As overhead for practices continues to increase with inflation and rising costs of labor amidst labor shortages, many private practices are looking for ways to diversify their income streams. An obvious one for many practices to consider is remote patient monitoring. While remote patient monitoring has been around for some time, new iterations and applications of RPM are being developed constantly as AI and health tech continue to explode.
In this article we’ll cover what remote patient monitoring (RPM) is, what the pros and cons are, and why you may want to consider adding it to your practice.
What is remote patient monitoring?
Remote patient monitoring is the ability to use technology to monitor patients outside of traditional clinical settings such as clinical practices or hospitals. This may be at home, in a residential assisted living facility, or in remote areas that don’t have access to specialists. The goal is to increase patient access to care while hopefully also decreasing healthcare costs that are often quite high in traditional care settings. Additionally, a big goal is to identify changes in trends that signal to the clinician that a condition may be worsening before it becomes a much more significant issue.
Remote patient monitoring has been around in some form for decades (think Holter monitors), but has only recently really exploded into widespread adaptation in the last few years secondary to CMS changes that allow reimbursement for the time clinicians and clinician offices have to spend to facilitate this.
Especially with wearable devices becoming mainstream, the number of potential opportunities for application and implementation in the remote patient monitoring ecosystem seem to be exploding.
What are some examples of things that can be monitored remotely, and what is done with that information?
Honestly, this article is likely outdated before it’s even written, as tech companies are finding innovative things to track and different ways to apply this information daily. Conventionally, though, RPM can involve things like monitoring vital signs, glucose measurements, apnea devices, telemetry, and medication adherence.
Almost all of these systems have a notification system built in and some sort of back end operations to ensure that abnormal results are addressed in a timely manner. The notifications can go to you, a member of your clinical team, or another outsourced service, depending on what works best for your practice. You can also customize these notifications so that they’re triaged in a way that you feel comfortable with without constant interruptions.
What are the pros of remote patient monitoring?
In addition to identifying problems earlier and an opportunity to earn additional revenue through your clinical practice, RPM offers additional benefits. It’s great for patient care and patient accountability, and offers clinicians a way to see if their recommendations are working or being enacted. Many patients love the idea that their clinicians are keeping an eye on them as well, and the families of patients may love knowing there’s an extra set of eyes on their loved ones when they can’t be around themselves. For those shifting to value based care, this can be an important component of reimbursement as well.
What are the cons of remote patient monitoring?
While RPM can add a lot of value for physicians and patients alike, there are a few considerations to keep in mind before adding this service to your medical practice. Since RPM provides real-time monitoring, patients will need a reliable internet connection to transmit the data. Stable internet isn't a given in all patient populations, so it can restrict assess. The data you receive is also only as reliable as the patient you are monitoring. If they don't wear the device consistency, you won't get good information to review and assess. Patients must buy into the monitoring process, which make take some coaching from you upfront. They also have to buy in on the technology. Depending on your speciality and the type of device required, the upfront setup costs can be prohibitive—for you and your patients, as you'll likely need new software for monitoring and related EHR integration to process and upload the results.
What are the logistics of remote patient monitoring?
As the physician, it is your job to identify patients that are appropriate candidates for RPM, and then make sure you get the appropriate consent. After this, you can be as hands on or hands off as the system you put into place allows. Insurance paperwork will need to be filled out, and though in many cases this is covered by insurance, the patient may still have a co-payment, deductible, or co-insurance requirement.
Next, depending on the technology you’re using and who is doing the backend for the technology, you can either facilitate the acquisition of the device by the patient or it can be provided or sold to them by a third party. If your practice is supplying the device, you can bill a monthly fee to insurance, much as the RPM companies involved in this space can. You can also bill a one time fee for patient education and enrollment and setup.
As with anything insurance based, you are going to have to meet the qualifying criteria to get reimbursed, and this requires proving that the RPM was actually used by meeting both transmission and time requirements. The tracking software through an RPM company that you use should facilitate this easily, by recording when data was sent back and forth between the two parties, including when you or your staff reach out to communicate about readings, provide counseling or recommendations, or to remind patients to submit their readings. The more time you or your staff spend, the more that can be billed.
How do I enact remote patient monitoring in my practice?
If you’ve been to an industry conference or subspecialty meeting lately and explored the vendor booths, you’ve probably met a ton of companies in this space. It can be overwhelming to figure out which ones the good ones are, but you want to find one that fits with your practice’s particular needs. Some will be tailored to specific patient populations or insurers (like Medicare), and each will have features that you may find either very helpful or burdensome. Some will basically run the program for you (but of course eat away at your profit) by supplying the devices, doing the monitoring, even having people or AI to do the patient interactions unless you really have to get involved, and doing the billing. Shop around and sample a few out before you get commit to one.
Also run the numbers to make sure that your model makes sense - factor in all the costs of implementing the program alongside the potential profits, including what you will have to pay your staff or if you’re selling the devices, the costs of keeping inventory if this is necessary. While the upside to being the person who supplies the product is that you get that monthly maintenance fee, you may not want to be involved in the supply side of things. Know how many of your patients you think you could enroll in these programs, and how many you would need to enroll to keep the program profitable. Think about how much staffing time will go into the average patient and what the average reimbursement per month per patient will be. Factor in the costs of the platform and/or vendor services as well.
For those physicians in fields where remote patient monitoring would be helpful for patients and clinicians alike, it’s worth looking into adding this service to your clinical practice. Not only can it generate additional datapoints that lead to better patient care and improve patient satisfaction, it can generate an additional stream of revenue for your practice for doing something you’d likely want anyways.