Health-E Law Podcast Ep. 9
Remote Patient Monitoring Innovating Health Tech with Dr. Vipul Kella of Physio AI
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Listen to the podcast released May 2, 2024 here:
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Welcome to Health-e Law, Sheppard Mullin's podcast exploring the fascinating health tech topics and trends of the day. In this episode, Vipul Kella, M.D., Chief Medical Officer at Physio AI, joins us to discuss how innovations in remote patient monitoring (RPM) are revolutionizing the healthcare landscape.
About Vipul Kella, M.D.
A Board-Certified Emergency Medicine physician, Dr. Vipul Kella has extensive experience working with healthcare-focused industries, health tech companies, and hospitals to deliver results through revenue optimization, value-based solutions, digital marketing, remote physiologic monitoring, go-to-market strategy, and other advisory activities. He earned his M.D. at the University of Toledo and holds an MBA with an emphasis on Healthcare Administration from Johns Hopkins University, where he pursued an interest in Standard of Care and Administration, policy and decision-making in hospitals, and healthcare facilities from a business perspective.
About Sara Shanti
A partner in the Corporate Practice Group in the Sheppard Mullin's Chicago office and co-lead of its Digital Health Team, Sara Shanti’s practice sits at the forefront of healthcare technology by providing practical counsel on novel innovation and complex data privacy matters. Using her medical research background and HHS experience, Sara advises providers, payors, start-ups, technology companies, and their investors and stakeholders on digital healthcare and regulatory compliance matters, including artificial intelligence (AI), augmented and virtual reality (AR/VR), gamification, implantable and wearable devices, and telehealth.
At the cutting edge of advising on "data as an asset" programming, Sara's practice supports investment in innovation and access to care initiatives, including mergers and acquisitions involving crucial, high-stakes and sensitive data, medical and wellness devices, and web-based applications and care.
About Sara Shanti
A partner in the Corporate Practice Group in the Sheppard Mullin's Chicago office and co-lead of its Digital Health Team, Sara Shanti’s practice sits at the forefront of healthcare technology by providing practical counsel on novel innovation and complex data privacy matters. Using her medical research background and HHS experience, Sara advises providers, payors, start-ups, technology companies, and their investors and stakeholders on digital healthcare and regulatory compliance matters, including artificial intelligence (AI), augmented and virtual reality (AR/VR), gamification, implantable and wearable devices, and telehealth.
At the cutting edge of advising on "data as an asset" programming, Sara's practice supports investment in innovation and access to care initiatives, including mergers and acquisitions involving crucial, high-stakes and sensitive data, medical and wellness devices, and web-based applications and care.
About Phil Kim
A partner in the Corporate and Securities Practice Group in Sheppard Mullin's Dallas office and co-lead of its Digital Health Team, Phil Kim has a number of clients in digital health. He has assisted multinational technology companies entering the digital health space with various service and collaboration agreements for their wearable technology, along with global digital health companies bolstering their platform in the behavioral health space. He also assists public medical device, biotechnology, and pharmaceutical companies, as well as the investment banks that serve as underwriters in public securities offerings for those companies.
Phil also assists various healthcare companies on transactional and regulatory matters. He counsels healthcare systems, hospitals, ambulatory surgery centers, physician groups, home health providers, and other healthcare companies on the buy- and sell-side of mergers and acquisitions, joint ventures, and operational matters, which include regulatory, licensure, contractual, and administrative issues. Phil regularly advises clients on matters related to healthcare compliance, including liability exposure, the Stark law, anti-kickback statutes, and HIPAA/HITECH privacy issues. He also provides counsel on state and federal laws, business structuring formation, employment issues, and involving government agencies, including state and federal agencies.
Transcript:
Sara Shanti:
Welcome to Health-e Law.
Phil Kim:
Today's episode is on remote patient monitoring.
Sara Shanti:
Hi, I'm Sara.
Phil Kim:
And I'm Phil.
Sara Shanti:
We're your hosts and we want to thank you for listening.
Phil Kim:
We're pleased to have Vipul Kella with us today, who's a practicing emergency physician and an executive with over 19 years of experience. Vipul currently serves as the chief medical officer for Physio AI, a medical device and remote monitoring company. He also consults and matters of health policy, health technology, hospital administration, and medical malpractice, in addition to much more. Thank you so much for joining us today, Vipul.
Dr. Vipul Kella:
Good morning. Thank you for having me.
Phil Kim:
So in terms of RPM, there has been a tremendous amount of development just in remote patient monitoring technologies and AI. From a provider's perspective, you have something so unique to offer for our podcast. Can you tell us and the audience what you're seeing in terms of innovation out there?
Dr. Vipul Kella:
This is a brand-new industry that really just came about around the time of COVID, and the remote patient monitoring industry has exploded just in the five years alone. So we are very much in the early days, but the number of advancements and innovation is happening at a pretty rapid pace, but the technology is getting much more sophisticated. So we're not just looking at basic physiologic parameters now, like pulse ox, blood pressure, heart rate. We're actually getting much more sophisticated, and this is a really, really exciting area of health technology, and I'll give you an example, where you look at things even at a much more personalized level, such as a voice and acoustics. So now RPM devices are looking at going beyond the traditional parameters, looking at voice, so your voice pattern, your voice cadence, inflection, and all of those things. And there's a lot of science in this.
And all of those things are being used to look at things like cognition. So early diagnosis of dementia, for example, mental health as well. So early diagnosis of depression or schizophrenia or bipolar disorder. So think about it just to a very 1.0 level where we're trying to monitor and manage chronic diseases. The 2.0 level is now going to have much more capabilities. You have things like motion detection, acoustics that are all going to be added to devices. So now you have a whole host of capabilities that you can use for early detection and disease management.
Sara Shanti:
And Dr. Kella, can you speak to why this has such impact? So I think all those points are so important as to the potential, but especially as a physician, can you kind of speak to exactly how you see this have real-time improvement and outcome?
Dr. Vipul Kella:
It is really episodic. Somebody comes into their physician's office, gets their blood pressure checked, and they may not be seen for another three, six months or even a year. A lot can go on between that time period. So what RPM is really, what the overall goal is to create more of a continuous disease management course where you have real-time monitoring with patients, whatever you're trying to measure. So blood pressure, for example. And the provider is being sent that data in real time. So the benefit to the patient is that now that the provider has access to that data, they can intervene earlier so they can tailor treatment based off of that.
So for example, if you're seeing trends and spikes in blood pressure that are happening over the course of several days to weeks, that would prompt the healthcare provider to call the patient, find out what's going on, identify if there's any diet or lifestyle modifications that need to take place, and discuss medical management. In the current state, that may not happen and a patient may end up finally when they're having symptoms come to the emergency room. As an ER physician, this is typically what we'd see. Most people don't recognize the number of times that patients come to the emergency room for typical primary care type complaints. For example, my blood pressure's high, I need to get my blood pressure checked, I need to get a medication refilled. So RPM really will provide earlier data to providers in which they can act on that and probably earlier interventions.
Phil Kim:
So Dr. Kella, we know that RPM is really great in doing all these things to improve quality of care, but no solution is perfect. And we know that RPM has many different challenges and hurdles. What do you see in terms of where the technology comes up short or where it can improve?
Dr. Vipul Kella:
Sure, absolutely. I think if you just look at it from a very simple level, number one is trust. So if you go to underserved communities and under-resourced communities where I said RPM is almost non-existent, one of the reasons for that is trust in how that data is going to be used. At the very base case, trust is a very important thing that explaining to patients how the data is going to be used, making sure they understand that that data will not be leveraged against them and what are the benefits to them. So that's still something that's very much a challenge.
The other thing is just in terms of healthcare practices, healthcare practices are typically overworked, they're limited in supply, and sometimes though they may see the value of RPM, the actual implementation, like the operational cost and all of that, may be an extra burden that they may not want to take on. So we see that very frequently as well. And there's an associated expense with that as well. If you look at it from a hospital perspective and you ask, "Okay, what are your top priorities right now? What are you thinking about for the year?" Number one is going to be labor, and number two is labor, and number three is labor. Then you start to think about things like inflation and they talk about quality measures, and AI, RPM is probably somewhere down the list. So right now, though many recognize and appreciate, they're just trying to keep their head above water in this current environment.
Sara Shanti:
And now are we into remote patient monitoring 2.0?
Dr. Vipul Kella:
I would like to think so, Sara, but I think that because adoption is still so low, if you look at overall RPM adoption, so by 2025 there are 70 million Americans that would benefit from RPM. Right now, probably less than 5% of that population is actually getting RPM and benefiting from RPM.
Sara Shanti:
So what does that RPM 2.0 look like, or what would you like it to look like as a practitioner to have real value add, not only in the access to healthcare, but also real movement into efficiencies and outcome? And does that play on this idea that we've talked with you about before, Dr. Kella, of a hospital at home?
Dr. Vipul Kella:
Yeah, absolutely. So if you think about what are the things that we'd want to optimize for RPM or really AI in general in healthcare, it's number one, the data has to be predictive. So we have to use large sets of data to create patterns that are predictive about what's going to happen. It has to be precise. So the data that's being transmitted, it has to be precise enough for the provider that's making the decisions can rely on it, and it has to do so in a way that's going to decrease the cost of healthcare and improve quality outcomes. And if it's not doing those things, then really those technologies are not going to last very long.
So in terms of what I like to see, I think what we would like to see is that the data that's being transmitted is much more sophisticated than what it is now, that it is much more integrative. And so by that I mean it's not just looking at your physiological parameters, it's looking at your, what we call, social determinants. So your environment. All of those, your active things like transportation, food, housing, air quality, so much more sophisticated data. And also looking at genetic factors because that's important in tailoring treatments to particular individuals and how you may respond or if somebody may respond to a treatment may be different than someone else.
So in an ideal state, RPM is going to look at all these things and bring together personalized treatment plans and in a way that's really non-invasive. If RPM is really working well, you shouldn't know that it's even going on because patient compliance right now is a very real problem. Right now, patients very much have to do the things to do the monitoring. So for example, if you're having to monitor blood pressure, patients actually have to put a blood pressure cuff on them and monitor that, typically 16 days out of the month. And that can be quite cumbersome for a patient. And there's usually a falloff in the RPM. There's just fatigue. People just get tired of doing that, like anything. So what we're seeing right now is miniaturization of the sensors in RPM so that it could even be embedded in clothing, for example, but we're going to see things like watches and wearables where it's just happening all the time, you don't have to worry about, it's less cumbersome, there's less barriers on the patient, and it just kind of happens in the background.
Sara Shanti:
And I think we'd be remiss, I know, Phil, we manage these questions all day long and Dr. Kella, I imagine you can't get through a day without thinking about how is this care and this new innovation going to be reimbursed? Who is going to pay for it and how? So maybe could you just speak to the reimbursement that you're seeing attached to RPM and what needs to happen to make it?
Dr. Vipul Kella:
Sure, Sara. So right now, fortunately there is reimbursement from Medicare for RPM, and there's a separate program that's called CCM, which is a parallel program that manages people with two or more chronic diseases. So what we see often happening is that people that, for example, have hypertension and diabetes and heart failure, they may be enrolled in a RPM and CCM program by Medicare. And Medicare offers five different codes for reimbursement that involve the setup costs as well as the monitoring. And there's regulations with Medicare on the barriers that need to be met in order for a provider to bill for RPM. Right now, for example, a patient needs to be monitored 16 days out of the month, somewhat of an arbitrary number, but that's the number that you need to shoot for. So there's very much reimbursement available. And now even private insurers have that as well.
But I think where we're lagging and where we're seeing much more disparity is in Medicaid populations. And typically there's a huge state variation in Medicaid RPM, and sometimes it's not even worth the potential benefit because it may only last for a few months or it's very limited. So state-to-state variation in Medicaid is very much, where the people need it the most, perhaps, is not happening. On the positive side what we saw and what we're seeing over the past year is that rural health centers and what we call FQHCs, Federally Qualified Health Centers, that serve underserved communities, there is now reimbursement for RPM for those populations. So we are seeing some movement in the underserved areas now with reimbursement attached. So hopefully that will continue to motivate providers and if not providers directly, RPM providers to come into these communities to care for these patients.
Phil Kim:
So Vipul, as far as healthcare as a whole, we see a large movement towards value-based care and that focus coming into light. How do you see RPM's role in monitoring and tracking value of outcomes?
Dr. Vipul Kella:
Yeah, absolutely. So value-based care really can mean a lot of things, but at a very basic level, it's improving outcomes of healthcare and doing it at a lower cost of care. Any intervention that's going to allow you to do that can be considered helpful or important for value-based care. One of the realities that we see in hospitals and healthcare right now is we are still operating on the old system, which was fee-for-service, a volume-based system, meaning the more care that you provide, the more procedures that you do, the higher the reimbursement. So we have two parallel tracks right now with the fee-for-service that most people are still operating on and this emerging value-based care system. And right now it's really just two worlds that are happening in parallel.
Over the course of the next decade, the VBC world is going to continue to occupy at greater and greater risk, meaning providers will have to take on more risk of their patients for the outcomes that they want to achieve. There'll be more dollars at stake. So ultimately, providers will have no choice. And by 2030, every Medicare population provider will have to be in some sort of VBC arrangement.
So what that means for RPM is that if you have dollars at risk for the outcomes that you're managing, particularly things like hypertension, diabetes, heart failure, chronic kidney disease, RPM is designed just for that reason. So you want to manage things on a much more closely. The interventions that you want to provide, you want to do that earlier. You want to enhance patient communication so they don't fall through the cracks between visits. That's really where the opportunity for RPM is.
So the upside for providers is that if they are in a VBC contract, they can actually, what we call risk-based contracts, they can engage in those. So they're having some dollars on the table for the outcomes that they want to achieve. And if you achieve those, then everybody wins. The patient has a better outcome, the insurers have lower costs, and the providers get higher reimbursement. So that's ultimately what I think will happen. And RPM, I think, will be a very key part of getting to this widespread VBC world.
Phil Kim:
Well, Dr. Kella, thank you so much for joining us here today. And that's it for us on this episode of Health-e Law. Thank you for joining us. For Sara and myself, we are signing off now. Thank you.
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