Lower is Better

Dr Tom Frieden, former director of CDC, referred to the Final Report of a Trial of Intensive versus Standard Blood-Pressure Control, published in May in the New England Journal of Medicine.

Conclusions:”Among patients who were at increased cardiovascular risk, targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of major adverse cardiovascular events and lower all-cause mortality than targeting a systolic blood pressure of less than 140 mm Hg…”

This month I also updated by comparison of the Healthmote BT-105 and the new CardioBlip by Carrematix to our office sphygmomanometer. We are still in the process of talking with both of these companies about their products as we continue to mainly use the Healthmote system for our own RPM services.

More Healthmote Experience

Healthmote continues to lend itself to a growth of patients using RPM. It is easier to set up than Qardio, and we have found that easily more than twice the number of Medicare patients can use the simple one-button Healthmote device compared to Qardio. Send your CCM and RPM questions to mark(at)vaughanmd.com. Emails may not receive a reply, but answers to the most popular questions will be provided in future episode of the CCM Pays and RPM Podcast.

Healthmote RPM

I am excited to tell you about both of our new sponsors. You can learn more about their products by clicking on the Foracare and Healthmote links. Foracare is covered in an earlier dedicated episode. Most of this episode describes the benefits and features of the Healthmote Remote Patient Monitoring (RPM) system. I also give some thoughts regarding the structure of staffing for RPM coverage.

Medicare 2021 RPM Update

Link to Official CMS Policy

There are a couple updates to RPM rules which provide significant clarification to time necessary for RPM monthly management and the nature of communication satisfying the “interactive communication” requirement.

ForaCare D40g

I am sharing my initial thoughts on the ForaCare D40g cellular (3G) BP monitor and glucometer. It is ideally suited for Remote Patient Monitoring. It eliminates the need for patients to have or operate a bluetooth mobile device, as is required to use the Qardio Arm. It also has some innovative time-saving features included in their online monitoring dashboard, Healthview 24/7.

Promotional consideration was provided to me in the form of discounted units for review.

Companion Fora D40g Video

RPM Support

Qardio Support

Welcome to the mid-Summer CCM Pays podcast for 2020.  I’d like to focus again on aspects of providing Remote Patient Monitoring services.  By the way, if you are doing CCM without RPM, you are missing out on a great opportunity to better manage hypertensive patients and increase practice revenue by at least the amount you make with CCM alone.

RPM pays very well.  The 99454 code pays about $69 monthly.  We need to plan to provide platinum level support for these patients when the monthly payment is not that much less than your one-time cost for purchasing the unit.  Our practice is to help patients at no additional cost whenever they have any difficulty with their Qardio unit.  I say Qardio unit, because we have chosen to use the Qardio Arm in our implementation of RPM.  

If a patient has a problem getting the system to work, we try to troubleshoot by phone if possible.  If that doesn’t work, we have the patient bring in both the Qardio arm unit and the mobile device the patient uses with it.  Oftentimes we only have to bluetooth pair the unit to the mobile device following an accidental erasing of the Qardio from the Bluetooth devices on the mobile phone or pad.  Other times we find that the pairing is fine, but the Qardio device has an error.  Sometimes just having the patient reposition the unit in a more medial position on the arm and allowing a loose fit of the cuff fixes the problem.  Sometimes the unit just needs fresh batteries.  Other times we find a leak in the cuff or mechanical pump failure evidenced by a unit which never achieves a pressure high enough to measure the patient’s systolic pressure.  When we come across a mechanical failure, we just exchange the unit for a new one and re-pair the patient’s mobile device with the new unit.  We have even had success with getting replacements from Qardio by emailing support with the model numbers of the defective units.

I cannot overemphasize how great RPM has been for hypertensive management and practice revenue.  If you don’t already have your own in-house RPM program, visit RPMpays.com to learn how to start your own program without having to share any of the revenue with outside parties.  Thanks for listening.

Medical Assistant Motivation

This month I wanted to give a couple aspects to consider in motivating your MA to keep doing CCM. Remind them of the great results CCM gets in patients with chronic conditions. Be sure to congratulate them when the pick up things that need to be addressed between office visits. The other way to help motivate CCM completion is to offer financial incentives based on production.

COVID-19 and CCM

CCM (Chronic Care Management) and RPM (Remote Patient Monitoring) can both be done during COVID-19. This podcast explains that new CMS announcments confirm that the set-up code (G0506) for CCM can be done over the telephone. This allows primary care physicians to set up CCM for monthly services with patients without the patient having to leave their home. This service will both keep patients with chronic conditions managed and provide desperately needed revenue to physician offices affect by low volume during this early social distancing time of the COVID-19 pandemic. Get your CCM templates at CCMPays.com.

CCMarch

We review lessons learned installing the Qardio app on patients’ mobile devices and the latest pricing of Qardio on Amazon.

Review RPM Lessons Learned

Dates on Android: (tap on “Year”) to change year

iPad Mini did not show option to review “Terms and Conditions” while creating new account, so we had to create the account on another device and then log in on the iPad Mini.

PLEASE have iOS users put in their first AND LAST names.  The app only asks for a first name at registration.

Consider requiring patients to come in with the app already installed and registration completed.

Have patients send in readings weekly.  Have your MA copy and paste the data into a phone message for you to review.  Doing this weekly with every patient should cover the 20 minutes for the month, allowing you to still do 20 minutes of CCM each month.

QARDIO

It was on Amazon with Prime for a lower price than we can get it from the company.

On 2/26 it is already back up to $99.  I guess you have to get it using our “drmark” coupon code to get it for $90.  Keep checking Amazon to see if Qardio puts it back for $75.

Remote Patient Monitoring Now

Dr. Mark Vaughan, Cristina, and Ian describe lessons learned in the first month of setting up Remote Patient Monitoring (RPM) using the QardioArm wireless blood pressure monitor. An update on January CCM is also discussed.

Download our consent form for RPM.

Use our template for tracking both CCM and RPM with Google Sheets. Be sure to pay for a G-Suite account to get a Business Associate Agreement with Google to maintain HIPAA compliance.

THE CODES

  • 99453 Set Up $21
  • 99454 Supply Device $69
  • 99457 Interactive Communication $54