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Remote MSK Care: Cost and Quality

Costs of MSK Care

Musculoskeletal (MSK) care has consistently represented one of the most significant cost burdens on the US healthcare system–costing upwards of $400 billion a year–and patient treatment costs and lost wages stemming from MSK disorders have also risen substantially over the past two decades. As a result, remote MSK care and digital health tools have seen greater proliferation in recent years as providers look to improve efficiency and reduce costs.

Standard care pathways for MSK procedures like total hip arthroplasty (THA) and total knee arthroplasty (TKA) follow a uniform pattern. Preoperatively, patients require comprehensive education on their care plan, including physical therapy sessions, form filings, and reporting pain levels, range of motion, and other metrics. In a non-digitally-enabled care setting, this translates into in-office visits, outpatient or in-home physical therapy, in-person joint classes, multiple calls, as well as the use of bulky, overwhelming, and sometimes outdated education materials. This can all add up to nearly $1400 in costs per patient.

In addition, a lack of patient preparedness and insufficient education can lead to same-day cancellations or rescheduling, costing approximately $3,000 per case. Reasons for cancellations or rescheduling vary from a lack of confidence in the ability to recover effectively or an inability to cover the costs required throughout the care plan.

The postoperative phase is the longest and most costly. The highest costs in a traditional treatment plan involve formal physical therapy (PT) and home care for patients who lack the necessary support structure. For example, Medicare PT costs are around $1,300, while private insurance costs are closer to $1,900. Home care, including home PT and support staff, has been shown to cost approximately $3,000. Additional typical post-operative costs also include time spent on calls, in-person care and education, and adverse events, such as readmissions or ER visits, which can incur $14,000 per patient.

To address these challenges, some healthcare providers have been exploring new models of care delivery that leverage technology to reduce costs and improve patient outcomes. By using virtual care and remote monitoring solutions, providers can improve patient education and adherence to the care plan, reduce the risk of cancellations and readmissions, and provide more efficient and effective care to a broader patient population.

Reducing Costs Across the MSK Episode of Care

A full-suite MSK remote care solution is a patient engagement and digital care management platform that covers all elements of MSK care starting from preoperative assessment all the way through postoperative goal achievement. This includes features such as real-time patient monitoring, population health management, direct patient messaging, virtual PT and joint classes, remote PROM submission, virtual telehealth check-ins, automatic registry feeds, and remote therapeutic monitoring (RTM).

As mentioned, without remote care, nearly every touch point in the patient's journey would require in-person interactions, taking up valuable resources from care teams. With a suitable solution, the need for such interactions is greatly reduced as the right information and tools are made available to the patient at the right time. Below are some examples of the value gained by providers from specific features:

  • Eliminating manual PROMs collection: patients can fill out forms through a smartphone application, SMS, or a website, eliminating the need for manual paperwork.
  • Reduced call volumes: another vital feature of remote care is direct patient communication, which can be achieved through SMS or in-app messaging. This reduces the call volumes that care teams would have to handle, freeing up their resources to focus on patients that require more attention. The ability to check in with patients virtually also eliminates the need for more in-person office visits.
  • Replacing formal physical therapy: remote care management should also offer high-quality patient education, including virtual physical therapy, care instructions, and joint classes. This education can eliminate the need for formal physical therapy for a majority of patients, thus reducing one of the major costs in an MSK patient pathway. Furthermore, virtual physical therapy has been shown to provide equivalent outcomes to home PT and outpatient PT, at much lower costs.
  • Enabling targeted, individualized care: population health management features enable providers to view their patient population as a whole and identify patients who are not making the expected progress in their care plans. This enables targeted care and timely intervention for patients who need it while streamlining care for those meeting progress expectations, which has a mitigating impact on adverse events such as ER visits and readmissions, particularly those that can be avoided through simple at-home adjustments.

In the post-op phase, the same capabilities discussed above are even more impactful due to the larger number of patient touchpoints, including the costs of formal PT and home care. Population health management capabilities enable providers to monitor the progress of all patients and make individualized care plan adjustments when necessary. Smart communication features, such as messaging and video conferencing, are essential in addressing patient concerns in a timely manner, avoiding the need for urgent in-person care, and reducing daily call volumes.

Additionally, high-quality remote care platforms can automatically submit patient data to registries, reducing the manual burden on FTEs. Furthermore, advanced versions of such solutions can also help identify patients who meet the minimum requirements for Remote Therapeutic Monitoring (RTM) coverage and optimize and streamline the RTM billing process for providers.

Financial Impact of High-Quality Remote Care

Providers can incur significant cost savings and bolster revenue generation through the use of remote care solutions, particularly when factoring in the reduction of in-person interactions, adverse events, and the implementation of remote therapeutic monitoring capabilities.

Dr. Ahmed Siddiqi, Total Joint Replacement Surgeon at Orthopaedic Institute Brielle Orthopaedics in New Jersey, recently gave a presentation about his experience using the Force Therapeutics platform. Taking into consideration the remote care capabilities that he has put to use, Dr. Siddiqi identified $2m-$3m in potential annual savings, split across his own practice and both public and commercial payers. In addition, Dr. Siddiqi presented his own experience with RTM, making him one of the first providers in the country to present real-world RTM data findings; having attempted billing for just 158 of his patients, Dr. Siddiqi received reimbursement of nearly $34,000 over 5 months, from both Medicare and commercial insurers in New Jersey.

Extrapolating his experience over the course of a year, Dr. Siddiqi’s practice will likely see upwards of $100,000 in RTM reimbursement from a case volume of approximately 500. Equally important, implementing a digital care solution should improve efficiencies in workflows and enable effective scaling of patient volumes, leading to even further revenue growth. Dr. Siddiqi, for example, is projecting growth of 30% in his annual case volume.

“In my practice, following this past year where we’ve had just over 450 patients, we are projecting about 600 patients for next year…. So not only does the right solution enable immense cost savings each year, it also helps expand patient volumes and subsequently overall revenues, further demonstrating the type of financial impact that could be produced through thoughtful and high-quality digital and remote care”
Dr. Ahmed Siddiqi, MD, MBA - Orthopedic Surgeon - Total Joint ReplacementOrthopaedic Institute Brielle Orthopaedics

Key Considerations

When evaluating remote MSK care solutions, metrics such as per-patient costs, clinical utility, and return on investment (ROI) are critical. An organization-wide solution may not provide the maximum clinical utility for specialized care and may require the use of additional solutions. This reduces the overall ROI. PROMs-only solutions, while cost-effective, also do not offer as much clinical value and ROI given that they address only one element of patient care.

A comprehensive MSK-focused solution such as Force Therapeutics, implemented as part of a holistic digital care implementation plan, may have higher per-patient costs than the aforementioned options but can provide maximized clinical value and higher ROI, empowering  physicians  to provide the best care possible for all their patients . To determine which digital care solution is right for you, look for a consistent track record of exceptional patient engagement and validated ROI within MSK service lines. Full buy-in from your team and patients is critical for high patient engagement, as is strong training for the care team and clear and consistent communication. Seamless integration into your EMR/EHR is also important for immediate value and team buy-in.

Only through high patient engagement can a remote MSK solution impact clinical outcomes and support more efficient care, without which any economic impact would be meaningless. Considering the significant costs of MSK care on patients and the national healthcare system, providers must look to high-quality full-suite remote patient engagement and digital care management tools to  produce more consistent and standardized outcomes across a larger set of patients and reduce the national healthcare cost burden.

Interested in seeing more specific details and data from Dr. Siddiqi’s experience? Download the webinar recording below.

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