Artículo del American Journal of Medicine sobre el RPM y el Hospital en Casa.

Remote physiologic monitoring (RPM) of a patient’s health status is rapidly becoming a leading tool of the “Hospita lat-Home” chronic care paradigm.1 Early affirmation of this telehealth-enabled “non-face-to-face” paradigm was afforded by the Centers for Medicare & Medicaid Services (CMS) on January 1, 2019, at which time 3 newly established Current Procedural Terminology (CPT) reimbursement codes were added to the Medicare Physician Fee Schedule.1 A Remote Therapeutic Monitoring (RTM) paradigm of non physiological patient data followed suit before too long with an eye toward auditing medication adherence, response to therapy, musculoskeletal activity, and respiratory efforts.1 Markedly accelerated by the severe acute coronavirus 2 (SARS-CoV-2) pandemic and the attendant increase in at-home care, RPM and RTM are presently widely predicted to display rapid continued growth.2 It is the objective of this Commentary to delineate the evolving scope of the RPM and RTM paradigms as well as to discuss the contributions of the legislative and executive branches to the development thereof.

At their core, RPM and RTM make it possible for some patients to forego in-person visits with their provider.2 Instead, these patients may be cared for either at their home/place of residence or, as required, at any other nonhospital location for both acute and chronic conditions.2 Apart and distinct from sparing patients the challenges associated with a hospital stay, RPM and RTM reduce the
risk of hospital-acquired infections to which inpatients are invariably exposed.2 Among the multiple medical conditions that lend themselves to RPM and RTM, special note is being made herein of hypertension, heart disease (eg, congestive heart failure), diabetes, chronic obstructive pulmonary disease, asthma, and obstructive sleep apnea.3 The ever-evolving (non-implantable) endpoint devices that render RPM and RTM feasible may comprise a glucometer, a sphygmomanometer, a pulse oximeter, or a weighing scale to name a few.3 More complex digital monitoring devices may include a Holter monitor, an apnea monitor, a Parkinson’s disease monitor, or a fetal heart rate monitor.3 Congressional interest in the prospect of RPM and RTM is long-standing. The aforementioned commitment notwithstanding, Congress has heretofore failed to enact a total of 8 relevant bills that were repeatedly introduced since the 116th Congress (2019-2020).4 Apart and distinct from the aforementioned legislative efforts, Congress dedicated several committee hearings to the ever-evolving field of RPM and RTM.5,6 Thus far, however, Congress has failed to act on the matter of RPM and RTM, thereby leaving the advancement of novel remote monitoring technologies in the hands of the executive branch.

Although the SARS-CoV-2-associated Public Health Emergency concluded on May 11, 2023, CMS policies relevant to RPM and RTM established during the Public Health Emergency were extended through December 31, 2024 via the Consolidated Appropriations Act, 2023 [Public Law No: 117-328]. Among the CMS programs extended, the “Acute Hospital Care at Home Program” deserves special mention in light of its central relevance to the continued exercise of RPM and RTM. Note is also made of the fact that the 2024 Physician Fee Schedule & Quality Payment Program of CMS saw to the institution of 2 new CPT reimbursement codes for the provision of RPM and RTM services in Rural Health Clinics and Federally Qualified Health Centers.7 Viewed collectively, the multiple initiatives of the legislative and executive branches strongly suggest that RPMand RTMare here to stay.

Going forward, CMS would do well to explore what additional medical conditions could be the subject of funded remote monitoring by increasingly sophisticated communication technologies at either the home of the patient or else wherever the patient resides. In addition, strong consideration should be given to the prospect of expanding the reach of coverage of RPM and RTM to subacute settings such as presently exist in a nursing home or in a senior living center. Moreover, every effort should be made to examine the impact of RPM and RTM on the promotion of patient safety as well as on the enhancement of patient satisfaction. After all, the very premise of RPM and RTM embraces the outlook that hospitalization is best viewed as a last resort. Stated differently, a substantial proportion of inpatients can now be cared for in an outpatient context assuming that adequate provider−patient communication can be maintained. A quote ascribed to Samuel Goldwyn says it all: “A hospital is no place to be sick.”

Eli Y. Adashi, MD, MSa
Daniel P. O’Mahony, MSLSb
I. Glenn Cohen, JDc
aDepartment of Medical Science, Brown University, Providence, RI
bLibrary Planning and Assessment, Brown University Library, Providence, RI
cPetrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Harvard University, Cambridge, Mass

REFERENCES

1. Agency for Healthcare Research and Quality (AHRQ). PSNet: Patient Safety Network. Remote patient monitoring. Available at: https://psnet. ahrq.gov/perspective/remote-patient-monitoring. Accessed September 12, 2023.
2. Miranda F, Oliviera MD, Nicola P, Baptista FM, Albuquerque I. Towards a framework for implementing remote patient monitoring from an integrated care perspective: a scoping review. Int J Health Policy Manag 2023;12:7299.
3. Telehealth.HHS.gov. Telehealth and remote patient monitoring. Available at: https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring. Accessed September 12, 2023.
4. Congress.Gov. Remote physiologic monitoring. 116th-118th Congress. September 12, 2023. Available at: https://www.congress.gov/searchq=%7B%22search%22%3A%22%5C%22remote+physiologic+monitoring%5C%22%22%2C%22source%22%3A%22legislation%22%7D&pageSort=dateOfIntroduction%3Adesc . Accessed September 12, 2023.
5. Govinfo.gov. Senate Subcommittee on Science, Technology, and Space. E-health and consumer empowerment: how consumers can use technology today and in the future, to improve their health. Senate Hearing 107-1054. July 23, 2001. Available at: https://www.govinfo.gov/content/pkg/CHRG-107shrg89265/pdf/CHRG-107shrg89265.pdf. Accessed September 12, 2023.
6. Govinfo.gov. Subcommittee on Health of the Committee on Veterans’Affairs, U. S. House of Representatives. Overcoming rural health care barriers: use of innovative wireless health technology solutions. House Hearing 111-87. June 24, 2010. Available at: https://www.govinfo.gov/content/pkg/CHRG-111hhrg58054/pdf/CHRG-111hhrg58054.pdf. Accessed September 12, 2023.
7. Centers for Medicare & Medicaid Services (CMS). Calendar year (CY) 2024 Medicare physician fee schedule proposed rule. July 13, 2023. Available at: https://www.cms.gov/newsroom/fact-sheets/calendaryear-cy-2024-medicare-physician-fee-schedule-proposed-rule. Accessed September 12, 2023.

Funding: None.
Conflicts of Interest: EYA and DPO declare no conflicts of interest.
IGC is a member of the ethics advisory board for Illumina and the Bayer
Bioethics Council.
Authorship: All authors had access to the data and a role in writing the
manuscript.
https://doi.org/10.1016/j.amjmed.2023.10.018