden um of extra responsibility in order to have a remote patient monitoring program. Um So that was great news. Um And then in 2022 we saw five new codes that sort of fall within remote patient monitoring called remote therapeutic monitoring. Um It's different than R PM. But it's it's along that same line. And then just this year we're seeing now codes for chronic pain managing. So managing that chronic pain at home as well. So you can just kind of see the trajectory there and that. Um More and more codes are being generated and more um care can be provided in the home not to take away from in person visits, but really just in conjunction with the in person office visits. ok I'm gonna pass the ball uh to Chelsea, who's gonna talk to you a little bit about the reimbursements for Medicare, Medicaid and commercial payers. Um as they are today. Thanks Rebecca Ok so just to start a few notes, just about R PM. Um according to C. MS, any patient with at least one acute or chronic disease is appropriate for R PM. Um So if the patient has one of those they're appropriate but they can stay on the program for as long as the physician seems that it's medically necessary. So according to Medicare in the 2023 physician fee schedule. There's five codes for R PM. Specifically and the first code is 99453. So for this code this is for the setup and the training for the patient who's on the program once the patient's been trained. Um The that practice can bill this 99453 which is an average national average of around $19. Um Keep in mind this this specific code is a one and done. So you can only bill it the first month. Um So next is 99454. This is for the supplying of the device. So as a practice you're typically purchasing the devices and then you're providing it to the patient uh C. MS and Medicare, they actually reimburse the doctor's office for supplying that device. So 99454 has a national average of around um 50 $50. Um according to 2023 position schedule. And so you can bill 99453 every month. Um but just to keep in mind that the patient has to use the device at least 16 days every month in order to build that and receive that reimbursement. So Next is the 99457. This is actually for the time spent monitoring the biometric data every month. So if you spend 20 minutes you can bill 99457. And then 99458 is also spent for the time which is also a national average of around $40. So you can bill 99458 twice. So if you hit 60 minutes see um managing that patient on a monthly basis. You can see and expect at least around 100 to 140 in reimbursement just from per patient per month, So the next if you go on to thank you Rebecca so for Medicaid, so Medicaid is a completely different ball game. You have to keep in mind that Medicaid every state is very different. Each state specifically has their own rules and their own consideration of what they consider telehealth and then also what they consider R PM to fall under. So currently as Medicaid you can see right here there's um There's currently 34 43 states that offer telemedicine, but 34 of those states specifically actually offer R PM reimbursement in some sort of fashion. Um The next as you can see in green, these are commercial payers. So the Green States are where there's parity laws and what that means. The States actually mandate that the commercial payers um actually reimburse for the R PM uh telehealth as if it's an in person visit so it has to be at least at that um specific reimbursement. But again keep in mind every state's different. Every reimbursement is um specific to that state. So it's really important to understand and know um what each state has. So um a few of the big commercial payers is United Healthcare um CIA and also Humana um AAA and Athena. So um if you have any questions about your specific state, please reach out to us. We can also connect you with our billing specialists on staff. So I am gonna throw it back to Rebecca and she's gonna finish. Ok, great thank you Chelsea All right so we're going to dig into how to implement an effective remote patient monitoring what that looks like in a clinic practice uh in a real setting. So um this is just kind of showing you the basics. So number one there's uh devices um So you decide which devices make the most sense for your patient population a lot of times there's an app involved and the app is important so that the patient can follow along with their health and see their trends over time. Without an app, the patient has a device, let's say they have the weight scale, they step on the weight scale, they see what their weight is today. They step off and they you know, that's it and they can't compare it to what they were yesterday. Um So the app is really important so that the patient can follow along um There's also either a hi a compliant web portal or there's um perhaps the data goes into the E. HR but there's something that the clinical staff will use to monitor that patient's data and then of course we have the clinical staff and this is the real star of the show. Um So if I sort of look at this and I break it down and I say ok we've got our medical devices, we've got our software and then we've got our clinical services. There's really three components to remote patient monitoring. Um So we talked about the medical devices and I know there's um as an example there's a lot of grants out there for hypertension patients right now. Um And so we have a lot of customers that may come and say um I need a blood pressure monitor to monitor my patients. Um and and that's great. But it's also important that there's some other devices down the road in case you may need them. Um Maybe you wanna have some of your patients who have diabetes uh monitored. So there's a number of different devices out there to choose from. Um The other thing to note is that a lot of times we'll get questions um like um do you have uh C. G. M. Uh devices uh the continuous glucose monitors that the patient can wear or um STSS and things like that. Um And it's not that it's necessary. difficult to um add another device to the program. It's that you have to take into consideration for this program. And this model. And with the reimbursements you have to take into consideration is that patient going to use that? Do they need to use that device every day or like at minimum every other day? Um and also the cost of it because this is something that the practice is purchasing on behalf of those patients and there is that reimbursement every month that $56 reimbursement that you can receive for supplying that device to the patient. So cost is something that you want to consider as well. But obviously having a number of different medical devices available um is important and then we have the software component again we kind of talked about that. So for the patient that's an app on their phone so they can follow along but also making sure that you have HIPA compliant software or web portal so that the health care professionals can view that data and then we have the clinical staff. And again, if they're the star of the show, I think you know, you definitely need all three of these components. But without this clinical staff it's it's very difficult to have a program. You can't just ship patients, you know, a medical device and expect them to kind of start using it the way you'd like them to every day. So um this is an important piece which we're gonna kind of dig into. All right. So to implement a program, the first thing that you want to consider is just what is where is the need. Um Is there a challenge that you're facing? You know, where do you think remote patient monitoring can be the best fit? Um And so is it that you're trying to better manage patients with chronic disease? Um Is it that you maybe are an Fa federally qualified health center and you're trying to improve access to care for those who live in rural areas or those with limited mobility. um Maybe you are in a value based care model or you are an AC O. And you want to improve patient satisfaction quality scores, things like that. Um Maybe everybody is trying to generate new revenue these days. Um So it could be one of these things, it could be more, it could be something that's not even on this list but just defining that need. and then once you have that you have to think about. Ok well what about my patient population, I've got all these patients, how do I start somewhere um so the thing that I think makes the most sense is developing sort of an inclusion and an exclusion criteria is so important that the right patients are enrolled into the program so that you can be successful. Um So some examples of inclusions um would be you know, patients with a chronic disease. That's a lot most of the patients that we have have some sort of chronic disease or acute condition like Chelsea mentioned with the reimbursements according to C MS Medicare patients just need to have at least one chronic disease or an acute condition. Um So maybe they have high blood pressure or diabetes or COPD or C. H. F. Um Maybe that patient in addition, maybe you've established, ok, I've got a really, you know, my diabetes population really could use remote patient monitoring but then you want to break it down some more. So maybe it's patients who have been high hospitalized, you know once or twice in the last year. Or maybe it's patients who require vital sign monitoring at home anyway. Maybe you know you have patients who are using a standard blood pressure monitor at home anyway and this will make their lives a little bit easier and it will allow you to have that data and get those reimbursements as well Um So just developing that inclusion list is important, but the exclusion list is just as important because you again, you wanna make sure you're enrolling the right patients. So is that patient physically and cognitively able to participate? Can they physically, you know, get up and walk over and step up on the scale or do they have a health um an aide or somebody that can help them a caregiver? um Also if you maybe patient makes perfect sense to be on the program but we ask them, you know, here's the program, do you want to participate and they say no I don't want to. Um Or they say um well I'll do it but can I only use that device if I don't feel good that that you know, maybe that's not an appropriate patient for the program. Ok, so you've got at this point your patient criteria, you you know the the why it's necessary, you know what you're trying to achieve. You have your patient criteria the next thing. Um and we usually have about a 30 minute meeting with the physicians to go over this data. Um but you want to think about the biometric alert setting. So as an example if your patient is um has hypertension and so you have them on the blood pressure monitor um you may want want. Um those nurses to get an alert if their blood pressure is 1 60 over 100 or whatever that looks like for you. Um Or you know if their blood oxygen saturation drops down to 86. Um So you just want to establish what that criteria looks like. Um An escalation contact is important as well because with our program our nurses will obviously respond to any of those alerts reach out to patients. confirm the result and then if that patient is in need of care we need to know ok who do I talk to about this? Who do I escalate this to? And nine times out of 10 it's it's a nurse at the office, it's not necessarily the physician um It can be but usually there's a nurse that sort of you know says ok the patient just needs to you know tell the patient to come in next week um or tell the patient yes they need to fill their meds. You know it could be something like that. Um But certainly they would bring it to the doctor if need be um And then the billing contact too. Um So every month there are reimbursements that you'll be billing and um we provide every um customer with a billing report that lets them know exactly what they can bill. And so we don't want to bother the nurse with that. We wanna let the biller know you know what they can bill So that's the protocol. and then this is sort of the daily flow. So everything else everything that you're seeing here is that the nurse or the clinical person is going to be responsible for. So number one patient enrollment. So we have our list, we know what type of criteria of patient is most appropriate. So now we're calling to talk to the patients to educate them about the program to see if it's something that they want to be a part of patient says yes I'd like to do this. Then we need to ship a device to that patient's home. It makes so much sense just to ship it to their homes so that they don't have to do anything and there it is on their front porch um Then patient training and set up needs to take place a lot of times that patient does need sort of hand holding in the beginning especially if it's an older patient. Um You know they may need somebody to walk them through Ok boxes on the front porch, go ahead Get it. You're gonna need some scissors to open up the box. You know take the device out. You know here's how it works. That kind of thing. So just walking them through the steps in the beginning even though it's not a lot that they need to do. But just being there to support them is really helpful. Um Then patients will use their biometrics on a daily basis if they don't they should have a phone call to remind them to use it to start to get them in the habit of using it every day. Um The results are monitored um as well as the compliance of that patient and then at the end of the month, all of the documentation and reporting is available to you and um you can receive your reimbursements. So that's sort of the clinical care workflow sort of the day in and day out that takes place. understanding your options. So there's um there's so many different um vendors out there. Um and there's you know, lots of different models and things like that. Um there's just a couple of things to consider. Um That's really important. Number one FDA compliance. So the medical devices should absolutely uh be FDA compliant um you know FDA approved. Um But in addition to the medical devices the software the software holds the patient data as well so that needs to be approved by the FDA and then the company themselves should also be registered with the FDA in order to provide this service for patients, Um And I will say that, you know, so many of the newer vendors out there do not have that FDA registration and the FDA has really been cracking down as well as the O. I. G. On this History is so important. Not just history with technology in general or having a fancy website or an app or something. Um But just history experience with patients. I can tell you all day long that this pa this program is wonderful but if the patient uses it and they say I don't like it. I don't want to use it. It's not that wonderful you know. So it's just so important to have that patient interaction and experience and really understand what it's like in the real world. um types of biometric devices. So there are two different types of, there's technically three but the third isn't really used anymore, but two different types of technologies that are used. So you've got Bluetooth medical devices and you've got cellular medical devices. the bluetooth devices are great because they connect to a phone. Therefore patients can have the app on the phone. And so that makes perfect sense for that patient population that does have a smartphone but there's some of them that don't have smartphones and in that case the cellular device is what is necessary. Um So having a combination of those two types of technologies within the devices is really important as well. Um The clinical services I can't stress enough how important that is. Um There's so many I think people that think again, you just ship the devices, you know to the practice and we're gonna get this program up and running and I can tell you that's not the case. Um I know I bought my um my aunt a long time ago. One of those um I don't even wanna say because it's gonna set everybody's off. But the the the echo dots, you know, the Alexa. And she's in her late 70's and she say I don't want to use this thing Rebecca you know that I don't like robots, you know, I'm not good with that and she didn't use it for years. And um one day I remembered it and I was on the phone with her and I said you just need to plug it in, go over behind the table in the kitchen, plug it in. She's like, all right, plug it in. Put these codes in. All right, I'll do it. She did it and now she uses it all the time. You know, what's the weather today? What time are my shows on? She uses it all the time And it's benefiting her so much. But it just took me on the phone with her to kind of get over that hump and and help her do it. So um you know that that human touch, even if it's not in person is so important. and then e hR integration capabilities. This comes up all the time. So there's a couple of different types of um integrations and I I don't think this is like common knowledge. I think this is confusing for a lot of people. So um The best type of integration that you can do is between like for us it would be us to integrate with Athena and it's a direct link between the remote patient monitoring program and that e. HR The problem is not all E HR s allow that. Um there are some such as Epic, E. C. W. And Athena that do allow that they have an open API network for vendors like us where they've built this connection, we connect to it and the data can transfer back and forth, but not all R PM or E. HR vendors have that. Um And so it becomes a little bit more complex and then there's a third party integration where you can sort of integrate directly with the customer, so that's another type. Um And then there's another one that's not a real integration. But sometimes people will say it is and that's where you just manually upload data from one portal and you manually put it into the E HR scan it, put it in. Um That's not an integration. Um But some people will say that that is but um you can do it that way. Um But there's just a couple of different types I think with the interoperability rules and policy that's been getting better. We're going to see more and more E HR s open that up. Um But it's a little tricky right now but some is much easier than others. and then I just had two more slides. So overcoming barriers, some of these barriers again are perceived and others I think are absolutely real. So staff shortages and physician burnout. This is absolutely a real thing rpm has been proven to um improve outcomes for patients and um reduce costs and it can relieve unscheduled office visits. Um It's not necessarily something that is used to take away from office visits. So patients, you know if you're seeing them once a year, twice a year, once a month whatever it may be, you can still have those office visits. But again this is a program that's just used in conjunction with those office visits to be able to monitor those patients in between. Um But if you do have that help that clinical service to help you it should not cause additional burden on the office, it should reduce that where you can kind of pass some of the day to day burden on to the nurses that are there for remote patient monitoring. um patient technological challenges. This is and isn't I I think obviously patients if they're, you know, shaking and they they can't use a smartphone, they can't use the program. But you know, in that story that I gave you with my aunt, you know, it was just a mental block, you know, and once we got her past that she was able to use it, you know? So um I think that um just having that additional sort of hand holding in the beginning can make a big difference. And as we saw in some of these studies, a lot of of patients are really open to this these days. Um patient compliance is huge. This will make or break an R. Pm program. Um compliance starts with making sure you're inviting the right patients to join the program. Um And again, if that patient says, you know, I really don't want to do this, you don't push them like, you know, because you want them to be compliant and sort of excited about the program. Um So the other thing with compliance is I can tell you even if you have a patient that's very excited and they're ready to go and they start using it and then you the next day goes by and you're not getting results. They forget a lot in the beginning. So again, some of those frequent phone calls to them in the beginning can be extremely helpful. High technology cost. Um you know, there's a wide variety of costs out there among different uh R PM providers. Um but it should not be, you know, high when you take the reimbursements and then you take, you subtract the cost of what the program um is. You should still be able to receive around $100 you know, per patient per month. And that's for everything included, you know, device clinical services. So um it's not very high technology cost anymore or at least if you're dealing with somebody that has extremely high cost and there's no R. O. I. Left over, you know, that's probably not somewhere you want to go. Um and then just loss of office visits. So I know a lot of physicians are afraid if I give them this monitoring device or they gonna still come into my practice and I try to stress this throughout. But again it's to be used in conjunction with it. Um Sometimes you know, you may have a patient that the nurse will call and say do you want to be on this and maybe that's a patient you have? haven't seen in the last five years. But now they're on the program, they're being monitored. Maybe they're setting off alerts. They realize, oh, I need to adjust their medication and you can get them into the office. So it kind of works both ways. Um But this is not something that you're going to start to see less visits or less encounters, Um Ok so I have a few FA Q. S up here, I'm just looking at the time. Um I was gonna go over some of these questions and I can still do that but maybe we can open it up Brandon to see if anybody out there has questions just so that way we save a little bit of time for questions and I'd rather answer yours. Um But I can certainly answer these as as well if there's no questions. Uh Actually we do have a few questions that have come in um and I'll go ahead and you know, take this time to let everyone know that uh if you do have any questions uh that specifically relate to cost or anything like that, we're really not in a position to talk about that on on the line today, but if you will just type the letter Y into your Q. And a box uh there on the bottom left corner, then we can certainly reach out to you after the presentation, I'll have um Rebecca Chelsea reach out to you directly. Uh But we do have some general questions that I can get into and then if we have time and then you can certainly address some of these frequently asked questions. Ok Uh So the first one uh is uh related to um implementing R PM in multiple care settings. Uh So we have a question from a general pediatrician with an active medical license uh who also owns an urgent care Their concern is being a pediatrician but interested in implementing an R. Pm program for nursing home registre uh residents. Um Do you have any insight or any uh advice into uh the multiple care settings? So, I know there's a lot of settings that it can be used. Um So definitely in that older population setting, the, you know, in the nursing home a lot of times there's a nurse that goes around and you know, takes the patient's vitals. Um So if you have that happening, um you know, that patient might not want to then, you know use their own medical device every day. And is there a need to do that? Um But if there is staff in that office, you know, if the patient is able willing to do it themselves, it can be used there um or if the staff in the nursing home, if you're affiliated with them somehow and they're able to help the patients to utilize the devices, it can be utilized there um in the pediatric space. You know, that's why I still love that a study because this was in the Medicaid population, these are younger patients. So while I absolutely think that it is appropriate for younger patients as well, um it's the Medicaid reimbursement, that's a little kind of all over the place. Um But definitely um you know, a little comment or something and we can look into your specific state and see if Medicaid is paying for it as well as some of the commercial payers because if they are then I think it should absolutely, you know, it could be used. Um But even if they're not, you know, if it's something that you're in a value based care model or something like that, you can absolutely use remote patient monitoring just for all the benefits that we talked about. Clinically speaking. Excellent. Thank you. Um Back to uh billing codes uh in a situation where uh a patient uh may end up going into hospital um during like uh towards the end of the month or a partial month. Are there codes for um for those like partial months or or how would you handle a situation like that? so I think I know, I think I know where the question is coming from. So I just pulled up the slide that has um the various C. P. T. Codes on there. So 99454. Um this is for the supply of the devices. Right. But the caveat here is that patients have to use the device at least 16 times out of the month. So if that patient was able to use that device 16 times out of the month, then You know, they can absolutely you know, build this code um if they weren't because they were hospitalized towards the end of the month or something like that. Um However oftentimes when a patient is hospitalized, there's a lot of stuff that's going on prior to that. So in most cases there's gonna be time that was spent with that patient talking about their bio. metrics throughout that month. And so if the nurse still hits the 20 minutes of time with the patient, even if that patient doesn't hit 16 readings that month, you can still bill for 99457. So I I I think that the question has to do with the reimbursements and again, please reach out and we can walk you through this. I hope I'm addressing the question that you're that you're asking. But um yeah, um here's a question uh more about uh logistics. How uh does your staff uh handle set up or is that um something the the practitioner um would do? Yeah, so our staff uh with our program we do handle setup absolutely. Um we try to make it as um stress free for the office as absolutely possible. So we have that um 30 minute meeting with the physician where we go over the protocol with the biometrics, who should we escalate to that kind of thing. Um and then after that we take it from there we do patient enrollment where we're calling them uh to educate and talk about the program. If the patient wants to be on the program, we will ship the device to their doorstep. Um And then we will um and we do this via video or through the phone but walking that patient through you know how to use the device, you know how to put the blood pressure monitor on their arm, that kind of thing. So we take care of all that as well as the monitoring time that's necessary for reimbursements throughout that given month. Um And then the billing and um Yeah. We take care of the only thing that we really ask of the physician or the practice is just to be supportive of the program. Um It's so helpful if the doctor sees the patient and says, hey, I think that this would be beneficial for you. That can be so helpful and go a long way with the patient. Whereas if they just have us calling and they're not, you know, does my doctor really think that this is a great program. You know, so that can be really helpful just to have everybody sort of aligned. But in terms of the leg work on the day to day we do all that. excellent thank you. Um I'm gonna ask one more question before we um get into uh just some of the other house housekeeping things. But um in a situation where a doctor's office does not have uh electronic health records, is R PM still an option there? Absolutely, yeah. You can bill for R PM just on the standard for you. Do not need electronic health records at this time. Excellent thank you. Um uh Let's see All right. Uh let's I'm gonna try to get one more in here uh regarding escalation. Is that provider or staff member identified as the escalation? Staff member required to be available 24/7? no and I think they're thinking of C. C. M. So with which is different than R PM. So with chronic care management somebody needs to be basically on call 24 7. That is not the case for with remote patient monitoring. And this is part of what we explain to patients. You know this is not remote patient monitoring is not intended to be used as an emergency response system. Right? It's so that little things happen with the We catch those early. We can take care of it hopefully before the patient gets worse you know. Um So they understand that you know if they take their blood pressure in the middle of the night on a saturday and it's sky high and they feel terrible that like they need to call 911 that's not you know we're not gonna do that for them. Nobody's gonna even see those metrics you know to the following day or or whatever the case may be for practice but um you do not need to be available 24 7 Excellent. Uh I think we can get one more in here. Is there an M. L. N. Booklet on the rules and regulations of R. Pm. I'm sure you could probably have plenty of documentation. Yes, I can send that to you for sure if we're talking about like Medicare specifically. Yes, I can provide that. And I know this deck will probably be available I think after this. And so this has a lot of good information on it too. Just in terms of the rules and regulations. But the good news is is there's not a lot of them Um And C MS has said that they didn't want to inhibit innovation and they they want providers to use remote patient monitoring because it saves them so much money in the long run. Um And so the basic requirements are that patient needs to have at least one chronic or acute disease. Um And and that's and and the doctor to think, you know, obviously Think that this is medically necessary for patients and you can continue to leave your patient on the program for as long as you deem medically necessary. We've got patients that have been on you know for years because even if they're doing really well and they're controlled the whole point of the program is so that when things start to happen, you know this program picks up on that you know before they become in a dire state. So But yeah, we can send you information for sure. Thank you so much. And that's actually a perfect segue. We have just about four minutes left the hour. Um And I would just wanna go ahead and leave enough time to thank you both so much for your time today for um speaking with our customers. And um it certainly I appreciate everyone on the line who's joined us today. We definitely appreciate your time Um You these are active links here, you see on your screen uh the website for re metric health uh or to schedule a meeting uh with Rebecca or Chelsea um Thank you both so much for joining us today. Um We did not get to all the questions. There's a lot of great questions still in here. Uh And I can assure you we will reach out to you after the presentation um uh to address those questions. Um You will receive a link uh to the recording of the presentation within about 48 hours or so uh within that window. Uh you'll also receive a link to download a pdf of the presentation um I'd like to direct your attention once more uh to some contact information here for uh for uh medical surgical for our team here and to just review our disclaimer one more time. and I also invite you to join uh future presentations. You can always see a list of our upcoming webinars at M MS dot McKesson dot com slash educational dash webinars. We post all of our upcoming events. and some links to previous events as well. Uh So watch your inbox for uh for a little uh recap of this presentation today and contact information for Rebecca and Chelsea. Um Thank you both so much for joining us today. I really appreciate it. Thanks very much. Thank you, everybody. Thanks so much. thanks so much, have a great day everybody. bye bye.