Population Health Insights

Keys to Maximizing Business, Clinical and Operational Efficiencies in the World of Remote Patient Monitoring


Is remote patient monitoring (RPM) a good fit for your organization?

Choosing an RPM program can be an exciting time. Providing RPM elevates you as a leader in the industry and tells the world that you're looking for the most innovative, efficient, and effective healthcare experience for your patient and member populations.

But before you take this step, your organization must first evaluate whether it will be a good fit for your patients, staff, and leadership. This is a critical step that must be carefully evaluated and thought through at several layers of your business.

First and foremost, it’s imperative for your leadership team to be fully supportive and willing to provide the resources necessary to implement and manage the program. Lack of executive sponsorship and support can easily result in technical and clinical constraints and operational barriers.

It’s also important to assign departmental staff with key roles in the implementation and operation of the program. By doing so, you develop inclusion across the teams, and increase the chances that the RPM program will be successful. It also drives the conversation within your organization that addresses clinical, technical and operational dependencies.

By ensuring the inclusion of teams across your entire organization, you also initiate a greater opportunity to align with your goals by forcing tough questions to be addressed early in the planning phase, and for solutions to be identified prior to rolling out RPM.

The Right Goals for the Right Condition

It’s fundamental for groups to select conditions that are amenable to RPM, as well as conditions that would optimize the organization's ability to meet its goals.

For instance, if the goal is to reduce hospital readmissions, it would be prudent to choose a condition that has high readmission rates, such as CHF (Congestive Heart Failure). This strategy helps drive a targeted focus on avoidable cost, prevention, adherence and medication compliance. It also helps you design a program with RPM that can be explicitly patient-centric or delivered across a chronic population.

In either case, focusing on a specific chronic condition like CHF allows your organization to think through the clinical pathways, workflows and engagement models that are right for your population. It also helps you identify alignment to savings, and how these savings can demonstrate both value and return on your RPM investments.

The Right Time and The Right Patient: Respect the Patient Journey

It’s always important to note that RPM is not for every patient. There will be times that are more favorable for participation by one patient than another. The reality is that not all patients are a good fit for RPM, and acknowledging that is crucial to program success. It’s vital, then, to construct clear inclusion and exclusion criteria that will yield the best participation and boost the success of the program.

Best practices have found that patients who were recently hospitalized often make great candidates for RPM, being that they're at a greater risk of being re-admitted. Also, recently discharged patients may be more motivated to participate in a program that helps them avoid another re-admission. Since an RPM program’s success is dependent on a patient’s participation, it’s crucial that the patient understands this expectation.

The patient must also have a clear understanding of how the program will help them, and what the benefits are to their health. This also leads into understanding that the engagement, coaching and support from their healthcare systems will continue, even though they're not at a brick-and-mortar location. Extending virtual care to the home using RPM allows for a closer engagement with clinicians and creates a tighter continuity of care that can track daily vitals and health indicators and better manage risk by exceptions.

As organizations embark on this journey, it’s also important to keep sight of the adoption model. Even if your inclusion/exclusion criteria were strategically implemented, adoption and adherence must also be actively pursued. Managing your patient and member population is a process, and it’s not uncommon to see peaks and lows during the patient journey.

The key takeaway is understanding the impact of behavioral lifestyles. Having patients swivel between compliance and non-compliance is normal; as a clinician, the role can sometimes better be defined as helping guide, coach and encourage better decisions via RPM.

The truth is that patients are on a journey, and you have to respect this journey. Your influence, clinical inflection and guidance may take time, but it's also a path along which you're building a relationship with your patients and helping drive them towards better health.

What to Know about CPT Codes for Remote Patient Monitoring

There have been increased initiatives at the federal level to support the expansion of telehealth, RPM and telemedicine, and we are seeing additional support from CMS over the past couple of years to support these codes with expanded reimbursement schedules. This is not only providing increased rates of adoption, but also helping offset investment costs and drive new clinical efficiencies, while providing a pathway to a sustainable model to increase customer ROI.

Just as with any new billing codes, it can be tricky to navigate and understand all the interworking of CPT coding. Organizations must ensure they are effectively meeting all of the billing criteria for reimbursement and can meet the specific billing requirements to support virtual care.

CPT codes that are helping pave the way for RPM include:1

  • CPT code 99453: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
  • CPT code 99454: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
  • CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

Several years ago, RPM was still understood to be a foreign concept for many healthcare organizations; however ,times are quickly evolving, and organizations now understand that RPM should be a primary offering to patients and members. RPM is truly one of the few medical interventions that has clearly been proven to benefit both the healthcare delivery system and the patient simultaneously.

With ongoing support from CMS, as well as the larger industry shift to value-based care, we at Care Innovations are developing innovative ways to help our customers gain greater efficiencies and adoption to improve their engagement with patients and members. Our goal is to show our customers how RPM can enable greater potential in how they operate their business and improve the quality of care to their respective populations.

Interested in learning more about how Care Innovations can help you leverage RPM to help you implement improvements in quality of care and operational efficiencies? Contact us here to schedule a complimentary consultation with one of our RPM specialists. And don't forget to follow us on Facebook for more updates and insights!

About Lesley Mathis, RN, MSSW, MSN, ACNP-BC

lesley-mathisLesley Mathis is a Clinical Manager at Care Innovations and a board-certified acute care nurse practitioner with extensive experience in traditional medicine, customer consuming RPM technologies, and now helping to deliver RPM solutions. Lesley was the NP for the Chief of Cardiac Surgery at Vanderbilt University Medical Center, and at Cigna, where she helped to deliver a 20% reduction in readmissions. She is a leading expert in RPM (remote patient monitoring) and in the development of clinical solutions for various patient populations.

1. Source: https://www.pyapc.com/insights/new-medicare-payments-for-virtual-services-effective- january-1-2019/