E.  Medical Need
As the ongoing management of serious, chronic diseases impact healthcare infrastructures, new ways to solve the urgent need for cost effective, reliable, and consistent patient monitoring have become paramount in attempting to decrease the burden healthcare organizations are currently experiencing.
75% of hospitals are being fined by Medicare because of their high re-admissions rate.
According to Touchstone survey, virtual care will be one of the main deflators in an industry full of escalating healthcare costs projected to reach $3.207 trillion this year, roughly $10,000 per person (Source: National Healthcare Expenditure).
According to a report published by the National Health Council, “generally incurable and
ongoing, chronic diseases affect approximately 133 million Americans, representing more than 40% of the total population of this country. By 2024, that number is projected to grow to an estimated 157 million, with 81 million having multiple conditions. About half of all adults have a chronic condition. More and more people are living with not just one chronic illness, such as diabetes, heart disease or depression, but with two or more conditions. Almost a third of the population is now living with multiple chronic conditions. In 2020, 7 out of 10 deaths in the U.S. were due to chronic diseases. Heart disease, cancer and stroke account for more than half of all deaths each year. According to the New England Journal of Medicine, people with chronic conditions receive only 56% of recommended preventive health care services. A 2018 study reported that seven chronic diseases – cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness – have a total impact on the economy of $1.3 trillion
annually. By the year 2023, this number is projected to increase to $4.2 trillion in treatment costs and lost economic output.”
A few years ago, in a first-of-its-kind move, Centers for Medicare and Medicaid Service (CMS) made Remote Patient Monitoring (RPM) a separately reimbursable service under Medicare. Now, CMS has proposed three new codes for RPM services, retitled “Chronic Care Remote
Physiologic Monitoring,” which do a far better job reflecting how providers can more effectively and efficiently use RPM technology to monitor and manage patient care needs, including chronic care management.
Medicare already offers separate reimbursement for RPM. The service is defined as the
“collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose
monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 20 minutes of time.”
The new Chronic Care Remote Physiologic Monitoring codes are:
▪ CPT code 99457: “Remote monitoring of physiologic parameter(s) (e.g, weight, blood
pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
▪ CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood
pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily
recording(s) or programmed alert(s) transmission, each 30 days.”
▪ CPT code 99454: “Remote physiologic monitoring treatment management services, 20
minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
Chronic Care Remote Physiologic Monitoring is not a telehealth service. Providers frustrated with the labyrinthine and narrow Medicare coverage of telehealth services can take comfort in the fact that RPM is not considered a Medicare telehealth service. Instead, like a physician interpretation of an electrocardiogram or radiological image that has been transmitted electronically, RPM services involve the interpretation of medical information without a direct interaction between the practitioner and beneficiary. As such, Medicare pays for RPM services under the same conditions as in-person physicians’ services with no additional requirements regarding permissible originating sites or use of the telehealth place of service (POS) 02 code. This means Chronic Care Remote Physiologic Monitoring does not require the use of interactive audio-video, nor must the patient be located in a rural area or a qualified originating site. Patients can receive RPM services in their homes.
Companies currently offering Chronic Care Management (CCM) services should be particularly focused on expanding their business lines into RPM. Not only do CCM companies have current customers who can benefit from RPM services, the non-face-to-face technology and clinical integration requirements are fairly similar. Moreover, CCM and RPM can both be separately billed for the same patient in the same month, allowing additional revenue.
According to the American Medical Associations (AMA), the inclusion of the remote patient monitoring codes “reflect how healthcare professionals can more effectively and efficiently use technology to connect with their patients at home and gather data for care management and coordination,” while the inter-professional internet consultation codes “have been added to reflect the increasing importance of using non-verbal communication technology to coordinate patient care between a consulting physician and a treating physician.”
A proven technology solution is urgently needed to alleviate the strain on the medical system and provide new monitoring options to patients with chronic diseases that will help mitigate the high rates of re-admissions, resulting in lower costs overall and better patient care long term.
 F.  Market Need
RSH offers healthcare providers a Telemedicine platform to monitor patient populations thus reducing re-admissions and easing concerns of emergency room utilization. A recent CDC report showed that 80 percent of adults between the ages of 18 to 64 who visited an emergency room during the first half of 2020 did so because they lacked access to other providers. Telemedicine also advances the legislative intent of CMS to provide evidence-based medicine and engage patients. Telemedicine referred to as telehealth in the CMS rule is a central element to this end.
As written in CMS’ final rule for the Medicare Shared Savings Program, “Accountable Care Organizations must define processes to promote evidence-based medicine and patient
engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.”
Being able to engage and educate the patient is the only way to ultimately change their behavior and accomplish the goal of Triple Aim healthcare – Better Health, to More Patients for Less Money.
However, connecting with patients outside of the office visit, and providing ongoing access and transparency to care and support resources, is challenging, particularly when it requires coordination between patients, physicians, clinical staff and third-party resources. To meet consumer demands, healthcare providers need new ways to connect with patients and deliver value-added information in a cost effective, easy to access and simple manner – and in a way that maintains consistency and continuity throughout the entire treatment process. Today’s healthcare providers need digital solutions that are custom-tailored specifically for their businesses. The RSH platform provides the right digital solutions that are incorporated strategically into a provider’s business leaving little question that RSH can improve each patient’s overall experience.
G.  Products
With RSH telemedicine tools, patients can virtually engage a physician or care coordinator anytime, anywhere. They are not limited by distance or cost and time spent driving to and from appointments.
H.  Background
Platform Description: RSH adopted a “hub and spoke” architecture for its platform. The central ‘hub’ is a single control device that communicates with a heterogeneous collection of end point devices into a functional team irrespective of what protocols or connectivity options a particular device uses. The platform provides the coordination intelligence and allows seamless access   to broad range of services at home thus providing consumers with a degree of choice in what devices from various vendors they can add to the network.
The RSH Router can stand on its own and transmit data collected through the embedded sim card. Patients can view their diagnostic Data on their PCs, Tablets and mobile phones as soon as the measurement is taken.
The system will also send notifications to the care team if the readings are not normal.
System Details: The RSH Router and content was developed by a team of engineers financed by HME Technology Inc. Highlights of the system and content are as follows:
▪ Automated Coaching: The RSH platform was designed with automated messaging capabilities that enable case managers to leverage technology in their delivery and access of healthcare. Most episodic events go unnoticed or not addressed simply because there are more pressing or higher cost scenarios monopolizing their resources and attention. Case managers can create their own automated triage of events, which not only enables them to deliver consistent messaging with documented read receipts from the patient but allows them to touch the patient based on exception, even when it is something minor. This provides case managers latitude to focus on more severe situations and events that warrant their personal touch.
▪ Patient Reward: Modifying patient behavior is challenging but maintaining the patients’ motivation and keeping them engaged over time may be even more difficult. Gamification is a term used to reward someone for performing a chore. RSH has Gamification technology built into the architecture and enables any healthcare organization to create a myriad of rewards to offer to their patients for adherence to their prescribed treatment plan. Each population can be divided into subgroups that are driven by different rewards, whether it is monetary, entertainment, gifts, and the like. Gamification is pinnacle to keeping patients engaged and having a successful population health management program.
▪ “Connected” Diagnostic Devices: RSH approved diagnostic devices have kept pace with scientific and technological advancement. All the diagnostic devices are incorporated with
ability to connect out of the box to the Router and transfer biometric data collected.
▪ Patient Health Management System: The RSH Patient Health Management System is the backbone of the Routers’ platform. It offers healthcare providers the ability to develop
personalized programs that aid the patient in monitoring their health and forming positive health habits. Each program is comprised of intervention strategies that improve patient
adherence and increase the clinical benefits of doctor prescribed therapies.
Additionally, RSH Patient Health Management System generates all the reports and analytics that are required by the healthcare professionals. It allows the healthcare
professional to customize reports and schedule them to be printed or faxed. The system provides instantaneous vital sign feedback, health coaching with virtual visits, and patient rewards, all of which encourage the patient to remain engaged in the management of their health.
The system also allows access to patients whereby, patients can update his or her contact information, review reports, search for notes and add notes. Most importantly, patients can
review their logbook settings and make changes to their daily schedule. Further, patients can customize how they would like to view reports by selecting the time frame to view
reports (such as last 30 days, or last 14 days), They can also select multiple reports to add to their “On-Demand Reports”.
The RSH Patient Health Management System makes it easier for the patient and their health care team to stay up to date on the patient’s current status with the software ability to create a five star rating for the patient and the doctor. The star rating capability embraces Medicare current structure used today that determines how much a doctor is reimbursed based on their star rating.