Virtual Care Alphabet Soup
Remember sitting down to a steaming bowl of tomato soup, swishing your spoon through the bowl, and then seeing letters rise to the surface? You would try to catch a few on your spoon with the hope of spelling a word. More often than not it was a jumble of letters that did not spell a specific word. That did not stop your imagination from creating meaning in the letters by seeing what they could stand for. It was a fun game with endless possibilities.
With an endless stream of acronyms, healthcare is its own alphabet soup – an entire industry dipping into a vat of soup, with a massive ladle, all at once. In fact, the Centers for Medicare and Medicaid Services (or CMS to go with its common acronym) maintains a searchable database of acronyms with more than 4,400 entries.
Given the number of acronyms that exist, how many can each person remember or remember accurately? In truth, we only remember what we use on a daily basis. However, the vast number of acronyms presents a real barrier to entry or discourse. It can be hard to come up to speed, or even stay up to speed. And let’s be honest: people may be hesitant to ask an acronym’s meaning for fear of revealing a lack of knowledge. We’ve all been there.
That’s why our team decided to level the playing field by creating a quick reference guide of the more common ones showing up within virtual care delivery of healthcare.
Virtual Care Acronyms
RPM: Remote Patient Monitoring
RPM sounds like it is a very broad term to encompass any remote engagement with a patient that includes monitoring. That is somewhat accurate, but for purposes of being paid by CMS through Medicare, RPM comes with a set of defined parameters, though not necessarily as clear as would be preferable.
For Medicare purposes, RPM is for either chronic or acute conditions and requires data to be automatically collected and transmitted to a care team to enable care delivery. One perspective on RPM is that it is a gateway to more meaningful engagement between patients and their care teams. It gets both sides comfortable with collecting, sharing, assessing, and working with each other to advance care.
How can RPM be used? Without CMS offering clear guidance on eligible conditions, the limit is only what an ordering physician determines is medically necessary. As with any service, a real clinical purpose is needed. Some of the more common conditions where RPM is used include hypertension management, diabetes, and respiratory illnesses. As suggested though, uses are only constrained by a clinician’s imagination and available devices. Examples of less common (or less publicized) uses for RPM are sleep apnea or weight management. A common thread through all of the use cases is proactive and preventive healthcare enabled by positive lifestyle changes.
RTM: Remote Therapeutic Monitoring
RTM is one of the latest entrants to the virtual care space. It is nearly identical to RPM, but actually allows for personally reported information, not just information that is automatically collected and transmitted. RTM also shifts the focus beyond traditional metrics to adherence issues too. Particular use cases for RTM are still evolving because it is still so new. Uses suggested by CMS include medication adherence, pain management, or therapy adherence such as use of an inhaler for individuals with asthma.
CCM: Chronic Care Management
CCM was one of the first virtual care programs adopted by Medicare. CCM requires a patient to have two or more chronic conditions that seriously impact the individual’s health. CCM also includes a number of requirements around use of various digital tools that could result in greater interaction with those tools. CCM ultimately recognizes that individuals with ongoing conditions deserve more extensive interactions.
CMS does not maintain an exclusive list of chronic conditions that qualify for CCM. The primary catch is that a patient must have two or more chronic conditions. For example, conditions such as hypertension, diabetes, asthma, arthritis, and dementia (among many others) could be grouped together to meet the goal of qualifying treatment for CCM.
A single issue, unless qualifying for PCM (see below), would likely best be managed under RPM.
PCM: Principal Care Management
PCM is the same as CCM but is intended for individuals with one chronic condition that really needs specialist intervention. Assisting individuals with a single chronic condition often still requires significant time and interaction with a patient. The additional knowledge of a specialist can make a particular difference when a condition falls within their expertise. To acknowledge and encourage connecting patients and appropriate specialists, CMS added PCM into the Medicare fold.
TCM: Transitional Care Management
TCM is about assisting a patient with settling back into a community setting following discharge from certain types of inpatient facilities. The interaction continues for the 30-day period following discharge and calls for a mixture of in-person and virtual interactions. The primary goal is to help patients with moderate or high complexity issues avoid readmission or other further complications that would adversely impact the patient’s health.
H@H: Hospital at Home
H@H programs are moving inpatient-level patient care into a patient’s home. The H@H model requires full integration of in-person check-ins with broader remote management and intervention.
Prior to the global pandemic, H@H was adopted in other countries and on an experimental basis in the United States. It received a bigger boost from a COVID-19 driven demonstration waiver by CMS. The aim of H@H is to enable individuals to receive treatment and recover in their own homes, which can be a setting more conducive to quicker healing and recovery. The interplay of virtual care and in-person check-ins is essential for success, but evidence is growing that supports the suspected benefits.
VBC: Value-Based Care
VBC is not unique to virtual care, but virtual care is positioned to drive success in VBC. Broadly speaking, VBC is paying for healthcare based upon quality and outcomes instead of on a per-service basis. VBC can come in many forms, but shared risk and savings is a primary vehicle to align the interests of all interacting with the patient. Being able to deliver effective, efficient care presents the opportunity for financial success on top of fostering better overall health and wellbeing for individuals.
HIPAA: Health Insurance Portability and Accountability Act
HIPAA should not require any introduction, but it does become an elephant in the room when considering any technology adoption or data flow in healthcare. HIPAA establishes privacy and security standards that inform how the data flowing through healthcare systems can be used, disclosed, protected, and more. While HIPAA is often presented as a barrier to innovation or advancement of developments like virtual care, HIPAA should really be seen as an enabler by establishing baseline expectations around system functionality.
FHIR: Fast Healthcare Interoperability Resources
FHIR is a standard for defining how healthcare information can be exchanged between different information technology systems regardless of how each system stores the information. The standards created by FHIR focus on data formats and elements. FHIR is also an application programming interface. Regulations from the Department of Health and Human Services adopted FHIR as the basis for interoperability requirements and efforts.
More to Come
While we all struggle to keep up to date with the current jumble of acronyms, it is a sure bet that more will be coming. Sorting through all of the names is helpful, but it is more important to understand what is being implemented and developed. The excitement around virtual care is building, while also making a positive impact on health outcomes. Having fun with alphabet soup of acronyms and terms doesn’t have to distract from that reality.
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