Chronic kidney disease may be one of the biggest killers of American adults, but individuals affected may not even know it. Today, more than 37 million people – 15% of the population – have chronic kidney disease, which is the ninth leading cause of death. But, according to the Centers for Disease Control and Prevention, as many as 90% of these individuals are unaware they have this disease.
One of the challenges is that chronic kidney disease often occurs alongside or as a result of other chronic conditions, such as diabetes, high blood pressure, or heart disease. These conditions put stress on the kidneys, causing damage over time and leading to impaired kidney function. When the kidneys do not function properly, waste builds up in the bloodstream and extra fluid can accumulate in the body, leading to further stress on organs and potential complications such as high blood pressure, stroke and early death if not treated effectively.
As a result, it’s critically important that impaired kidney function is screened for and identified and that people with chronic kidney disease optimize management of blood glucose, blood pressure, weight and other potential risk factors. This is where remote patient monitoring (RPM) comes in as an important tool.
Growth of Remote Patient Monitoring for Chronic Conditions
While the technology has been around for a while, RPM became more commonplace during the COVID-19 pandemic as a way to ensure that people with chronic health conditions could be supported, even if they were unable to attend in-person office visits. Early efforts to deploy remote monitoring tools focused on collecting blood pressure, blood glucose, heart rate, and oxygen levels.
Advances in medical device technology, including greater affordability of connected devices, combined with the revisions to the RPM CPT codes by the Centers for Medicare & Medicaid Services (CMS), allowing for supervision of RPM participants by clinical staff, encouraged more physicians to embrace remote monitoring tools to supplement patient health and wellness. In fact, by 2025, more than 70 million U.S. patients – more than 26% of the population – will benefit from some kind of RPM.
RPM is particularly making a real difference in the lives of patients who need to manage chronic conditions. With diabetes, for example, RPM allows diabetes management to be more of a partnership between doctors and patients.
Connected devices used in RPM programs have made it easier for patients to manage their blood sugar with the help of their doctor in between in-person visits by ensuring providers can see the patient’s blood glucose data and take proactive action to prevent a decline in the patient’s health.
Bringing Chronic Kidney Disease Management to the Home
While utilizing Remote Patient Monitoring for comorbid conditions like diabetes and hypertension can help providers proactively manage patients with early-stage kidney disease, individuals in later stages may already require dialysis and need a deeper level of care. Historically, dialysis has been provided on-site at clinics, with a significant time burden on patients who might need treatment 2-3 days per week. Now, as more healthcare tools are coming into the home, home dialysis is emerging as an important treatment option to make care more accessible, convenient, and affordable. Its use has increased over the past decade, but still, only about 13% of dialysis patients currently take advantage of in-home dialysis, despite studies showing that it has similar outcomes to in-patient treatment, greater patient satisfaction and reduced Medicare costs.
It’s possible that number could continue to grow as a result of some relatively recent changes. The Advancing American Kidney Health Executive Order put forth ambitious targets for increased use of home dialysis, which resulted in CMS introducing new payment models to incentivize home dialysis. In its 2020 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule, the CMS added a new transitional add-on payment for dialysis machines used in patient homes. The rule specifically expands eligibility for the ESRD PPS’ transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES) to certain capital-related assets, including home dialysis machines. Proposed revisions to the 2024 ESRD PPS are still in draft form but we expect further adjustments to pay rates and quality programs.
With the increased use of in-home dialysis, we expect to see alignment of RPM programs with home-based care options like home dialysis to continue to drive convenience for patients, more proactive management by clinics, better outcomes and lower cost. Innovations in connected devices and systems for treating and assessing the progression of chronic kidney disease will be the foundation for this progress.
About Lucienne Ide, MD, Ph.D.
Lucienne Marie Ide, M.D., PH.D., is the Founder and Chief Executive Officer of Rimidi, a leading clinical management platform designed to optimize clinical workflows, enhance patient experiences, and achieve quality objectives for chronic disease management. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.
