Healthcare Team Outcomes Utilizing Remote Patient Monitoring in Pediatric Cardiology
Presented By:
Amy Ricketts, MSN, CPNP-AC; Melissa Elliott, Ph.D.(c) FNP-BC; Sara Crawford, MSN, CPNP-AC; Lori Erickson, Ph.D., CPNP-PC
Children's Mercy Kansas City
amricketts@cmh.eduOverview:
Purpose: To delineate an implementation project of remote patient monitoring revenue codes in the pediatric cardiology population
Project Design: Remote patient/physiologic monitoring (RPM) utilizes technology to enable the monitoring of patients outside of conventional clinical settings in an asynchronous store and forward digital health model. In the last 2.5 years, CMS has updated RPM codes to match current care models of adherence of transfer of monitoring of physiologic parameters (99454) and provider time reviewing and communicating with patients and families (99457 (RVU 0.61), 99458 RVU 0.61). Children’s High Acuity Monitoring Program (CHAMP®) transfers the physiologic data of parent-measured oxygen saturations and heart rates via pulse oximeters. The use of CHAMP has been shown to improve communication with the pediatric cardiac healthcare team, high-risk populations’ access to care, and reduce mortality and morbidity, but we had yet to review the impact on the implementation of RPM billing from the administrative and healthcare team outcomes. Through this work- we have had numerous PDSA Cycles, which included- 1- Heart Center Clinical team RPM workflow, 2- Health informatics (Document types/templates), 3- Revenue integrity, revenue education, and HIM coding (understanding codes and requirements), 4- Payor and Government Relations (Reviewing charges and matched payments), 5- Health Informatics- Order set for three codes.
Results: There were July 2020 to June 2022, 69 patients had qualified encounters with RPM billing codes with all parents allowed access for mobile or tablet access for home monitoring use. 32 (46.4%) Commercial insurance, 34 (49.3%) Medicaid, and 3 (4.3%) self-pay. There were 162 total billable units (FY 21 - 35 units 99454, 70 units 99457 (42.7 RVU), 57 units 99458 (34.77 RVU) and 240 Units (FY22- 90 units: 99454, 85 units 99457 (51.85 RVU), 65 units 99458 (39.65 RVU)). Of the billed encounters, commercial insurances matched payments to charges ranging from 25-28%, with no reimbursement from Medicaid (although some were from a capitated integrated pediatric care network).
Conclusion: RPM with mobile health platforms and engaged healthcare provides improved patient outcomes through a reduction in mortality and less morbidity on readmissions during the interstage period. This project showed the PDSA cycles for implementation of an RPM innovation with the collaboration of the Healthcare, Revenue, Coding, Health informatics, and Administration teams. There was an increase in the number of units from FY 21 to FY 22, likely due to improvements in health informatics interventions. Future PDSA’s will be focused on the rate and reasons for non-billable encounters, which may include data transferred less than 16 days (99454), reviewed and communicated with family less than 19 minutes or less in a calendar month (99457), or regulatory restrictions.
Project Design: Remote patient/physiologic monitoring (RPM) utilizes technology to enable the monitoring of patients outside of conventional clinical settings in an asynchronous store and forward digital health model. In the last 2.5 years, CMS has updated RPM codes to match current care models of adherence of transfer of monitoring of physiologic parameters (99454) and provider time reviewing and communicating with patients and families (99457 (RVU 0.61), 99458 RVU 0.61). Children’s High Acuity Monitoring Program (CHAMP®) transfers the physiologic data of parent-measured oxygen saturations and heart rates via pulse oximeters. The use of CHAMP has been shown to improve communication with the pediatric cardiac healthcare team, high-risk populations’ access to care, and reduce mortality and morbidity, but we had yet to review the impact on the implementation of RPM billing from the administrative and healthcare team outcomes. Through this work- we have had numerous PDSA Cycles, which included- 1- Heart Center Clinical team RPM workflow, 2- Health informatics (Document types/templates), 3- Revenue integrity, revenue education, and HIM coding (understanding codes and requirements), 4- Payor and Government Relations (Reviewing charges and matched payments), 5- Health Informatics- Order set for three codes.
Results: There were July 2020 to June 2022, 69 patients had qualified encounters with RPM billing codes with all parents allowed access for mobile or tablet access for home monitoring use. 32 (46.4%) Commercial insurance, 34 (49.3%) Medicaid, and 3 (4.3%) self-pay. There were 162 total billable units (FY 21 - 35 units 99454, 70 units 99457 (42.7 RVU), 57 units 99458 (34.77 RVU) and 240 Units (FY22- 90 units: 99454, 85 units 99457 (51.85 RVU), 65 units 99458 (39.65 RVU)). Of the billed encounters, commercial insurances matched payments to charges ranging from 25-28%, with no reimbursement from Medicaid (although some were from a capitated integrated pediatric care network).
Conclusion: RPM with mobile health platforms and engaged healthcare provides improved patient outcomes through a reduction in mortality and less morbidity on readmissions during the interstage period. This project showed the PDSA cycles for implementation of an RPM innovation with the collaboration of the Healthcare, Revenue, Coding, Health informatics, and Administration teams. There was an increase in the number of units from FY 21 to FY 22, likely due to improvements in health informatics interventions. Future PDSA’s will be focused on the rate and reasons for non-billable encounters, which may include data transferred less than 16 days (99454), reviewed and communicated with family less than 19 minutes or less in a calendar month (99457), or regulatory restrictions.
