Dr. Ahmed Siddiqi, an orthopedic surgeon at Orthopaedic Institute Brielle Orthopaedics in New Jersey, started implementing models of digital, remote and hybrid care in early 2020.

THE PROBLEM

While the pandemic was one impetus, as an orthopedic surgeon, he also was eager to improve engagement and monitoring for his patients once they were discharged to the home for recovery.

"Historically, providers don’t have direct and continuous visibility into patient progress during recovery but rely on one to three in-person interactions following surgery to understand how their patient is doing," he explained.

"A standard post-surgery care protocol requires patients to fill out piles of forms in person, take home large amounts of bulky, overwhelming educational materials, and participate in numerous sessions of costly outpatient or home-based physical therapy," he continued.

In addition, this approach makes it much more difficult to avoid adverse events, like ED visits, readmissions and infections, he said.

"Of course, all of this incurs costs on providers, patients and payers due to the use of team resources and any coverage/co-pays for in-person elements of patient care," Siddiqi said. "I was looking to take advantage of digital care management to improve that process for my patients, as well as my team.

"In late 2022, I started looking for a new digital care solution, because I found the ones being used by colleagues were not sufficiently robust for my needs," he continued. "One solution was not designed specifically for MSK or orthopedic care, making it less useful for my team’s purposes, and another was not effectively engaging patients and collecting patient-reported outcomes over time."

"The most critical determinant of success is finding a solution that has a demonstrable track record of exceptional patient engagement. If the solution you implement cannot engage patients easily and consistently, then its clinical utility will diminish substantially."

Dr. Ahmed Siddiqi, Orthopaedic Institute Brielle Orthopaedics

In both cases, the communication features were lacking and could not provide the long-term, direct communication he wanted with all his patients, he added.

"Ultimately, my team would have had to spend more time using both of those tools while getting subpar patient engagement and patient-reported outcomes," he said.

"In Q4 2022, I implemented a new digital care solution – Force Therapeutics' digital care platform – to further improve my team’s reach and raise patient satisfaction levels," he continued. "Specifically, I wanted to be able to do more long-term remote patient monitoring while easily and directly communicating with all my patients."

Siddiqi's goal was to effectively move more elements of in-person care into the home, including virtual check-ins, education and physical therapy. With effective digital and remote care via remote therapeutic monitoring, he has been able to solve more substantial problems.

PROPOSAL

Siddiqi's practice already was doing many of the activities that now are reimbursable under the new RTM codes, particularly providing patient education and engaging patients consistently during their care journey via the digital care platform.

"The Force Therapeutics platform regularly monitors patient-reported outcomes both in terms of standardized forms, such as HOOS Jr., KOOS Jr. or PROMIS Global, as well as other nonphysiological measures, such as pain and range of motion," he explained.

"What the RTM codes do for my practice now is acknowledge all the time that my team and I spend monitoring these metrics and interacting with patients remotely," he continued. "By making that time reimbursable, CMS has created an incentive for us to quantify remote patient engagement to meet the minimum engagement requirements for reimbursement."

This not only ensures the time the practice spends on those activities is covered, but also that staff have extremely high and consistent visibility into the patient’s recovery remotely.

"Engagement at this level with patients in their homes was not possible before and directly helps reduce adverse events, free up the care team to focus in-person care on those who need it the most, and help patients feel heard and taken care of," Siddiqi reported.

"All told, remote care can have a massive positive impact on patient outcomes and financial performance, while enabling efficient scaling of patient volumes," he said.

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MEETING THE CHALLENGE

Starting in September 2022, Siddiqi's practice began using the platform with its RTM module. The platform identifies which of his patients are meeting the minimum engagement and data submission requirements to be eligible for RTM coverage.

For example, patients must engage with the platform by accessing educational content and provide patient-reported outcomes a minimum number of days per month. The platform also tracks that data for staff.

"In addition, as my team monitors patients during their recovery, including tracking their functional outcomes scores, quality-of-life data, pain levels and range of motion, we use the platform’s monitoring time recorder to document the time our team spends monitoring these nonphysiological patient-reported outcomes," Siddiqi explained. "For each billing cycle, I simply download that data and make it available to our billing partners for submission.

"From a patient care perspective, augmenting the care journey with digital tools that are easy for my patients to use gives them ongoing access to resources prescribed for them anytime, anywhere and as many times as they want," he continued. "Instead of a big binder of paper, the educational content is presented in multiple ways, making it digestible, understandable and easily shared with a spouse or other care partner at home."

And as they participate in activities, such as remote physical therapy and tracking their goals, they can monitor their own progress. Helping patients better understand their surgery and recovery and actively engaging them in their own care leads to significantly better outcomes, Siddiqi said.

RESULTS

Siddiqi said it is important to note that this is still early days for RTM reimbursement, so his experience may be one of the first to be made public in the country.

"Given these codes are new and there is still some hesitancy on the part of providers, an important takeaway from my experience is that Medicare, as well as many private insurers, are now actively reimbursing for RTM," he reported. "My practice is in New Jersey, so it’s also important to note that private insurers may behave differently, and reimbursement amounts for each code may vary from state to state.

"Nonetheless, it’s clear payers are actively looking to incentivize more high-quality and thoughtful remote care," he said. "In terms of revenue, having submitted RTM claims for 158 patients between September 2022 and January 2023, I have already seen reimbursement approaching $34,000 for those patients."

In addition, about one-third of those RTM claims are still pending, so that total amount will be much higher for those 158 patients alone. So far, Medicare payments are averaging around $185 per patient, while private insurance payments are averaging closer to $500 per patient, which demonstrates how these payers are trying to incentivize this type of care, Siddiqi explained.

"If we extrapolate based on these outcomes, my practice is very likely to see upwards of $100,000 in RTM reimbursement by the end of 2023 – all while delivering high-quality remote care and making my patients feel well cared for," he said.

The other side of the equation – cost savings – is also very important. For Siddiqi's patient population that is using the digital care platform, there are significant overall savings per care episode, a big contributor to his return on investment.

"For example, by replacing paper-based, manual and in-person processes for preoperative care, we are saving $1,400 per patient," he reported. "The digital process is easier for patients, so they are more reliably completing their presurgery activities and preparation, so we are avoiding last-minute cancellations and reschedules, which would cost about $3,000 per patient on average.

"The biggest impact, though, is that by working so closely with our patients we can tell when something is wrong and intervene immediately, helping avoid visits to the ED or worse, readmissions – avoiding an average of $17,250 per patient," he continued.

The financial impact of the cost savings across Siddiqi's patient population is expected to be $2-3 million over one year.

"Moreover, the efficiency gains from using our holistic MSK digital care platform are helping us increase our patient volumes," he said. "In 2022, my practice saw just under 500 patients, and we are projecting a 30% increase in 2023 due to the efficiencies we have achieved through smart remote care and RTM."

ADVICE FOR OTHERS

"The most critical determinant of success is finding a solution that has a demonstrable track record of exceptional patient engagement," Siddiqi advised. "If the solution you implement cannot engage patients easily and consistently, then its clinical utility will diminish substantially.

"And more specifically, because successful RTM reimbursement requires a minimum level of patient engagement, providers need a solution that’s a two-way street, making it possible for care teams to communicate directly and effectively guide patients toward care goals, while receiving reimbursement," he continued.

Another consideration is that RTM may not be successful in a vacuum, so it has to be a deliberate and thoughtful process of rethinking the way providers care for their patients to be more aligned with an increasingly digital care landscape, he added.

"Often, providers and facilities look to implement digital or remote capabilities only for specific elements of patient care, such as capturing patient-reported outcomes, or they attempt to use a single platform across multiple specialties," Siddiqi said.

"In my practice, having the data and technology specific to MSK care to support a holistic view of my patients, plus the means to communicate directly with them, offer timely virtual education, collect patient-reported outcomes, etc., helps ensure patients are fully engaged in their digital care plan and are completing all tasks I’ve prescribed for effective recovery," he continued.

As both public and private payers continue to incentivize behaviors via digital technologies, patient care and satisfaction will improve, and the national healthcare cost burden will decrease, he added.

"To reiterate, this is still early in the adoption of RTM, so I'm personally looking forward to hearing about the experiences of other providers in other states across the country," he said. "I think this is a big step for our national healthcare system to continue encouraging and enabling providers to adopt smarter and better care processes for all patients that also reduce costs, which we recognize are much higher in the U.S. than in other major economies.

"Lastly, as adoption of current RTM technology expands, and we receive more clear guidance from both public and private payers nationwide, the application of RTM to a wider range of conditions will continue to expand," he concluded. "Patients and providers alike have much to gain from this progress."

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