6. Financial Sustainability

from TIPs Research Report 2021

4. Wrap Around Services Summary

Financial sustainability has been a goal of the Fannie Mae TIPs project at Grace West since its inception. CPT codes exist that permit billing for services provided via remote patient monitoring. In theory, the codes could provide revenue to offset some of the costs of the Remote Patient Monitoring hardware and software and ongoing monitoring costs.

However, there are some challenges:

• Services must be provided by a doctor or a qualified health professional.

• Individuals MUST provide 16 (or more) remote patient monitoring readings (blood pressure, pulse/ ox, and weight) within a 30-day period.

• An entity that is familiar with CMS billing codes and procedures must do the billing.

For the past two years, we have explored these options. We have learned a great deal about what could work, and what will not work. The opportunity is there, but there are some definite challenges, which are outlined below:

Challenges:

• Remote patient monitoring readings in a congregate setting, once or twice a week (i.e. – our “TIPs

Classic” model), are not currently eligible for reimbursement. This model would NOT yield the requisite 16 times per month number of readings (individuals typically show up once or perhaps twice each week).

• And TIPs in a congregate setting is NOT set up for a doctor’s supervision. The individuals who participate in TIPs do not all have the same primary care physician.

There are, however, potential opportunities in continuing to explore the potential for finding a reimbursable model for telehealth through a TIPs at Home Tech pilot. Such a pilot would involve providing a subset of telehealth enrollees with a full suite of Bluetooth enabled vital monitoring devices, as well as a tablet for transmitting readings. We would use the pilot to test the reimbursement potential of a version of the TIPs program.

We expect that a TIPs at Home Tech pilot will yield a great deal of information, and some revenue, that can be used to partially offset the cost of the TIPs program at Grace West.