Remote health devices not covered by most insurance
When the COVID-19 pandemic hit the region and Gov. Tom Wolf ordered all nonemergency medical care to shut down in March, the impact on the interaction between patients, technology and health care was immediate.
“We went from less than 5% of visits being telehealth pre-COVID to almost 100% between March and May,” Dr. Srinivas Murali, a cardiologist and director of Allegheny Health Network’s Cardiovascular Institute, said of the health network’s cardiology patients.
While the rise in telehealth visits — where patients talk to their doctors on a computer screen, or at least over the phone, instead of an in-person visit — has been well known, a related phenomenon was a massive increase in the use of remote patient monitoring devices, particularly for cardiology patients who need regular checks of their heart’s vital signs.
With recommendations from their doctors that they buy them, cardiology patients began bringing home devices in droves that measure blood pressure and heart rates, even ECG — electrocardiogram — devices that can do a more detailed evaluation of a heart’s rhythms, some for as little as $40, but many costing $100 or $200, and even more sophisticated versions that cost more than $1,000.
The devices, many of them wireless and portable, come from dozens of companies like Omron, Infobionics and Alivecor. They have found their way onto kitchen and side tables all over the country — and, with wearable devices, including the new Apple Watch that can perform an ECG, onto patients’ arms.
They are being used at home with patients recovering from heart attacks, strokes or congestive heart failure, to those at-risk with arrhythmia, high blood pressure and other issues.
Dr. Indu Poornima, director of AHN’s Section of Preventive Cardiology and board president of the American Heart Association of Greater Pittsburgh, said fewer than 30% of her patients before COVID-19 had any kind of remote monitoring device. But since March, more than 50% now have at least one such device.
Such massive growth “is a sea change,” Dr. Murali said.
“The pandemic has forced us to really transform and look at remote monitoring in a different context,” he said. “For this to grow more, reimbursement is the key element.”
Like telehealth itself prior to March, insurance is the main stumbling block to even further use of remote devices shown to benefit health.
The reason telehealth use exploded was not just because patients were so determined to see their doctors. After the COVID-19 pandemic was declared in March, the federal Centers for Medicare & Medicaid Services suddenly approved telehealth visits for reimbursement — after resisting for more than a decade — and all the private insurers followed.
“Without [CMS’ approval of telehealth coverage], we would not be able to provide most services” during the pandemic, said Dr. Heba Wassif, a cardiologist at Cleveland Clinic and a member of the American College of Cardiologists Care Innovation Council. “So what I’m seeing with what CMS has done is that they showed they were embracing digital health before this. But they were only taking baby steps.”
Dr. James Adisey, a cardiologist at Excela Health, which has three hospitals in Westmoreland County, said it looks as if eventually CMS will have to approve reimbursing remote patient devices, much in the same way that they eventually approved telehealth.
As with telehealth, he said: “Once we can show CMS and other insurance carriers that they have become part of our guidelines, that they enhance care, they’ll start to cover them.”
Part of his optimism, he said, is that “I think once we come out of this [pandemic] the whole country’s health care is going to be transformed. It’s going to force us in a good way to transform how we take care of people.”
Many of his colleagues in the field agree that CMS’ approval of telehealth bodes well for the eventual approval of reimbursement for remote devices.
“We’re optimistic that we’ll get reimbursement [from insurance] eventually,” said Dr. Sahil Parikh, a member of the American College of Cardiologists vascular disease council and an interventional cardiologist at Columbia University’s Irving Medical Center. “With one fell swoop we were already able to get all the insurance companies and CMS to reimburse us for telehealth visits” early in the pandemic.
But for now, “too many of these remote monitors remain inaccessible physically and financially for some of our patients,” he said. “Remote testing sounds great. But if we can’t bring them to the populations that need them the most, that [health] gap [between demographic groups] will only widen.”
During a pandemic, inhome monitoring becomes less of an added feature to care than “invaluable replacement” of the kind of testing that typically is done in a hospital or doctor’s office, Dr. Poornima said.
“Every time I do a televisit now, vitals are such an important part of our physical exam,” she said. “Now, before the visit, my nurse calls and asks the patient if they have a home blood pressure monitor and if they have any data available we can look at.”
Dr. Bill Belden, a clinical cardiac electrophysiologist at Allegheny General Hospital who works with patients with heart arrhythmia issues, said since March he has seen “a grand total of two patients in person” because of the desire to keep patients at home.
And much of what he does with his exams — ECGs — can now be accomplished by remote monitoring devices, he said.
“These electronic recording devices are fantastic,” he said. “I just need a tracing of their heart rhythms. They can do it at home and email it to me.”
A lot of patients now have the Apple Watch that can both monitor heart rates and even do an ECG, he said.
“There’s going to come a day when we send patients home with these devices,” he said. “Though I don’t think any insurance companies will be reimbursing people to buy an Apple Watch anytime soon.”
Stuart Long is CEO of Infobionics, which makes one of the most widely used remote patient monitoring devices — the MoMe Kardia — to monitor ECG data for heart patients at home.
His device, however, is used for diagnostic tests ordered by their cardiologists, and the test — even though it’s conducted at home — is reimbursable by insurance.
But Mr. Long said one advancement he hopes to see for nondiagnostic devices is when products like a Fitbit, which easily monitors heart rates, could be synced to work with approved medical devices to provide that data.
Dr. Colin Movsowitz, a cardiologist in Norriton, outside Philadelphia, uses the MoMe device for many of his patients, and looks forward to the day when even nondiagnostic tools are better at providing the kind of realtime information he can get from MoMe.
“We are going to have to advocate to get” insurance reimbursement for such devices, he said.
“But we also need better information to continue to do telehealth visits,” he said. “I know a lot of physicians who love doing the telehealth visits, but people are missing things in those visits.
“It’s not all roses with telehealth. It comes with significant shortcomings,” he said. “And if we’re going to continue to do them, we need appropriate monitoring of the patients.”