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The Importance of RPM programs

by | Jan 19, 2022 | Thought Leadership

An abstract image depicting remote patient monitoring

Establishing a 365-Day Patient Relationship for Better Outcomes

COVID-19 has forever shaped the U.S. healthcare system, leaving a lasting impact on the industry. Perhaps one of the most significant changes is the push to provide care outside the hospital or clinic. While healthcare providers were already shifting some care to remote settings, COVID-19 forced providers to ramp up innovation and adoption. As a result, Remote Patient Monitoring (RPM) programs were pushed into the spotlight. It enabled providers to leverage technology to remotely engage, monitor, manage, and treat patients during a time when access to hospitals and clinics was restricted.

This article examines why RPM programs are a valuable method for delivering care and supporting patients. It also outlines how healthcare providers can leverage RPM to generate reimbursement and a consistent revenue stream during a period of disruption for both operating margins and patient volume.

RPM by the Numbers

  • 23.4 million U.S. patients used RPM services and tools in 2020 (1)
  • 30 million U.S. patients are expected to use RPM services and tools by 2024 (2)
  • 80% of Americans are in favor of using RPM (3)
  • 46% of millennials have used blood pressure monitoring device (4)
  • 24% of practices have RPM technology available (5)
  • 76% reduction in readmission rate credited to RPM by the University of Pittsburgh Medical Center (6)
  • 26 states have adopted Medicaid coverage for remote patient monitoring (7)

Ongoing Reimbursement Changes to RPM

While a form of RPM has been around since the 1960s, today’s concept is completely new. With the help of new technology and reimbursement rules, RPM has expanded and is gaining widespread acceptance by physicians, patients, and payers.

It started in 2018 when the Centers for Medicare and Medicaid Services (CMS) introduced new reimbursement rules. However, the biggest shift came in 2020 when CMS increased access, enabling providers to bill for additional 20-minute increments of RPM service per patients, per month with no limit.

Starting in January of 2021, CMS is again expanding coverage through five new codes. This time the changes will impact Remote Therapeutic Monitoring (RTM), specifically respiratory system status, musculoskeletal system status, therapy adherence, and therapy response.

Understanding the Financial Value of RPM

The new RPM reimbursement rules are creating significant revenue opportunities for healthcare providers. Many healthcare providers have found that RPM not only increases patient engagement but can reduce healthcare costs while adding additional revenue streams. Success is determined by a provider’s ability to drive patient engagement without disrupting organizational workflows.

For example, healthcare providers can collect up to $207 per patient per month for many chronic or acute conditions. If a provider can enroll 50 patients into an RPM program, they can expect to generate up to $124,200 a year in additional revenue. This can effectively create a revenue stream between office visits, simultaneously decreasing the high costs associated with emergency or acute episodes and related readmissions.

Additionally, RPM business model provides financial leverage for a typical provider practice. While RPM starts with the ordering physician, almost all ongoing billable activities for most conditions can be delegated to a Care Manager. This both reduces the cost structure for a practice and allows the Physician to take on a larger patient panel.

Where to Start

Developing a successful program that is both profitable and compliant is not easy. While healthcare providers can start their own program, it is much easier to partner with an organization that specializes in care management and healthcare digital solutions. These organizations bring vast knowledge and experience, which can help providers get programs up and running quickly.

One helpful tip is to start small by identifying a specific patient population for the program. Many providers find early success by focusing the program on high-risk/high-cost patients. Many of these patients require near-constant management of their care by a care manager, enabling healthcare providers to fully leverage an RPM program without the costs associated with frequent office visits with a physician.

Next, create well-defined goals for the program. These goals can center around health outcomes, patient experience, financial outcomes, or even physician/staff satisfaction.

Once a process is established and positive results are achieved, the program can be scaled accordingly.

Ensure Medicare Compliant Workflows and Billing

The lower cost structure and financial reimbursements are one of the biggest advantages of an RPM program, but it is only possible if healthcare providers have established seamless workflows that drive efficient and effective care. Three critical areas need to be addressed:

Train Physicians/Staff

Effective training for physicians and clinical staff is a top priority. RPM must be initiated by a billing physician, so focus should be placed on educating them about the program. The assignment and training of a Care Manager who will be responsible for the day-to-day RPM patient engagement will be key. It is also a good idea to make sure they are knowledgeable on device utilization. Create guides and materials that physicians and staff can use to work through potential issues or patient questions.

It is also important to communicate how an RPM program will make the jobs of physicians and clinicians easier. Highlight the success the program has in increasing staff satisfaction, reducing time for certain tasks, or improving turnover.

Educate Revenue Cycle Staff

Don’t overlook the revenue cycle staff when it comes to training and education. It is critical the organization’s billing staff is knowledgeable of the RPM program. They should have a firm understanding of the Medicare requirements for billing RPM services.

Prepare Patients

Successful RPM programs require extensive engagement from patients. This will require healthcare providers to not only educate patients, but also set clear expectations. Additionally, emphasize how the RPM program can help patients achieve their overall healthcare goals. It is a good idea to have these messages first delivered by a patient’s physician. Since physicians have earned the trust of the patient, they can more effectively communicate the programs value and motivate patients to enroll.

Importance of Incorporating Care Management with RPM

Starting a new RPM program can be stressful. The program will require establishing a 365-day relationship with the patients. Dedicated care managers are a necessity, since physicians are not able to provide this level of support to all patients all the time. Healthcare providers should set themselves up for success by finding a partner who can support the program through a centralized or shared-services model. Several benefits include:

  • Dedicated care manager roles
  • Support of multiple billing physicians
  • Medical device distribution
  • Patient registration and training
  • Patient technical support
  • Monitoring and management of patient treatment plans
  • Interactive patient communication

Conclusion

As this article clearly defines, RPM programs are a valuable method to build patient engagement and loyalty while simultaneously generating a new revenue stream for healthcare providers. As an industry leader in digital health solutions, Healthfully supports organizations in establishing and maintain successful RPM programs. The Healthfully platform was designed specifically for patients, physicians, and staff to improve patient care and increase financial outcomes.

If you would like to learn more about how an RPM program can benefit your organization, or if you would like a demo of the Healthfully platform, contact us at info@healthfully.io.

References

  1. The technology, devices, and benefits of remote patient monitoring in the healthcare industry. Insider Intelligence. July 28, 2021.
  2. The technology, devices, and benefits of remote patient monitoring in the healthcare industry. Insider Intelligence. July 28, 2021.
  3. MSI International Study: Americans View Remote Monitoring of health Favorably. Savanta: MSI. June 8, 2021.
  4. The Health of Millennials. BlueCross BlueShield. April 24, 2019.
  5. 2020 ACP Member Survey about Telehealth Implementation. American College of Physicians. March, 2020.
  6. The technology, devices, and benefits of remote patient monitoring in the healthcare industry. Insider Intelligence. July 28, 2021.
  7. State Telehealth Laws and Reimbursement Policies Report, Fall 2021. Center for Connected Health Policy. October, 2021.
Paul Viskovich
Paul Viskovich is the founder and CEO of Healthfully. Paul has over 20 years of experience in the healthcare software industry. Previously, Paul served as President of Orion Health in North America where he led the company from start up to one of leading Health IT companies in North America.