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Technology advances, payment changes may spur more remote patient monitoring


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Technology advances, payment changes may spur more remote patient monitoring

The monitoring of patients at home is poised to accelerate as payment policies and technological advances make it possible for hospital clinicians to remotely keep track of how their patients are doing.

Instead of waiting for patients to come into a facility to have their blood pressure checked, doctors and nurses at Partners HealthCare the largest healthcare system in Massachusetts use Bluetooth-connected monitors in patients' homes to keep an eye on their condition. Any unusual readings trigger a response from clinicians, who follow up with the patient and try to keep the problem from getting worse enough send the patient to the hospital.

That is one example of how hospitals could rapidly expand the use of technology to monitor patients' readings around the clock, according to a January report from healthcare consulting firm, Accenture Federal Services.

The remote monitoring of patients is still "not yet in widespread practice," Accenture wrote in the report, which was commissioned by the U.S. Office of the National Coordinator for Health Information Technology, the federal agency charged with promoting and coordinating technical advances in healthcare.

But as soon as within the next decade, it could be common for hospital clinicians to get alerts when a patient's blood pressure spikes or if someone's glucose level is out of range, the report said.

In part, that's because the federal government is trying to tie healthcare payments to how well patients do, instead of the traditional fee-for-service model based merely on the number and types of procedures.

"We all believe the shift from fee for service to value-based is real," Joseph Kvedar, vice president for connected health at Partners HealthCare, said in an interview. "The government is certainly going to go deeper in that direction."

That and technological advances like Bluetooth and smartphones capable of capturing and transmitting information about patients' health "create an environment that is ripe for the capture, use, and sharing of patient-generated health data," said the report, which predicted the use of the data could be standard at hospitals by 2024.

Partners HealthCare plans to show blood pressure, weight, and glucose readings, as well as data on activity, an important measure after surgeries.

Digital health investments

Investors have noticed, last year pouring in $11.5 billion into digital health companies, according to a study by Startup Health, an industry accelerator. The investments, made mostly in the early stages of companies, outpaced the $8.2 billion in investments made in 2016, and the $1.2 billion made in 2010.

Additionally, healthcare systems and hospitals are doing 82% of the 860 clinical trials worldwide to figure out new ways to use digital health, according to a November 2017 report by market intelligence firm IQVIA Holdings Inc.

For doctors, the technology deals with a long-standing quandary: How well patients do largely depends what they do at home.

"It extends the clinical encounter," said Gary Bennett, director of Duke University's Global Digital Health Science Center, said in an interview.

At the same time, deals like Walmart Inc.'s potential purchase of Humana Inc. are also bringing the threat of more competition for patients and financial uncertainty.

Technology could also help with one of hospitals' main financial concerns since the passage of the 2010 Affordable Care Act, said Drew Schiller, CEO and co-founder at Validic, a startup tech company working with Partners HealthCare. The ACA in 2014 began lowering Medicare payments to hospitals with readmission rates higher than the national average.

That year, Signature Healthcare's Brockton Hospital asked a group of patients with congestive heart failure to use a blood pressure cuff and scale linked by Bluetooth to an iPad with a wireless signal, Schiller said.

Clinicians were alerted within 30 seconds if a patient's weight, blood pressure or heart rate were outside their normal range, and could follow up, Schiller said. Though 28% of the hospital's congestive heart failure patients had been readmitted within 30 days of being discharged, none in the remotely monitored group were readmitted, a study of the project found.

For the most part, Medicare only reimburses doctors for time spent with a patient. In January, though, the federal Centers for Medicare and Medicaid Services began paying for up to 30 minutes a month for patient care when a doctor is not physically with a patient.

CMS could in the future increase the amount of time doctors can be paid for, Kvedar said. It could also pay for time other medical professions like nurses and clinical staff spend monitoring results and following up, he said.

Still, the Accenture study noted the technology might not catch on more quickly because of concern over protecting the data collected. Some clinicians and patients question how accurate wearable devices really are, while some doctors also worry that they cannot be sure a patient is not having somebody else wear the blood pressure cuff or step on a scale, the study said.