Reducing ED Visits with Remote Patient Monitoring in Primary Care

The combination of simple technology and good service is helping to make remote patient monitoring (RPM) a key part of keeping patients healthy for primary care physicians. The team at Medical College of Georgia at Augusta University rolled out RPM and has seen a drop in avoidable ED visits and improved patient experience.

Healthcare IT Today sat down with Dr. Janis Coffin, Chief Transformation Officer and professor at Medical College of Georgia at Augusta University, Department of Family Medicine to learn more about their successful implementation and how RPM fits into their patient workflow.

RPM fueled by Chronic Care Management

According to the CDC, 6 out of 10 adults in the US have a chronic disease and 4 out of 10 adults have two or more chronic diseases (heart disease, cancer, COPD, diabetes, etc). Chronic diseases are the leading cause of death and is a significant driver of the $3.8 Trillion spent on health care in the US.

In 2015, the Centers for Medicare and Medicaid Services (CMS) introduced a program for non-complex Chronic Care Management (CCM). Under this program, Medicare patients with two or more chronic conditions could receive non-face-to-face service from a healthcare provider to prevent chronic conditions from worsening. The program would reimburse the provider for 20 minutes per month for this remote service.

The goal of the program was to prevent unnecessary hospital admissions and ED visits.

Dr. Coffin and her team at Augusta University offer CCM to their Medicare (Part B) beneficiaries. “We have RNs, RPNs, and CMAs reach out to patients every month for 20 minutes,” explained Dr. Coffin. “They will discuss the patient’s medications and help them understand why they are taking certain pills and what they are for.”

To enrich these non-face-to-face discussions, Augusta University rolled out RPM for these same patients.

RPM made easy

The team at Augusta University did not rush into RPM. Instead, they took time to carefully assess their own readiness and capability for RPM before diving in. “We asked ourselves – do we have the infrastructure, the platforms and personnel, to make it work? And at the time we did not,” said Dr. Coffin. “So we looked for a vendor who could help us and we ended up partnering with NavCare.”

NavCare, also based out of Augusta, provides a turnkey RPM solution that includes devices, a communications/telehealth platform and support services (clinical and technical).

“Patients we enroll in the program are sent home with equipment–a glucometer, a pulse ox, a blood pressure cuff, and it links to their medical record,” said Dr. Coffin. “All they have to do is open the box, press the ON button and use the device. That’s it. The readings are taken and automatically uploaded to the EHR.”

There is also a NavCare app that allows loved ones to see these same readings in real-time. If the readings fall within the ‘green’ zone, then everything is good and nothing needs to be done. However, if they fall in the ‘red’ zone, then someone from the health team will reach out to the patient to find out more.

This real-time capability provides peace of mind to patients, families, and the care teams. Dr. Coffin noted that having the support of both the technology and the teams that reach out to patients when a result is flagged is a huge help. The person that contacts the patient can help schedule a follow-up appointment, arrange delivery of durable medical equipment, arrange transportation for patients and much more.

The system is so easy that Dr. Coffin’s parents, aged 84 and 86, have had no problems using it for the past year.

Data overload did not happen

When implementing RPM solutions, there can be a concern about being overwhelmed with data. After all, daily weight, heart, and glucose measurements is a lot of information to handle. Dr. Coffin and the team at Augusta University had these same concerns, so they built protocols into the system to provide “guardrails” that would prevent data overload.

For example, if a patient has congestive heart failure, the system is set up so that an alert is generated only if a patient gains or losses more than three pounds. This reduces the potential for alarm fatigue. If this threshold is crossed, then a member of the care team is alerted and contacts the patients for the appropriate treatment.

Encouraging results

The experience RPM actually showed the Augusta University team that they can provide better care for their patients. Since implementing RPM, they have seen fewer ED visits from this patient population.

“With the combination of chronic care management and remote patient monitoring, we’ve been able to avoid ER visits, hospitalizations, and readmissions within 30 days,” said Dr. Coffin.

This is partly because they’re catching problems before they become serious, but also because these patients now have easier access to a healthcare professional. It turns out that some patients would go to the emergency room if they couldn’t reach their primary care physicians. Now, these same patients know they have someone looking out for them every day via the NavCare platform.

Watch the full interview to see:

  • Dr. Coffin demonstrate the NavCare app in action (unprompted)
  • Dr. Coffin’s advice for implementing a remote patient monitoring program
  • How RVU credits are applied and factor into their new workflow, and how it can help get providers on board with a remote patient monitoring program

Learn more about NavCare: https://navcare.com/

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About the author

Colin Hung

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

   

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