TAMPA, Fla. — When our world locked down in March 2020, many of our lives changed forever. Remote medicine is one area where things continue to make dramatic turns.
Hospitals were at capacity, patients searched for beds, and the sick and dying were lined up in emergency rooms worldwide, waiting for care. It is hard to go back and relive those horrific first days. But, the pandemic forced medical professionals to find ways to treat patients better.
"And it's a very innovative idea," Dr. Pete Chang said. "The beginnings of these programs really started with COVID. When we were starting to look at how we can get patients home sooner safely, we did some remote patient monitoring of our COVID patients, and that's really where it started."
Chang is the medical director of the TGH at Home program and said this is a first-of-its-kind program in the Tampa Bay Area.
"If you'd have asked me two or three years ago if this was possible, I would have said maybe," Dr. Chang said. "I think the pandemic definitely taught us a lot about how to treat patients remotely. We're taking those concepts and applying them across all disease processes now."
To qualify, patients have to be admitted to the hospital for care, and right now, must be covered by Medicare or a handful of select Medicare Advantage programs.
Therefore, highly sick people would not qualify for the program; the qualifying conditions are congestive heart failure, urinary tract infection, cellulitis, COPD, and diabetes.
"I had pneumonia, and then I had E. coli in my bloodstream," Randy Gibson, 78, said. "So I couldn't. I couldn't walk. I could hardly eat. And things just got rough."
Gibson was facing weeks in the hospital to clear his infection through IV antibiotics. Then, hospital staff approached him about the new program.
"They were telling me I probably had to stay here for a long time because the infection was so bad," Gibson continued. "And so 'oh, shoot, you know, I don't want to stay in this hospital. It's terrible.' Then they started talking to me about this coming home and being treated at home. And I was excited about that. So I said, 'yep, I'll take it. Anything to get me out of this hospital.'"
Dr. Chang said all the patients are set up at home as if they were in the hospital. With technology, special monitors measure their vitals and transmit the data back to staff monitoring at the hospital.
"The sensor that we have that adheres to a patient's chest measures blood pressure, heart rate, temperature, and oxygen level at intervals of every five seconds," Dr. Chang said. "So, we're getting continuous telemetry on how our patients are doing. We can even get an EKG reading off this patch. Everything is transmitted wirelessly to a cellular-enabled tablet that we provide for our patients. And then that transmits the signals to our command center where we're monitoring patients 24/7."
The program waiver to provide the care is through the Center for Medicare and Medicaid Services' (CMS) COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. Dr. Chang said there are strict guidelines they follow to be approved.
"We have to be able to reach the patient within 30 minutes of us noticing something or if the patient contacts and asks us to come out," she said. "So we are geographically limited by how far patients live away from the hospital. In the event of extreme emergency, we partnered with Tampa Fire Rescue and the Hillsborough County Fire Rescue, that we can dispatch some of their services if there are immediate services needed for our patients."
Regarding costs, Dr. Chang said patients are billed the same as if they are an inpatient in the hospital (Medicare copay). Until more data is available, Medicare reimburses at the current inpatient rate. Dr. Chang believes that those reimbursement rates will decrease as that data becomes more available, reducing costs by a third.
"And so if quality goes up and costs can come down, this should be a program that considers expansion across not only our governmental payers like Medicare and Medicaid but also hopefully spread to some of our commercial providers too," Dr. Chang said.
