When telephones began to appear in American homes and businesses physicians were one of the early adopters. As health insurance began to spread patients became more reluctant to pay out of pocket for services not covered by their health plans. For their part, health insurers were reluctant to reimburse for services outside the usual and customary practices. At some point midcentury doctors stopped routinely talking to their patients on the phone because nobody wanted to pay them for the service.
If you stop and think about it nothing could be more inconvenient – and antiquated – than having to make a doctor’s appointment to record routine health information. What if your car speedometer could only reveal your speed once you pulled back into your driveway, and then only one snapshot in time during your most recent trip. Same for your car’s oil pressure, temperature gauge alternator output, etc. It would not be especially useful to only learn information about your car’s engine performance after the damage had been done or you were left stranded.
Billy Abbott, a retired Army medic, wakes at 6 every morning, steps on the bathroom scale, and uses a cuff to take his blood pressure.
The devices send those measurements electronically to his doctor in Gulf Shores, Alabama, and a health technology company based in New York, to help him control his high blood pressure.
Nurses with the company, Cadence, remotely monitor his readings along with the vital signs of about 17,000 other patients around the nation. They call patients regularly and follow up if anything appears awry. If needed, they can change a patient’s medication or dosage without first alerting their doctor.
Medicare led the way by paying for remote monitoring and tech companies have responded.
In 2019, Medicare made it easier for doctors to bill for monitoring routine vital signs such as blood pressure, weight, and blood sugar. Previously, Medicare coverage for remote monitoring was limited to certain patients, such as those with a pacemaker.
Medicare also began allowing physicians to get paid for the service even when the monitoring is done by clinical staff who work in different places than the physician — an adjustment advocated by telemedicine companies.
Dozens of tech companies have streamed in, pushing their remote monitoring service to primary care doctors as a way to keep tabs on patients with chronic illnesses and free up appointment time, and as a new source of Medicare revenue.
One problem is that not everyone needs intensive remote monitoring, at least not at taxpayers’ expense. Within two years after Medicare relaxed eligibility for remote monitoring the number of Medicare patients being monitored grew by 17 times.
Part of the allure is that Medicare will pay for remote monitoring indefinitely regardless of patients’ health conditions as long as their doctors believe it will help.
For doctors with 2,000 to 3,000 patients, the money can add up quickly, with Medicare paying an average of about $100 a month per patient for the monitoring, plus more for setting up the device, several companies confirmed.
While some small studies show remote monitoring can improve patient outcomes, researchers say it is unclear which patients are helped most and how long they need to be monitored.
As usual, third-party payment created problems. Competition should drive down the costs of remote monitoring to pennies a day, rather than $3 dollars a day. However, technology companies and doctor’s offices are not competing for Medicare’s business on the basis of price, quality or even convenience. Thus, there is little incentive to use remote monitoring efficiently or shop for a better deal.
Denton Shanks, a medical director at the American Academy of Family Physicians, said remote monitoring helps patients manage their diseases and helps physician practices be more efficient. He has used it for the past two years as a doctor at the University of Kansas Health System.
It has worked well, he said, though sometimes it can be challenging to persuade patients to sign up if they have to pay for it.
Remote monitoring is a fitting example of what is wrong with American health care. Having a running record of your health metrics on a daily basis over a lifetime could be useful information to have. The problem is $100 a month times 330 million Americans adds up for $400 billion (about $1,200 per person in the US) a year. That is would substantially boost health expenditures. By contrast, your Apple watch can do a lot of this for a small fraction of the cost. Remote monitoring illustrates how something that is both valuable and easily affordable as a consumer good can be infinitely unaffordable when paid collectively.