Remote Patient Monitoring: A Viable Virtual Care Option for the COVID-19 Pandemic

Implementing Remote Patient Monitoring (RPM) for COVID-19 patients has many potential benefits. Some of the benefits are outlined below:


1. Decrease in risk of virus transmission to other patients, community members and healthcare & administrative workers.

2. Patients get required care in a timely manner and have access to timely hospital-based care, as and when appropriate.

3. Data on qualitative measurements of patient’s health status to monitor disease progression (Healthcare organizations indicate onset of severe pneumonia in adolescents and adults is likely when the SpO2 is less than or equal to 93 percent).

4. RPM data also eases patients’, families’ and friends’ anxiety over disease progression when in quarantine.

5. Patients recover without having to be hospitalized, which helps with potential hospital bed shortage (general guidance from professionals state that most COVID-19 patients can recover at home).

6. RPM data and alerts also allow notification of hospital staff to prepare for COVID-19 patient’s arrival.

7. At a macro level, RPM also helps lower instances of hospitalization so that healthcare systems do not get overwhelmed.

Process of implementing RPM in public health setting:

  • Once patients test positive for COVID-19, they are entered into an Electronic Health Record.

  • Existing chronic conditions including status is updated in the EHR to fine tune and identify critical risk areas.

  • Current Medications are pulled in from Medication History interface to have a complete overview of patient’s current treatment regime if any.

  • EHR can also absorb a CCDA record from the patient’s PCP and other specialists and absorb all data into EHR

  • The patient is automatically registered into RPM program.

  • Patient is informed about the RPM program verbally over the phone; a text and email is sent to the patient explaining in detail the process, which is simple and easy to use.

  • The automated RPM kit, including a blood pressure machine and pulse oximeter, is delivered to the patient’s home.

  • The patient takes their vital signs mainly using the Pulse Oximeter and the reading automatically is transported to the RPM platform.

  • Oxygen saturation from the pulse oximeter is accurate and based on experience, alerts are transmitted for levels below 89%.

  • Each patient’s alert levels are adjusted over a period of 1 to 2 weeks so that there are no false alarms.

  • Patient is also involved in educative sessions outlining the prospect of the oxygen levels coming in lower at specific points in time. For example, readings could come in at 70s at a specific point in time. If the reading is taken after some intervals in succession, the readings could be back to normal. These education sessions are conducted so that the patient and the caregivers don’t have to go through the anxiety of alarms.

  • If the oxygen levels stay below the pre-set levels for an extended period of time they are requested to contact their RPM nurse or their physician. They are also encouraged to have a video or telephone visit with a physician or an advanced practice provider while symptomatic.

  • If their symptoms worsen, they or their caregivers are instructed to call 911 for transportation to the hospital when appropriate.

  • The RPM program encourages patients to take their own vital signs.

  • Nurses involved in the RPM program will contact the patients once a month or more, as appropriate, to monitor and follow up on the health of the patient. All such conversations will be recorded in the EHR for the patient’s Primary Care Physician or Pulmonologist to review and take actions.

Since onset of COVID-19, CMS has expanded coverage. On March 30, CMS released interim final rule to last through national public health emergency, which also includes permanent fixes.


CPT codes for the provision of RPM include:

  • CPT Code 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); set-up and patient education on use of equipment.

  • CPT Code 99454: Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. (Initial collection, transmission, and report/summary services to the clinician managing the patient)

  • CPT Code 99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes

  • CPT Code 99458: Each additional 20 minutes (List separately in addition to code for primary procedure)

  • CPT Code 99091: 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 30 minutes of time, each 30 days

  • 99457 and 99091 cannot be billed concurrently in the same month.

Reference:

Blog by 3M Health Information Systems & Victoria Sharp MD

EHI’s Internal Processes and Data. Joshua Baron MD


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