Managing Remote Patient Monitoring Operations for Rural Populations (with Darby Davenport, UAB)

A conversation with Darby Davenport, the Manager of Operations for Telemedicine at UAB Health Systems. The discussion focuses on UAB's advanced telehealth initiatives, especially in the context of rural Alabama. Davenport shares insights into how telehealth services were enhanced before and during the COVID-19 pandemic, the challenges of connectivity in rural areas, and the shift to cellular-enabled monitoring devices to ensure patient compliance and data accuracy. The episode covers the importance of health and technical literacy among patients, the impact of telemedicine in preventing hospital readmissions, and the potential for telehealth to standardize care delivery through remote patient monitoring programs. Additionally, Davenport emphasizes the significance of choosing the right technology partners, such as Withings for their health monitoring devices. The episode ends with a reflection on the future of telehealth as a standard of care and an invitation for further dialogues on healthcare innovation.

Transcript

0:01

Welcome to what to expect when you're connecting a podcast for IOT professionals and the IOT curious. Who find themselves responsible for growing executing or educating others about the challenges with connecting products and services to the internet. You'll learn from industry experts who understand those challenges deeply. And what they've done to overcome them now for your host, Ryan Carlson.

Ryan C: 0:27

Today on what to expect when you're connecting. We're here with Darby Davenport, who's the manager of operations for telemedicine at UAB health systems. We met at a New Orleans conference on remote patient monitoring tell me about UAB and the process that you've been involved in this evolving world of e medicine and telemedicine.

Darby Davenport: 0:51

Yeah, absolutely. So, UAB was actually really ahead of the game with regards to the telehealth world, even prior to COVID. So we had a lot going on over here. That was pretty revolutionary in terms of telehealth before the pandemic hit. our department is technically called medicine, but we use medicine and telehealth is interchangeable. Words, they're pretty much the same, but we have a variety of different operations here. So we're split both into the inpatient side and the ambulatory side as well. the inpatient side, we have a lot of tele acute services, so we are partnered with over 20 hospitals across the state of Alabama. We said specifically in Birmingham, Alabama, which is in the sort of the northern part of the state in Jefferson County and. There's a lot of rural areas in the state of Alabama, as you can imagine. I think according to Alabama Department of public health, where just over 43 percent of, residents of Alabama are considered to live in a rural county. about half the population of the state, roughly is living in a rural area. And so what does that mean? it means that not a lot of people have access to tertiary care or. the needs of high acuity care. So there's a number of really great hospitals and health systems around the state, but not all of them are this kind of level 1 trauma centers and actually the only level 1 trauma center in the state of Alabama. So we are seeing, the sickest of the sick and, the highest acuity of the highest acuity over here. And so that means that typically when there is an emergency or a really sick patient somewhere in the state, they're typically transferred up to Birmingham up to UAB and. Sometimes that can be over a four hour drive. And so it's not necessarily a super close option and we're serving not only just Alabama residents, but we also serve Western Georgia, all of Mississippi for level one trauma, and then, Southern Tennessee as well. we're also the only level one burn center in the state. we see some really sick patients. So really the purpose of, Telehealth and medicine from our point of view is just how can we expand the wonderful services that we have at UAB to other areas across the state without necessitating those patients to actually have to leave their homes or their counties or their cities that they physically reside in. So the inpatient side of the medicine department at UAB is we have a lot of tele acute services, such as telestroke, which is our biggest 1 tele neurology. We've had tele cardiology. Telecritical care, tele nephrology, we have multiple different services and we have really cool carts and they actually roll up to the bedside of patients. And so we have a lot of wonderful, nurses and very. smart apps across the state, but they need, the licensure of an actual doctor physician to give them the okay to go ahead of different procedures, which is lacking in a lot of places. Since a lot of places don't have, stroke neurologist on call if they're in a rural county.

Ryan C: 4:09

so help me visualize. You're talking about these carts. Are these at other hospital facilities where it's a. A telepresence

Darby Davenport: 4:20

yeah,

Ryan C: 4:20

is like rolling up robot style and then interacting.

Darby Davenport: 4:25

so they're like robots. They don't move on their own. So the cart has to be pushed up to the patient's bedside, but we have cameras that are so clear that they can actually zoom in and a provider sitting at UAB up in Birmingham could see a patient anywhere across the state and they can zoom in so closely that they can see if their pupils are dilated. So really strong, cameras, which can help in a strict situation, understand if a patient needs to be administered a thrombolytic, if they need other scans, other medication, things like that. So that's just specific to a stroke example, but we have these carts that are across different units and different hospitals across the state. And really, what that allows is we have providers on call at and then those providers are able to remote into the rooms when they're paged basically. when they have a patient, that's an emergency or admittance, that's more high acuity. They can either be consulted or they can be the managing provider during that high acuity case. And they can help that patient receive the care that they need in their kind of home hospital without having to be transferred up to UAB. And what that really does is, it keeps beds open at UAB because it's allowing for those hospitals to take care of patients that maybe don't necessarily need to be here because they can be managed at home. It also helps the case mix indexes of those more rural hospitals as well. And then it keeps those beds open at for sicker patients and we also get rid of a lot of those transfer costs as well. And just the poor patient experience of having to be transferred so far away from your home and potentially your family as well.

Ryan C: 6:07

the 1 thing that is, known is that, we've got factories, retail operations, large, Commercial or industrial, or even healthcare enterprises where you've got significant infrastructure. There's fiber. There's network stuff. Connectivity is not a problem. Having 1 hospital talk to another hospital. What I think is interesting is when you've been talking, actually, at the event, you were talking about. The idea of remote care, but dealing with patients after they were being discharged for a procedure or, some sort of illness, but then having to provide them care in their homes and especially in, the rural predominance of Alabama, you're actually dealing with a lot of connectivity issues. issues or challenges. Talk to me about the program that you've got where you're actually having to go out into these places where you don't control all the variables. where is there friction in that telemedicine process?

Darby Davenport: 7:15

Yeah, absolutely. even on that inpatient side, we struggle with carts going down sometimes to, there's connectivity issues with WiFi, Bluetooth, cellular, anything across the board, with the inpatient side. What's nice about our sort of ambulatory side of the telehealth department here at UAB is we're a little bit more multifaceted in the sense that we are more in the patient's home and have a wider presence outside of just the hospitals. So remote patient monitoring specifically, which is a platform I help run here, is we're dealing with patients predominantly with congestive heart failure, hypertension, and diabetes. And so they're, a, blood pressure cuff, bariatric scale, and then also glucometer as well. we have had previous vendors, and this predated my time at UAB, but even when I was starting at UAB, we were live with a vendor that had Bluetooth enabled devices, and in kind of rural Alabama, this was really tough. We were not really having great success with all of our compliance areas. We weren't able to fully hit some of the CPT codes. That are, required for reimbursement when you're talking about our remote patient monitoring platform as well. So we switched over to a new vendor and they're cellular enabled, and that's been a huge win for us because they're just not really reliable. Wi Fi or Bluetooth and. For a lot of patients with congestive heart failure, hypertension and diabetes, they might be, a little bit older as well. So we can't always assume that they're going to have those things or that, you're a 95 year old grandmother with hypertension. she might still have a landmine. so the way that these devices work is that a patient can take a reading. So either, I put on my blood pressure cuff like a normal cuff does, I press one button, it inflates, it sends my reading or it gets a reading, it automatically gets sent over to the patient's chart. And then we're interfaced with our electronic medical record, which is Cerner. So not only is that reading sent over to the platform that we use, but it's also sent over to that patient's actual electronic medical record and Cerner as well. the beauty of that is that, with the glucometer, a blood pressure cuff or a scale. These are readings that patients are taking regularly. So when you're enrolled in a remote patient monitoring program with us, the per CMS guidelines, you have to be compliant for 16 calendar days out of a month for readings, which means 16 out of 30 days, you need to take at least one reading on one of those devices for whichever one or a combination of ones that you have.

Ryan C: 9:56

if it's not, I'm here, I just wanted to interject. if I, if the program, if the hardware, if the process isn't easy enough to use to get people to comply, and they don't have enough consistency, their inability to adopt the program, for whatever reasons, means that you can't bill out. And get reimbursed for, through, the insurance plans, you don't get paid. if they don't, due to those compliance means, so 16 days out of the month, I want to back up just a moment when you were talking about, the previous hardware was Bluetooth. My understanding is it was Bluetooth that then pairs with a phone, like a smartphone or a smart tablet, and then that tablet is either connected to a home wifi or, would use the cellular in the smartphone. So it's. having to use it as its own cellular gateway. And so that was one, assuming that people had the device themselves, or they had the internet or they

Darby Davenport: 11:02

Right, or

Ryan C: 11:03

or, and, and even pairing. So talk to me about just that transition and how you see your patients interacting with the hardware itself. And is it as simple as it sounds?

Darby Davenport: 11:20

it is in some ways, it's not in others. And I think it's really dependent on the type of technology. You're using the company that you're paired with as well to, in some areas and in some states, Bluetooth enabled devices work just fine. especially if you have a relatively high health literacy and your patient population. Or you can assume, or you first off make sure that those patients have some sort of smartphone or device that's part of the enrollment process, then, that's a different, standpoint and you may have more luck with that, but that's just really not the case in the state of Alabama. And. To give you all just a little side story, I'm from Charleston, South Carolina originally, so I was born and raised in the south. And, not long after I took this job at UAB, one of my colleagues and I went down to a rural county and one of the hospitals that we were partnering with for tele acute services. And, we went there, we did a tour, we met with the senior leaders, which basically means, You hear about the local high school football games and things like that. It's a very relational conversation, not, heavy on contracts or, percentages or regulations or things like that. And then, we went to a lion's club meeting, which is like a Kiwanis, it's like a, just a local meeting. So I walk into this room and, just from a visual standpoint. There's a good chance that a lot of people sitting in there had hypertension, congestive heart failure, diabetes, there's some combination of them. And so we gave this whole, wonderful practice spiel on what telehealth is at UAB and, how we plan to come into their community and hope for their support and, how we hope to help their patients. And, we had probably a man that was in his. 70s or 80s raises hand and, I'm excited. I'm new to the job. I'm hopeful. It's yes, I'm ready for these questions. And he raises his hand and says, are y'all the ones that put the micro chips in us and, it you're like. No, sir, we do not do that at UAB or in general. That's not, remotely what we're talking about at all.

Jason: 13:25

Only if you ask nicely, do you get the microchips.

Darby Davenport: 13:28

it was a really good kind of factor and reset button for me where I was so engaged in the technological side of things, the informatics, the technology, getting this compliance metrics down and understanding them. And then it's, when someone hears telehealth or e medicine in rural Alabama, they're thinking that we're maybe implementing microchips in them. So that's a really good. Lens to say, whoa, we need to take a big step back and really think about how, we're thinking about the patients that we're serving and the right ways to garner trust with them. And just a lot of them don't have smartphones. They don't trust them. there's a lot of heavy, influence based off of local politics as well. And it was just, we got to a point and it was a blessing in disguise when our previous vendor that was Bluetooth enabled, unfortunately went bankrupt. So we switched over to, our cellular enabled vendor and it was great because we were basically able to bypass that whole issue and that process for patients. And it's not. you need to have a smartphone, you need to figure out how to use this app, and it wasn't where you're troubleshooting with, grandma or grandpa or whomever to try to help them figure out how to use an app. It was, hey, all you have to do is step on the scale, or all you have to do is prick your finger, and this little thing here is going to slurp up some blood, or just take your blood pressure, it's not going to hurt. And what that does is it presents this beautiful amount of data for the providers over here at UAB, because suddenly we have way more readings on this patient than we would have ever had before, because you can imagine, we were pretty much only ever getting readings when they were actually in the clinic, and if they were seeing other doctors in more local areas, Those readings may not have transferred over to us. So suddenly we're getting this really beautiful landscape of what the patient's day to day looks like and how we can actually navigate and care the best for that patient based off of a really good lens of what their life actually looks like from a more holistic perspective.

Jason: 15:38

To that end, what does, for the patients who are entirely home based and can't make it into a medical center, what does their setup look like? How are they operating?

Darby Davenport: 15:48

So you can be enrolled in remote patient monitoring from a variety of different platforms for, or from a variety of different ways from us, I should say. So there's the more. Typical way that's, I'd say probably what you can expect from this from a patient monitoring programs and that's, you would go in for a regular outpatient visit with your doctor. It might be your primary care provider, cardiologist, your endocrinologist, nephrologist, what have you. And they say, Hey, it looks like your congestive heart failure, diabetes, or hypertension is uncontrolled. You seem like you'd be a really great candidate for remote patient monitoring. I'd love to refer you for this program. And so the patient would say yes or no. And if they say yes, that sounds great. The referral would be placed. We would then call the patient and confirm that they, will consent to the program. And we'll explain to them, the expectation is 16 days of readings. and then the devices would be sent to the patient's house. So some programs across the country will, have. Nurses that manage the patients from outside of the facility. there's a variety of different ways you can contract with other people to help manage the patients. We have our own in house team of nurses that physically sit at UAB whose sole job and functionality is to focus on remote patient monitoring patients. once those devices are sent to the patient's home, they're getting regular calls from our UAB nurses and they're forming relationships with them too. So instead of it being a random person that's calling, you get used to, Hey, this is Sally from UAB. just wanted to check on you. I saw that your blood pressure reading was a little high today. What's going on? you start to form relationships with people and you're typically, we want patients to be enrolled for six months. So a patient will hopefully be recording. daily would be ideal, but at least half a month for six months and, you get used to having that one person or a couple of people that you're in contact with regularly about it, you have the peace of mind that your provider, your doctor, too, it's getting those recordings as well. And based off of those recordings, they can then decide, do we need to change medications? do we need to look at another form of care for you since we have this much broader, better picture of what your care looks like and it also I'd say one of the biggest pluses is that it increases your, the nursing footprint and your access to nurses. So it's just, you suddenly have way better access than maybe you've ever had to someone who's clinical that can help support you and answer your questions. So that's the typical process looks like. And most of that is the same in our other processes as well. But, another way that you could get it is that you have again, another, outpatient. Visit with so and but we have some, departments and providers that actually want to have the devices stored in their department. So the patient would leave with those devices in hand and we would assign the serial number to the patient's, chart and identification. We also have an inpatient process, so a patient may be highlighted as a good candidate for my patient monitoring. as part of the discharge process, we actually can have those devices delivered to the patient's bedside on May campus. If they are interested, we can still have them sent to their house if they would prefer and then the patient can actually immediately leave and feel like they have a connection with UAB and they have some control over those readings as well. And then the newest.

Ryan C: 19:28

Oh, my apologies.

Darby Davenport: 19:30

No, you're fine. The newest way that's not live yet, but that I'm working on implementing, it's going to be through our emergency departments, because we have a lot of people that come into the ER because they just need some insulin or they need some, blood pressure medication and they don't have a great, footprint at UAB, or they don't have a great relationship there. So we can then get them enrolled in this program and help them find a managing provider. And hopefully that cuts down on those repeat visits to the emergency room as well and we'll cut down on sort of the risk of that patient continuing to be uncontrollable and end up in a high acuity situation with us.

Ryan C: 20:09

I'd love to hear what the, if we're talking about companies that or entrepreneurs or whomever people that are looking at. putting home health devices, out into the world, knowing that there's different types of customers with technical literacy and health literacy. Knowing that you're, on a very challenging end of that scale, where socioeconomics, health literacy, and technical literacy might be on the lower end. From your experience, what impact has having, having that direct connection to the device done for adoption or participation in these programs? Thank you. Was there any before and afters?

Darby Davenport: 20:57

I think that, one of the ways I've approached this is that when I approach a new doctor or a department in the hospital about potentially implementing remote patient monitoring for their, patients, it's not just this little, here's this whole spiel of what remote patient monitoring is, and this is how you can sit back and maybe get some work, RVUs allocated to you and blah, blah, blah. I've actually taken the approach of either bringing the devices to them physically or having some sent to them as well, so that they actually can play with them and understand how they work and how easy they are to, and so that in and of itself may sound small or obvious, but it's not something that everyone has done. And. For your provider to be able to speak to it when they're talking about it, because they've actually used it, or they can bring 1 into the room with them and say, hey, this is what the scale looks like. Look, I'll step on it right now. Look, you can see that was so easy. It's already sent over. that garner is a huge amount of buy in for patients as well, and that trust of the understanding that, their doctor knows all about it. And, a lot of people are using it too. And I'd say as well, blood pressure cuffs are not most people know what a blood pressure cup is. but you can certainly place other stipulations around eligibility for patients to, if you feel that maybe you're casting too wide of a net. So you can look at different metrics. So if you want to focus on, a, 1 C is that are only greater than 10 or 11 or something like that. maybe you go as low as 7 or 8, but you want to start with your really uncontrollable patients and then slowly expand. You can do things like that. there are other areas to that look at specific age groups. So they say, we don't do any pediatrics with remote patient monitoring. It's a small caveat there. But if you say, I want to look at patients that are, just 18 to 50. You can have maybe more of an assumption that they probably have a little bit more savviness with, technology as well. there are different ways that you can approach different age groups and different populations there and also just making flyers and good marketing materials and speaking to patients regularly. and making sure that they feel comfortable and that they understand where the data is, and also making sure they are somewhat literate with the patient portal as well, so that way they can actually see their readings themselves and it's not just sent out into the ether somewhere where they don't know.

Ryan C: 23:29

I can't help but think about over adoption by pediatric remote patient monitoring. this kid is weighing himself, and now he's holding a stuffed animal and now he's holding onto mom's purse and now he's holding a book and the weight would be wildly flush

Darby Davenport: 23:45

Yeah, I would

Ryan C: 23:46

and, playing with the blood pressure cuff and putting it on their ankle. And I could only imagine the readings, Giving a kid free reign of the blood pressure cuff. Are there any, I'm wondering if there's any stories that you've got around. the, what mission success looks like when it comes to putting this monitoring out into the home as far as keeping people from coming back into the hospital or early intervention. That's interesting. you're

Darby Davenport: 24:16

So to me, it's just such a no brainer. I think that the more opportunities and the more engagement we can get with, finding ways for patients to monitor and record them in their home environment, the better. even if you just think about it from a mental health perspective, nobody wants to be in the hospital. Nobody wants to go to the doctor. it's not fun. It's not like you're in a hotel. it's not like you're sitting there. You get to watch whatever you want on tv and someone's bringing you room service It's you know, you're being potent prodded. You're not being able to sleep So I think that there's you know in some ways there's that obviousness of you know I want to do whatever I can to not end up back in the hospital And there's also the financial side of it, too. So we from a I guess an insurance standpoint, we, remote patient monitoring is covered by most insurances, but not all. for example, Blue Cross Blue Shield does not cover remote patient monitoring unless the patient is an inpatient patient. if they're coming from the hospital, it will be covered. but hospital stays are really expensive. And remote patient monitoring itself is not going to be a huge moneymaker. It's not that we're going to show that we've generated millions and millions in revenue. But where we can really show the big win for that program and where I think a lot of other hospitals need to focus in on it when they're thinking about launching remote patient monitoring is just the incredible amount of cost savings that can be attributed from keeping those patients out of the hospital and keeping them compliant and another really cool part of it too has been that. a lot of these things, like congestive heart failure, hypertension, diabetes, they run in the family, they run in communities, they're not unknown. diagnoses and so you have 1 person in the family that, starts monitoring themselves regularly and it has a ripple effect. And oftentimes, we hear, oh, my, my nephew decided that he wanted to start taking better recordings of his blood pressure to, that's not a quantitative analysis that we can run to see, the result that may have had, but slowly entering a patient's home in a safe, dependable way. Really increases not only that trust, but that health literacy, and it's hopefully going to better help them understand how to take care of themselves and others in the community and they're in their home will understand what that diagnosis looks like, how you might get there. And if you're already there, how you might be able to take care of it as well.

Ryan C: 26:52

Get rich quick, you're not making money on it, but I think there's a whole change and even how our health care system approaches the business side, right? With value based care where it's not fee for service, but these are providers and out of being paid on how much they save. Like Medicare, Medicaid by keeping people from going to the hospital. you already mentioned this is your A1C levels on your blood check when you do your finger prick and to keep people because once you go to the hospital for a diabetic attack, that's going to be expensive and having to do the whole recuperation,

Darby Davenport: 27:26

scary and

Ryan C: 27:27

just right, but I've been rolling someone into 1 of these programs for 6 months. And if they're just getting that base compliance, and you're able to Have someone on, let's say your staff who can call up and go, it looks like these levels have been elevated for a little bit. Is there something that we can do to intervene before it gets so bad? that patient has to go to the hospital. hypertension and, there's a lot of these easy to prevent. The conditions that just requires a little bit of awareness, right? so I've seen the hardware, I got to play with the hardware that you guys use. the fit and finish is really cool. Talk to me a little bit about just the physical experience of some of these devices and. what first impressions are.

Darby Davenport: 28:16

Yeah. And I unfortunately don't have the blood pressure cup with me, but, the glucometer is here. for example, this is my self, this is a regular. iPhone, it's pretty small, so you can see it's a little bit thicker. But it's pretty easy to carry around, wouldn't be hard to keep in a pocket or a

Ryan C: 28:33

It's like a big candy

Darby Davenport: 28:34

too. Yeah, and it's relatively inconspicuous as well. And for our diabetics specifically too, a big cost for them are those actual testing strips. So if they're not on some sort of continuous glucose monitoring, like a Dexcom or something like that, and they're needing to put their finger often. Those strips can get expensive. And 1 thing that's great about our program is the strips are actually included. So you have 6 months of free strips, which already basically pays for itself in the program. And then, the scale is a bit hefty, the scales, big. So this is the box that it comes in. So you can see it's. It's a little hefty. the blood pressure cuff is It's probably like that big around, I would say. So from a physical standpoint, they're not the blood pressure cuff and decometer very easy to transport and to take around with you. They hold a charge for a really long time. I'm talking over a month if you need it. And then the scale is. You want to do and then to your kind of example of, kids stepping on the scale and adding things and changing weight, that was, one of the oopsie daisies that I made was I had one scale in my office and I was like, yeah, everybody can try it. Everyone can step on and, I didn't realize that it was supposed to be specific to me. you actually don't want people to do that. And with the body pro two scanner that we have. there's other things that are read through the sweat glands in your feet too. And so I was getting crazy notifications that I've, lost 40 pounds and that I gained 20 pounds. And,

Jason: 30:05

you shot up to 210 pounds. What

Darby Davenport: 30:07

I know. Yeah. So I just had a huge breakfast and, no, but it was, So that's one of the things that we've had to be like, Oh, we need to make sure that we're telling patients, make sure your friend that comes over, in the afternoon for a glass of sweet tea, doesn't use your restroom and step on your scale. things like that. So keep it maybe a little bit less conspicuous than a normal scale or things like that, or just educate your family about it. So the use case is really easy in the sense that, It holds a charge for a long time. They're pretty small, so they're easy to transport and to keep around. And it's nice because you don't have to have, that smartphone, you don't have to have an app connected to it to make sure the reading comes across as soon as it blinks or it turns green, you know that you're good to go and it's sent across. and I think that for, a lot of patients that are Medicare and Medicaid, they're, they're eligible for the program, but there's still, even though they have the Insurance, there's still that kind of lack of health literacy in some ways. And so we have a lot of Medicare and Medicaid patients that just keep going to the emergency room because they don't have a primary care provider. they know that urgent care will be expensive because it's going to have at least a copay associated, and they know that they can go to the emergency room and they can get care. thanks. And it's a great opportunity to make sure you're getting taken care of, but. waiting for the emergency room is terrible. It takes, it's a full day situation and especially if it's just that you have something that, I don't want to say it is small, but in comparison to maybe some other reasons to come in, gunshot wound, things like that, having slightly high blood pressure is not necessarily a reason that you needed to have come to the emergency room. So if we can work with those patients to get them actually to leave with these devices in hand, or to be sent to their house, that's a lot of money that you're going to save by not having those patients come back to the emergency room.

Ryan C: 32:04

for a company health program that is looking to release or deploy, or is even planning a product line to go into the home as someone who has been involved in both operations, deployment, and ongoing maintenance of a program like this, what recommendations would you give Those companies now,

Darby Davenport: 32:32

so previous to UAV, I was working for the collegial clinic and, I was with Cleveland Clinic in South Florida. The patient population was very different than the patient population that we see in Alabama. And I think that, when I 1st started my job about 2 years ago here, I still had that kind of Cleveland clinic mindset and I needed to take a step back and really get to know the patients that I was serving and demographics involved. 1st and foremost, really get a good handle of the patients that you see. the types of insurance that you're more likely to see, average age of your patients, get a hold on those things as best as you can. Then I would say, make sure you have a good understanding of what the CPT codes are and how those can be attributed to the providers. remote patient monitoring typically has 4 CPT codes associated with it. So there's, 9, 9, which is that kind of initial set up 9, 9, 4, 5, 4, which is making sure that. The recordings are being transferred over every month and those 1st, 2 codes, there's no worker views attributed to them. At least for how we do things that you would be. But then the 2nd, 2 codes, 9, 9, 4, 5, 7 and 9, 9, 4, 5, 8. Those do have 0. 61 worker views attributed to whomever that managing provider is. So really

Ryan C: 33:58

outside world, what does that lingo mean?

Darby Davenport: 34:02

so for someone in the outside world, the work RV use are basically, in layman's terms, how you can attribute time and effort from clinicians to actually transfer over to. Reinforcement and pay and all of these other things. it's, a relative value unit, but the work relative value unit is that specific attribution. So providers are going to want to have as many work or be used as possible. And so the goal of remote patient monitoring is that, if you're the managing provider, Ryan, if you're my primary care provider, I have uncontrollable hypertension. The goal is that you can totally sit back in your seat and be a little bit hands off because you can trust that the nurses at your institution are going to take care of me. And you're really only going to be contacted in case of an emergency, or regular updates. And so you're basically just sitting back looking pretty and having those work RVs attributed to you because you're the managing provider, but you can focus your efforts on other patients or other things. So it's a really great way to gain worker views without putting that stress on the managing providers and also giving them peace of mind. Cause I think some institutions have a lot of providers that'll assume that, remote patient monitoring, takes patients away from them. Like it's this whole separate entity that now. We're taking the patient. We're monitoring them. They're my patient. that's not the case. We don't want your patient. We definitely want you to keep those patients and to manage them. But what we can do is provide you with a heck of a lot more data points than you would have ever had with that patient vet beforehand and you can get a little bit more credit for it as well.

Ryan C: 35:51

And all those CPT codes, those are, when it, for those of you who get your insurance states statements that says, this is not a bill. It's that super bill that lists all of those little items. You're like 17, 18, 56. Like each one of those is attributed to that CPT code that the provider puts in the system. So they can. That's how they get to the total amount. It's not a, it's not a flat fee or a guess. It's a, it's an accumulation of. All of the different moving parts in your care. And so when we talk about CBT codes, when you're a remote patient monitoring solution or an in home care solution, that's your life's blood. Because cash pay is a luxury, from, only a specific subset of the population, but so many of us are all Taking part in some sort of health insurance plan. And the understanding like you're right, it's when you are making a product for a region, understand going to cover what will they pay for, because otherwise you're putting a lot of R and D and effort into what could be a very small adoption, even if people want to use the service, if no one is willing to pay for it. it's no different than any other business that you might create.

Darby Davenport: 37:10

and I appreciate the fact that you took us back for a minute to add some of those definitions, because I think that it's easy to get caught up. In all of it, especially when it's my day to day, but the CPT codes to are really the way that you can quantitatively analyze how well your program is doing based on how you are meeting those metrics. So they serve as a baseline. Compliance is attributed to a CPT code. So those 16 out of 30 calendar days a month is a CPT code. the amount of time nurses spend actually working with that patient talking with them and working on their chart, working on their care. Those are CPT codes. when you have an inpatient appointment versus an outpatient appointment, there's CPT codes attached to all of those things. And, it really serves not only as. a standardization of care in some ways, but it also helps us to understand, in level stat, how we're doing in comparison to other remote patient monitoring platforms to other health organizations. That may be similar or different to us as well. And just how well our patients are doing on the program, because if we're not hitting. CBT codes, then it probably means that we have a problem, whether that's, health literacy, a problem with the way we have things staffed, a problem with the way that we're, referring patients. So it means something. So if if you're hitting those CBT codes, you know that you're doing a good job.

Ryan C: 38:36

So I'm already familiar with, the idea of the CPD codes. every time we go into the clinic and they give you a clipboard and they're asking you to fill out those surveys, that's actually yet another CPD code. That's getting billed to insurance or, as part of your care plan. Providers get to keep money or make money or keep a larger percentage of their payouts from provider or from the payers, just by going through those little steps. And I know that some of those, Bluetooth enabled, like the tablet, the E home, Or e medicine programs where they'll have a tablet and they might ask questions of someone. So not only is it like a little, Bluetooth sensor, but I've heard that when you can ask different diagnostic questions, why people like, we could get more codes. We can bill more codes because we're asking. Specific diagnostic questions throughout, that patient's care, but again, health literacy, technical literacy versus just getting people to do at least 16 days worth of. Standing on a scale or slipping on a blood pressure cuff. it's know your audience. Does your staff, rather than them having an iPad, do you have staff interactions that are scheduled to ask some of those diagnostic questions too? help with that, that ongoing in home care.

Darby Davenport: 40:03

we are not home health. That's a separate area of the health system specifically, but with our program that we have, the nurses are interacting with those patients basically daily. And so they're calling them regularly, so they have the opportunity to, help answer any questions they may have, but from a CPT code. Specific mindset, we have just those four that we stick with for the sake of the program. So there's certainly others.

Ryan C: 40:30

So you've got your telemedicine, you've got your home health and then there's telemetry as well. what's the gap, the delta between, the remote telemetry versus, The RPM program that you're using for like diabetes and hypertension,

Darby Davenport: 40:48

I'd say the best way to describe the difference and I think our medical director does this in a really great indirect way is that, our remote patient monitoring program is not staffed 24 7. So we operate during kind of regular business hours, Monday through Friday. And so the question we always get asked is, what if my patient, has a extremely high reading and they have a red alert at 1 a. m. Thursday night? we'd see it in the morning, but what if they had that reading? They weren't on remote patient monitoring at all. what would the difference be? At least we have someone that's going to immediately follow up and start handling those red alerts first thing in the morning. And then a step further than that is if you feel like your patient needs to be 24 7 monitored, then they do need to be on telemetry and remote patient monitoring is not an appropriate platform for them to utilize.

Ryan C: 41:40

which is a whole series of different CPT codes and costs and everything. So probably for like higher risk post operative patients. And I'd imagine that there's a whole different set of criterion. To qualify for the 24 7 monitoring,

Darby Davenport: 41:57

the tele ICU actually sits right behind me. And so that's a subset of medicine as well. And we do lots of different monitoring for different types of patients, different forms of care, different, Levels of need in the hospital as well. We also have, remote centers and virtual centers too. So if you have a dementia patient or something like that, we are those eyes in the sky that we can help monitor those patients and make sure they're not. getting out of the bed or something. They don't know where they are. We can help answer questions. So there's a lot of beautiful ways that telehealth, telemetry, home monitoring, all these things can really improve the patient experience. but they all come with a variety of different, ethics, politics, CPT codes, revenue generators. there's a lot in the mix.

Ryan C: 42:46

not just that, things that I heard was, you're going to have different vendors, the people that are, inventorying, stocking, fixing, refurbishing, cleaning.

Darby Davenport: 42:57

Big IT.

Ryan C: 42:57

yeah, so there's a lot of moving parts. It's not just do we have some nurses and some devices and a FedEx account. There's a lot of different moving pieces in those managed health services.

Jason: 43:08

almost as if telehealth in general is a complicated issue. That's not as simple as some people like think it might be.

Darby Davenport: 43:14

I know. I knew it wasn't just FaceTiming.

Ryan C: 43:18

thank you so much for sharing a snapshot of this world that is far more complex than it might seem on the outside. It's not just a device sending some data out to the internet and then a doctor getting a notification. But there's so many other moving parts, but the data is really clear. That it is a solid way to intervene early with a patient that you want to keep them out of the hospital. You want to keep them from getting to that critical, moment in their own health journey.

Darby Davenport: 43:52

And I guess my final head of two cents is, if you're someone that's listening to this and you feel. Overwhelmed, this took me over a year to learn all of these things and to become an expert in it. there's lots of people out there that know a lot about it that are willing to help myself included. it is wonderful with regards to helping reduce readmissions and possibly reducing length of stay metrics as well. happy to always speak more on it to anyone and, the second thing I'll say is if you are from Blue Cross Blue Shield and you hear this and you want to talk about the reasons why you should cover this for patients, please reach out to me.

Ryan C: 44:31

and Darvey Davenport will have your, LinkedIn, information in the show notes as we put this out. So Darby Davenport, thank you so much for sharing your time and, Your experience, this is cool.

Darby Davenport: 44:44

I appreciate it. Ryan and Jason. This was really fun. And, it's obviously a subject I'm very passionate about. So it's, it was a joy to share that with y'all.

44:57

This has been another episode of what to expect when you're connecting. Until next time.

Ryan C: 45:03

Your impressions of interacting with the hardware equipment?

Darby Davenport: 45:06

Yeah, I would say, since we've transitioned to using Withings health, it's been just a huge blessing in disguise. They've been super wonderful to work with their cellular enabled devices are very aesthetically pleasing as well as just very clean and easy to use. the transmission has come across really beautifully, even in our most rural areas. The connectivity issues have been, almost completely alleviated and resolved. Also, thanks to Soracom a little bit there too. And we, we feel really good about the decision to be with the cellular enabled vendor. And we look forward to expanding this as often as and as much as we can, because, again, looking at. congestive heart failure, hypertension and diabetes. That's likely over 20, 000 eligible patients of the over a million patients who UAB sees every year. And right now we're barely scraping the surface of this. So my goal and, what would make me extremely happy would be to make this just a standard of care. And I'm really thankful that Withings is along for that journey and supportive of that goal as well.

Ryan C: 46:13

when AT& T had its outage affecting millions of customers nationwide, did you get any, reports from people out in the field using your equipment that we're talking about outages.

Darby Davenport: 46:27

I did not.

Ryan C: 46:29

All right. the automatic failover worked exactly as we'd suspected. we had 0 support tickets ourselves across all of the IOT devices that we're supporting the U. S. and so it's nice to know that. we have another anecdotal confirmation that, the technology works as advertised and, stuff just needs to stay connected and needs to stay simple and no one needs to be troubleshooting their devices when they're not feeling well and they just need this device to do its simple thing.