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

Federal Considerations and Barriers to Full Implementation

Telehealth and Remote Patient Monitoring in ESRD Patients

• 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

A New Paradigm

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

• utcomes 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