The COVID-19 crisis is wreaking havoc on our health system, healthcare workers, and communities.
Patients who rely on consistent care for and management of chronic conditions are increasingly finding themselves lacking access to their physicians for what just a few months ago were considered routine blood pressure or other vital measurement checkups. While traditional telehealth is a phenomenal resource, some of our more vulnerable patients require remote care solutions other than a video or phone call with their doctor. Enter remote patient monitoring (RPM).
Remote patient monitoring combines the continued necessity for quality patient care with the capability of mitigating infection risks for patients and healthcare workers. Reducing physical interaction has become crucial, and RPM allows providers to extend the barriers of patient care past the confines of a traditional office setting.
While the concept and practice of remote patient monitoring has been around for quite some time, it's mostly been conducted by hospitals and larger health systems. These organizations have increasingly leaned on RPM for good reasons: Research has shown that RPM can greatly reduce the overall cost of healthcare through proactively decreasing the occurrence of emergency room visits as well as hospital admissions and readmissions.
Despite widespread adoption of remote patient monitoring solutions by hospital groups, the implementation of RPM by other types of organizations (e.g., private practices) is somewhat new territory for the U.S. healthcare industry. While the data supporting RPM in a hospital or health system environment has been well documented over the last decade, the evidence that it is beneficial and cost-effective in private practices has just started to be gathered over the last few years.
In response that initial evidence, support for remote monitoring in private practice has been steadily increasing. In 2018, the American Medical Association introduced procedural codes designed to incentivize adoption of RPM by independent practices. Medicare started covering those codes in 2019 at relatively high reimbursement rates and many private payers have followed suit. Medicare has also urged providers to use remote solutions for the provision of services to all beneficiaries during the pandemic. It is clear that the clinical and financial benefits of a well-tailored RPM program are greater now than ever before.
Determining If RPM Is Right for Your Practice
With the emergence of COVID-19, and with the support of the federal government, remote patient monitoring is blazing new territory. Independent practices have begun to use RPM not just for the health and safety benefits for their patients, but also to create badly needed revenue during a difficult time.
If you are thinking about launching your own remote patient monitoring program for your practice and patients, here are six things you should consider before committing time, money, and staff to the new venture.
1. Patient goals: What will your remote patient monitoring program achieve for your patients?
Remote patient monitoring can help place control of your patient's wellness directly into the hands of your patient while also keeping them cognizant of their plan of care. An RPM device can also help your patient feel empowered and connected to their care team, strengthening the patient-provider partnership.
With that said, it is important to create a protocol for selecting which patients should be monitored to maximize patient benefit. Consider prioritizing patients who are high-risk or have been previously hospitalized for conditions related to blood pressure, diabetes, heart failure, or COPD.
Although monitoring vital measurements alone can be beneficial, remote patient monitoring is most effective when used in conjunction with a personalized patient care plan. Medicare and other insurers have understood this and now cover RPM care management codes that reimburse for clinical staff time spent coordinating with RPM patients over the phone.
2. Technology partner: Choosing an RPM platform and technology for your practice.
Finding the right technology partner that best suits your intended goals and remains mindful of your team's technological aptitude will be key to successful remote patient monitoring implementation. With RPM gaining traction on the frontlines of healthcare, there are now many remote patient monitoring companies providing technology solutions that offer an array of services and devices. You must consider whether your practice will need a partner to track billable time and submit claims every month or if that function can be performed in-house.
You also should consider how your remote patient monitoring platform would interact with your current EMR and other technology. Some RPM platforms integrate with EMR systems while others function separately. There are also variations on what it means for a platform to be “integrated,” with some interfaces just exchanging patient demographics while others incorporate the RPM workflow directly into the EMR window. Depending on cost and other factors, you may want to weigh what level of EMR integration you need and then narrow your search accordingly.
With remote patient monitoring, the quality and function of the patient devices is just as important as the doctor-facing software platform. To date, RPM programs in independent practices have focused primarily on monitoring blood pressure, weight, and blood glucose, but other device types are being increasingly advertised as well.
Finding easy-to-use devices will help ensure patient participation and support the overall success of your remote patient monitoring investment. RPM devices are typically either Bluetooth enabled and require a mobile phone app or connected directly via cellular networks. Cellular devices are easier for patients to use but are generally more expensive.
Depending on your tolerance for providing technical support and the tech savviness of your patient base, you can decide on what mix of device connectivity to offer.
3. Cost: Keeping your technology budget realistic.
A remote patient monitoring program will need new technology that often requires an upfront investment. Before jumping headfirst into RPM, consider the following: Does your practice have enough qualifying patients to support an RPM program? The average annual RPM reimbursement per Medicare eligible patient starts around $1,400.
Some remote patient monitoring platforms will require you to pay for patient devices up front, while others lease the devices or incorporate device costs into their platform fees. You can estimate your potential total annual income derived from RPM and then begin your search for a platform and technology that will fit best into your practice's needs.
In response to the COVID-19 crisis, the FCC is providing grants that can be used by non-profit, rural, and other qualified health organizations to purchase RPM devices. The CDC also has a narrower grant program that covers RPM devices that is focused on tribal health organizations.
4. Getting paid: Meeting the requirements and staying compliant.
It is important that you understand all guidelines and requirements for providing and billing remote patient monitoring services as well as the expenses associated with delivering services. Not only are you submitting your billable time to Medicare and other private payers for payment, but you are also most likely paying your RPM technology partner based on patient count.
If you lack a firm understanding of how the billing piece of remote patient monitoring works, choose a technology partner that can accurately track your billable time and help you through the claims submission process. Some technology partners offer platform and billing solutions as an all-in-one service to make the process less cumbersome for your practitioners and staff.
It also is important to make sure your technology partner understands the security and other regulatory requirements inherent in a remote patient monitoring program. Not getting paid for time spent is bad, but getting audited for time spent incorrectly is even worse.
5. Trial and error: Maintaining realistic expectations.
Implementing any new process into a practice is bound to have a few hiccups. Being proactive and anticipating unforeseen barriers can make the remote patient monitoring implementation process less frustrating.
Plan ahead and map out your vision for your remote patient monitoring program with the understanding that changes and evolution may be necessary along the way. RPM vendors provide differing amounts of consulting in support of their platform. Pure software platforms may be great for some doctors with tech-savvy and telemedicine-engaged staff, while others may want more of the burden borne by their RPM vendor partner.
6. Buy-in: Gaining staff and patient support.
Does your practice have team members dedicated to figuring out the new remote patient monitoring process puzzle? The novelty and technical requirements of RPM means staff buy-in and training is particularly important for implementing and running a successful RPM program — not only so that staff understand the logistics of RPM, but also so they can explain the program to patients.
In addition to staff support, patient buy-in will make or break a remote patient monitoring program. The last thing you want is an expensive connected device sitting unused in a patient’s house costing money while not delivering any benefits. To avoid such a scenario, ensure the RPM patient onboarding process clearly explains the program, what is expected of the patient, the benefits for the patient, and information on co-pays as needed. If a patient is recalcitrant, explain the benefits of RPM, but do not proceed with enrollment if you determine the patients is uninterested.
Is your practice ready for remote patient monitoring?
Adding a new program and taking on a technological upgrade are decisions not to be taken lightly. In our country's current state of affairs, adding remote patient monitoring and its associated technology may prove to be your most proactive line of attack to promote wellness, but you may need to overcome some resistance to the change before proceeding. Understanding what RPM will look like within your practice while anticipating the expected costs and revenue will go a long way in helping your team create an effective and meaningful program for your patient population.
Daniel Tashnek is the founder of Prevounce Health. Prevounce is a cloud-based platform that supports organizations in their delivery of remote patient monitoring services as well as chronic care management, annual wellness visits, and preventive services.