Patient Monitoring in ESRD Patients Federal Considerations and - PowerPoint PPT Presentation

Telehealth and Remote Patient Monitoring in ESRD Patients Federal Considerations and Barriers to Full Implementation

A New Paradigm  The 2010 passage of the Patient Protection and Affordable Care Act signaled the Federal government’s intent to change healthcare delivery  Greater focus on preventive and maintenance services for chronic diseases  Increased use of technology to facilitate care  More patient engagement and empowerment for self-care  Push towards community and home-based healthcare

Telehealth and RPM in Chronic Disease  Telehealth has been utilized to manage patients with varying types of chronic disease including:  Stroke  Diabetes  Dermatology  Asthma  Cardiovascular Disease  Some mental health conditions

ESRD Patients  End Stage Renal Disease (ESRD) currently affects over 400,000 patients in the US  The majority of these patients participate in the Medicare program  The only treatment available is a kidney transplant or renal dialysis, which most patients undergo.  The two types of available dialysis modalities include Peritoneal dialysis (PD) & Hemodialysis (ICHD or HHD)

Home Therapy for ESRD Patients  Only 10% of patients on dialysis are on home therapy, even though:  Many patients prefer to receive health care, including dialysis, at home.  Home dialysis offers patients health benefits such as reduced risk of cardiovascular mortality, lower rates of hypertension, and fewer of the physical health impacts of regular dialysis.  Patients on home dialysis can be more active in the workforce.  It can be a lifeline for patients with limited ability to travel and who live in rural areas far from dialysis facilities. References Available Upon Request

Telehealth, RPM & ESRD Patients  Medicare telehealth services are currently covered only if patients are seen at certain designated sites (e.g., certain hospitals and health centers).  Providing patients options to access telehealth services from home may incentivize patients to adopt home dialysis as a treatment option.  Patients can avoid costly, time-consuming and unnecessary visits to facilities, and stay engaged in the workforce.  Increasing telehealth access will encourage access for patients in rural and underserved areas.

Barriers to Telehealth & RPM Use In Home Dialysis  Despite the existence of technologies that allow effective monitoring of home dialysis patients, barriers preventing full access to such services exist.  Home as originating site  Geographic restrictions  Lack of economic data  Parameters surrounding “meaningful interactions”  Patient education

CMS Actions  The Centers for Medicare & Medicaid Services (CMS) has also been actively engaged in telehealth issues related to ESRD patient services  In 2015, CMS finalized the addition of several CPT codes in support of the addition of monthly capitation payment services for the treatment of ESRD to their telehealth list  The Center for Medicare & Medicaid Innovation (CMMI) also supported a pilot exploring use of telemedicine in peritoneal dialysis aimed at improving outcomes of patients and establishing a sustainable telemedicine model for that patient population

Congressional Actions  There are several bills that have been introduced in Congress that specifically call out home dialysis as a part of the telehealth environment  HR 2550: Medicare Telehealth Parity Action (status: pending in House)  HR 3178: Medicare Part B Improvements Act status: passed the House)  S 870: Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care/”CHRONIC act” (status: passed the Senate)  HR 1130/S 598: Chronic Kidney Disease Improvement in Research and Treatment Act (status: pending in respective houses)

Telehealth Definitions  Ongoing discussions regarding what constitutes a meaningful telehealth intervention  Video component necessary?  Frequency of interaction?  Synchronous vs. Asynchronous interactions?  Combination of above modalities?

Contact Crystal A. Riley, PharmD, MHA, MBA Senior Manager / Healthcare Policy & Reimbursement Baxter International, Inc. 901 15th Street NW, Suite 500 / Washington, DC 20005 / USA T +1.202.508.8211 / M +1.202.604.9580 crystal_riley@baxter.com