Improving Care for High Risk Seniors While Increasing Practice Revenue

Jan 24, 2020 at 07:35 pm by pj


 We need more game changers




Editor’s note: Author John Whitman is a professor in the Wharton MBA Health Care Management Program and is not vested in nor in any way does he benefit financially from the products mentioned.


Historically, our healthcare system has not made it easy for physicians to provide in-depth comprehensive care services for our nation’s seniors. Reimbursement (or lack thereof) has often been a significant barrier, especially for those physicians and nurse practitioners focused on the medically isolated senior population living in the community.

Adding to the challenge is the rapidly growing number of seniors, especially in the 85+ cohort who are the fastest growing segment of the U.S. population and are, of course, the greatest consumers of healthcare resources. Chronic conditions are one of the many challenges of caring for the senior population. The Centers for Disease Control estimate 85 percent of all seniors have at least one chronic condition and 60 percent have two or more.             

The reality is clear: the number of high-risk seniors with diabetes, CHF, blood pressure and other chronic conditions continues to increase and they are living longer. Monitoring these high-risk seniors on a monthly basis through physician office visits, as we have historically done, is no longer adequate to assure their safety.

Through amazing advances in technology over recent years, high risk seniors can now be monitored daily in real time and their physician can be alerted any time their readings fall outside the specific guidelines they have set on a patient by patient basis.  These alerts serve as an “early warning system” allowing the physician to provide an appropriate medical intervention to resolve the issue before it escalates to a medical crisis requiring an emergency room visit, hospitalization or worse.

One immediate solution to the growing number of high-risk seniors is a program I recently reviewed called the “Link+ Program” created and powered by a company called LiveCare in New York City. This progressive company has created the first two-way, real time video pendant that qualifies as a Personal Emergency Response System (PERS). Adding video capabilities is a milestone in PERS programs and the quality of the video on their business card sized pendent is amazing. Even more amazing is the fact that this PERS pendant can link to a wide range of FDA approved monitoring devices using Bluetooth technology. When a reading is taken by a senior, that reading is immediately Bluetoothed to the pendent. The pendent immediately transmits that reading to the Remote Monitoring Platform where the readings are compared to the physician’s predetermined, patient specific ranges. If those ranges are violated, an alert is immediately sent to the physician so an appropriate medical intervention can take place. The combination of the pendent and the remote monitoring devices working together is called the “Link+ Program” and is the Hub/Gateway that links FDA approved remote monitoring devices that measure daily readings for hypertension, diabetes, obesity, SPO2 with heart rate, and temperature.

Linking the two-way video pendent with the remote monitoring devices by Bluetooth and then having the pendent transmit that information to the remote monitoring platform is brilliant. LiveCare has automated this process eliminating the need for a patient to use a smartphone, table and laptop to self-report their readings. This automation also eliminates any accidental and intentional inaccuracies being sent to the remote monitoring platform. Furthermore, no internet connection is required in the patient’s home because the pendent can transmit the information independently without a local internet connection. This too is a significant improvement over previous remote monitoring programs.

Last week I had the pleasure of interviewing Dr. Erik Ilyayev, an Associate Professor at Touro College of Medicine. Dr. Ilyayev also has a medical home practice and he and his staff of nurse practitioners visit medically isolated seniors in their homes in New York City.  Dr. Ilyayev called the LiveCare Program a game changer because of the daily monitoring it offers for his high-risk patients, and the support it provides for clinicians allowing them to take even better care of their patients. He also commented on the added revenue he can generate for his practice using a range of CMS’s billing codes specific to remote monitoring.

He provided multiple examples where the LiveCare Program recognized serious changes in a patient’s medical condition while at home. Without the alert, and the added time it offers the practice to respond to the senior’s needs, many would have escalated into true medical emergencies.

One specific example he offered was an 86-year-old woman with a history of high blood pressure that was normally controlled by medications. She takes her blood pressure twice a day with a simple cuff device and her readings are immediately Bluetoothed to the pendant. The pendant immediately sends the readings to the remote monitoring platform. If the readings fall outside the requirements established by the physician on a patient by patient basis, an alert is sent to the physician. A few weeks ago, Dr. Ilyayev received an alert on this patient because her blood pressure was significantly elevated.  He immediately went on his tablet and was able to view not only the reading that generated the alert, but 30 days of data in a simple, easy to read graph. He was able to see a full month of readings and not just an individual reading at a moment in time. He called the patient on the pendant and had a meaningful face to face interchange. Based on his findings, he adjusted her medication in response to the immediate need and was then able to monitor the impact of the changed medication for several days making two additional adjustments as needed…something he would never have been able to do if the patient’s care were dependent upon traditional face to face office visits.

Bottom line, not only does this program provide additional protection for high risk patients, it allows clinicians to do a better job taking care of them while generating additional revenue for the physician practice. In most states, the two-way video pendant is paid for my Medicaid as a PERS unit. The monthly billing potential for the physician depends on the number of remote monitoring devices recommended by the physician for his/her high-risk senior patients. For example, a senior with the Pendant and one remote monitoring device will be able to generate approximately $50 or more a month of net revenue for the physician. For a senior with two remote monitoring devices plus the pendant, the net monthly revenue for the physician would likely be $75 to $100.

I recently had the pleasure of meeting the management team of LiveCare. Peri Avitan, the CEO and Founder was appropriately proud of the program his company has created and its ability to help improve care for high risk patients while at the same time helping physician practices generate significantly more and well-deserved revenue.

Peri offered to have his Director of Business Development, Eric Ditkowsky run a free, no cost evaluation for any physician practice interested in learning more about the program. Based on several practice specific statistics, Eric will be able to generate an estimate of the level of added reimbursement available for a given practice by offering the pendant and remote monitoring devices to their high-risk patients.

Bottom line, not only does this program provide additional protection for high risk patients, it also allows clinicians to do a better job caring for them while generating additional revenue for the practice. Better care, better revenue…yes, I would call that a game changer!


John Whitman is a faculty member at the Wharton MBA Health Care Management Program specializing in senior car services. John is the founder and Executive Director of The TRECS Institute and for the past five years he has been aggressively evaluating the ability of telemedicine and remote monitoring to improve care for high risk seniors, reduce costs for our health care system and improve revenue opportunities for those providers utilizing telemedicine and remote monitoring services.