At-Risk Patient Populations Desperately Need Solutions to Keep Them Healthy at Home

By Jon Bloom, M.D.
CEO of Podimetrics

COVID-19 has made a lasting impact on the health care industry in terms of how we deliver care and monitor our patients, and in particular, how we remotely manage patients with chronic conditions and other comorbidities who are at an increased risk of experiencing severe COVID-19 complications.

For instance, patients with diabetes are hospitalized due to COVID-19 symptoms six times more often than those without. One of the most common and devastating causes of hospitalization among this population are diabetic foot complications–at least half of patients who’ve had a diabetic amputation die within five years. The beginning of the COVID-19 pandemic forced many countries to issue mandated lockdowns, meaning patients were isolated at home and without the necessary tools they needed to help prevent or manage diabetic foot complications. A study published this fall in the Journal of the American Podiatric Medical Association analyzed patient data from the first eight months of 2020 and concluded that the odds of undergoing any level of amputation was 10.8 times higher during the pandemic than before the pandemic.

It is critical that we provide solutions not only to care for these patients virtually but also those that allow patients to prevent and manage their conditions at home. A single diabetic amputation costs nearly $100,000, and up to one-third of diabetes expenditures are linked to lower-limb-related problems. The more patients with diabetes, and potential related complications who contract COVID-19, the more there will be an increased burden on hospitals and an increase in overall health care costs.

The at-risk population, particularly older adults living in underserved and rural parts of the country, are in desperate need of virtual care management that can help detect early signs of diabetic foot complications to ultimately prevent a costly and possibly life-threatening amputation. Research published this fall in BMJ Open Diabetes Research & Care examined the impact of a once-daily foot temperature monitoring device for at-risk patients within the Mid Atlantic Permanente Medical Group. The researchers found a 71 percent reduction in all lower-extremity amputations, a 52 percent drop in all-cause hospital admissions, and a 40 percent decrease in all-cause Emergency Department visits.

While the BMJ study period occurred before the pandemic, its findings have major implications for this vulnerable patient population. This study is the first to report on its impact on health care resource utilization, and these results suggest that use of a telemedicine solution for remote temperature assessment is associated with decreases in rates of major amputations, all-cause inpatient admissions, and emergency department visits.

In addition, the study confirms the importance of maintaining a proactive strategy to manage diabetic foot complications, while also showcasing the dramatic results such a strategy can have. More than ever, we need tools to keep these patients healthy and at home, helping to not only “flatten the curve” but also “raise the line” — increasing the capacity of the health care system overall.

Despite the science on prevention, outcomes, and savings that would be most beneficial to Medicare patients (given the higher prevalence of diabetic amputations), Traditional Fee-for-Service (FFS) Medicare has not reimbursed or covered these related services. Remote patient monitoring codes may provide a path to partial reimbursement, however, in a roundabout and slow way as technology companies must partner and bill through providers. Furthermore, these remote patient monitoring codes do not consider outcomes and therefore do not incent prioritization of solutions with rigorously peer-reviewed and validated health outcomes. Without a path for reimbursement in Traditional FFS Medicare, about 60 percent of Medicare patients are essentially precluded from accessing the benefits of such effective and recommended preventive solutions.

Fortunately, in Medicare Advantage, incentives are aligned to cover these services. Recent BMA research showed that Medicare Advantage delivers superior health outcomes for vulnerable beneficiaries by emphasizing preventive and primary care that, in turn, leads to reduced avoidable hospitalizations and lower health costs. The pandemic has underscored the importance of services, such as ones that prevent diabetic amputations, but the need for them will surely last beyond this era.

Jon Bloom, M.D. is CEO and Co-Founder of Podimetrics, a BMA Ally organization. Learn more at www.podimetrics.com.