Keeping hearts healthy is the focus of February’s American Heart Month, and telehealth is well-positioned to lend a hand. Digital stethoscopes and mobile echocardiograms make it easier for cardiologists to diagnose and treat patients in remote regions. Additionally, patient monitoring devices can collect and relay actionable data from a patient’s home to health care providers in real time. But like many other specialties, cardiology and stroke care are both victims of the unrequited love between telehealth potential and telehealth policy.
Cardiovascular disease is the leading cause of death in the United States and experts have predicted a shortage of cardiologists in the next decade that will affect rural areas the most. The American Heart Association stresses the vital role telehealth can play in reducing morbidity and mortality from the disease by alleviating the maldistribution. These underserved areas have the potential to benefit greatly from telecardiology and telestroke care, but they are often the least equipped with technology and training.
In order for telecardiology and telestroke services to be effective, the AHA emphasizes that “programs need timely data, appropriate staff and a feedback loop to patients with sufficient empowerment to understand and implement instructions.” Remote patient monitoring (RPM) devices are promising tools to fit these needs in prevention, emergency care and transitional care. In one study, an RPM transitional care program for chronic obstructive pulmonary disease and heart failure patients reduced 30-day hospital readmissions by 50 percent when compared to the control group.
However, lack of Medicaid reimbursement for RPM remains a significant barrier. According to the Center for Connected Health Policy, only 21 states provide reimbursement for RPM in their Medicaid programs. This deficit is because many states define telehealth as a live interaction with a health care provider, essentially excluding RPM programs from reimbursement eligibility. While Kansas, Missouri and Oklahoma each offer some form of RPM reimbursement, provision is limited to specific types of providers and services.
Like a rocky relationship, progress in telecardiology and stroke care is also slowed by an inability to reconcile differences, poor communication and financial conflicts. The AHA reports that in addition to reimbursement challenges, other hurdles for cardiovascular and stroke care via telehealth include disparities between different states’ laws and expectations, lack of telehealth licensing across state lines, unclear patient privacy and data security regulations, high technology costs and poor technological infrastructure in underserved areas.
The budding romance of RPM devices and cardiology and stroke care has the potential to help health care providers expand and strengthen patient care. But until the aspirations of telehealth proponents and the accommodations of policy are peacefully wed, the feasibility of widespread RPM adoption for heart health will remain uncertain.