While home-based cardiac programs could be the key to improving rehab participation and outcomes for heart attack survivors, reimbursement often stands in the way.
However, one remote patient monitoring company has cracked the code to developing a successful model and getting it paid for — possibly creating a framework or partnership opportunities for home-based care companies hoping to follow suit.
Roanoke, Texas-based NextGen RPM offers cardiac in-home rehab to patients in portions of Texas and New York City via remote patient monitoring. All services are billable through most insurance plans, in addition to Medicare, according to CEO Tim Bilbrey.
“Our program is special in that we use 14 different Current Procedural Terminology (CPT) codes,” Bilbrey told Home Health Care News. “It’s not home health. It’s a mix between remote patient medicine, some telemedicine, some care coordination and care management.”
In other words, rather than developing a program and waiting for the codes to sustain it, Bilbrey built a program around codes that currently exist.
“I don’t want to say it’s the secret sauce of the program, but then again it really is, for lack of a better phrase,” he said. “I was able to piece together 14 CPT codes … that mirror as close as possible what a cardiac home-based [rehab] program would look like.”
Bilbrey, who has worked in cardiac rehab settings since 2003, did so out of necessity. Currently, Medicare only covers cardiac rehab if it’s supervised by a physician in a medical care facility, making home-based programs few and far between.
That requirement has also contributed to low cardiac rehab participation nationwide, with only one in five of those who need it taking part in center-based cardiac rehab largely due to scheduling and transportation conflicts.
The ramifications of low participation are troubling, according to Randal Thomas, medical director of the cardiac rehab program at the Mayo Clinic in Rochester, Minn.
“The consequences of not participating in cardiac rehabilitation are significant,” Thomas previously told Home Health Care New. “They include lower quality of life, lower functional status, lower strength and viability measures, higher rates of rehospitalization, recurrent heart attacks and higher death rates.”
The goal of Bilbrey’s program is to improve participation for anyone who can’t make it to clinic-based rehab, improving outcomes while also cutting costs.
“Something is better than nothing,” Bilbrey said. “If a patient is high risk or moderate risk, we don’t want to turn them away. … We still go by all the recommendations of the referring physician.”
Currently, NextGen RPM gets referrals from physicians, clinic-based cardiac rehab programs and home health companies. Upon receiving a new referral, staff goes to the patient’s home to gain insight into their condition, go over their prescriptions and build a specialized program.
From there, the program is mostly remote, barring physical training, which is done in-home with a trainer present.
“In an outpatient setting, most of it is exercise, exercise, exercise, which is really understandable because you have treadmills, dumbbells and weights inside an in-patient setting,” Bilbrey said. “When we’re inside a patient’s home, we do have the exercise component, but we go through a lot of education and we go through a lot of one-on-one counseling with the patient. We really attack it more as a lifestyle change.”
Some services offered include biometric monitoring, care coordination, symptom management, medication education, heart rate variability testing, dietary consultations and more.
Since NextGen RPM got started about 2 years ago, it’s seen about 250 patients to date with much success, Bilbrey said. In fact, between February 2017 and January 2018, heart failure patients referred to the program had a 30-day readmission rate of just 2.1%, according to statistics Bilbrey shared from a pilot program.
While NextGen RPM is not a home health company, it works closely with them, pointing to home health providers as frequent referral sources and recipients, especially in rural areas. The company has even licensed out its home-based cardiac rehab program to a home health provider in Dumas, Texas.
“When the patients discharge from home health, [the provider] would still continue to see patients and use [our program].”
NextGen RPM also offers home-based pulmonary and peripheral artery disease rehab, along with chronic care management. While currently only serving patients in Texas and New York City, Bilbrey is looking to expand into new areas.