ACA Will Help Spark Boom in Remote Patient Monitoring

February 14, 2013

The number of Americans remotely monitored at home with devices such as pulse oximeters and peak-flow meters for 5 major chronic illnesses will grow 6-fold by 2017 as healthcare reform pushes hospitals and physicians to stop revolving-door admissions, reports InMedica, a division of IMS Research.

In 2012, clinicians reviewed long-distance vital signs on computer screens for some 227,000 patients with congestive heart failure (CHF), chronic obstructive pulmonary disease, diabetes, hypertension, and mental illness, according to the InMedica report released in January. By 2017, that number will jump to almost 1.3 million. The figures include a smattering of patients followed for a grab bag of other conditions such as asthma, coronary artery disease, and hemophilia.

Helping to spur this growth is the Affordable Care Act (ACA), said report coauthor Shane Walker, associate director for digital health at InMedica.

"It's all about moving toward preventive care and reducing avoidable hospital readmissions," Walker told Medscape Medical News.

The ACA creates several kinds of financial incentives in Medicare to remotely measure the weight, blood pressure, and oxygen level of a patient with CHF for early signs of fluid build-up that might trigger an ambulance call. In some bundled-payment experiments getting off the ground, various combinations of providers — a hospital and several medical practices, for example — will share a payment for a single episode of care. They will earn a bonus or take a pay cut depending whether they come under or exceed a cost target, and unexpected and avoidable hospital readmissions just might result in the latter.

Likewise, accountable care organizations promoted by the law stand to either make or lose money in "shared savings" arrangements, depending on how well they manage patients after a hospital stay. In addition, as if that is not enough to drive home the message, the ACA also created the Physician Feedback/Value-Based Payment Modifier Program, which will dole out Medicare bonuses or penalties to clinicians based partly on hospital readmissions. The law also imposes a Medicare penalty on hospitals with excessive readmissions within 30 days of discharge.

Other forces are pushing healthcare into the age of remote monitoring, according to the InMedica report. Some providers want to hook up their patients to digitized medical devices at home for the sake of improved care, regardless of any economic angle. Demand for this monitoring also comes from patients and private insurers, which seek to reduce costly hospitalizations. All of these trends build on an even larger one — an aging population beset with chronic conditions.

InMedica lumps all forms of remote monitoring under the term "telehealth," which other groups have used to refer to all electronic interactions between clinicians and patients, including email and secure messaging.

Diabetes Will Overtake CHF as the Leading Condition to Remotely Follow

Roughly 2 in 3 remotely monitored patients in 2012 had just been discharged from the hospital. The rest were ambulatory patients who were not hospitalized that year. However, InMedica projects that the number of ambulatory patients under home surveillance will snowball in the near future and approach the number in the postdischarge category by 2017.

Patients with CHF accounted for nearly half of all patients remotely monitored in 2012. In 2017, diabetes will overtake CHF as the leading condition, according to InMedica. Most of the remote monitoring for patients with diabetes will be on the ambulatory side, which will grow by 67.5% from 2012 to 2017. The second fastest growing category — at 64.6% — is ambulatory patients with a mental illness. Clinicians check up on these patients electronically through videoconferencing and questionnaires.

The job of reviewing remotely generated clinical data usually falls to nurses at third-party triage and call center services, who alert the patient's physician to any red-flag changes. With traditional fee-for-service reimbursement, physicians lack an economic incentive to take long-distance vital signs that do not involve a billable office visit, according to InMedica. However, "the financial incentive is on the way," said Walker, referring to shared-saving arrangements for accountable care organizations, bundled payments, and other payment reforms that reward quality of care.

Making remote-monitoring data more manageable in hectic medical practices also promises to win over physicians. Right now, remote-monitoring systems generally do not feed data directly into electronic health record (EHR) systems. Because of this lack of interoperability, physicians are forced to either view and manage 2 separate sources of patient information or manually enter remote vital signs into their EHRs. However, InMedica says telehealth services are working to integrate their systems with EHRs, and EHR vendors themselves will be under pressure to make their programs "telehealth-ready."

InMedica, together with its parent IMS Research, is owned by the research and consulting firm IHS.