Realizing the potential of remote patient monitoring

Data security concerns

Wireless communication technology has become so ubiquitous that the average consumer likely takes their everyday information security for granted. Healthcare providers, however, have an ethical and legal obligation to protect patients’ health information. For some providers, unfamiliarity with RPM technology—or full awareness of wireless transmission’s inherent risks—could limit their willingness to adopt, despite advantages in terms of convenience and access.

The concerns certainly aren’t unfounded. On average, two major healthcare data breaches happen every day, and the rate of successful breaches seems to be going up.

Luckily for infosec-conscious providers, the National Institute of Standards and Technology published guidance on identifying risks associated with telehealth and RPM, as well as what to look for in potential telehealth platform partners, in February 2022.

Depending on the technology in question, the security of the physical device— and thus the accuracy of the data it transmits—could be a concern as well. While an implanted pacemaker is unlikely to go anywhere without surgical intervention, a Wi-Fi-enabled blood pressure cuff, for example, could be stolen, misplaced, or commandeered by a curious child, leading to inaccurate readings and even clinical trial noncompliance.

Listen to our Definitively Speaking episode with Alan Foreman of B-Secur for an industry leader’s perspective on wearable security.

Fee-for-service payment models

In its current state, the U.S. healthcare system functions by using a blend of fee-for-service and value-based payment models. While most healthcare providers seem to approve of CMS’ shift toward a greater emphasis on value-based care, the reality is that providers rely on revenue streams from both models to stay afloat—and shifting resources toward value-based care usually involves compromising potential revenue from fee-for-service activities.

With benefits like reduced hospital readmissions, fewer emergency room visits, and overall improvements to quality of life and preventive care, RPM is tailor-made to deliver greater value with fewer patient-provider touchpoints. Unfortunately for providers operating in a fee-for-service framework, that means fewer opportunities to bill for services and less revenue.

CMS has sought to bridge the gap by introducing the CPT codes discussed earlier in this report, enabling providers to seek reimbursement for RPM-related tasks like data collection and interpretation, equipment delivery, patient education, and consultations. But some providers balk at the time and data volume restrictions associated with these codes.

To bill for device setup and patient education (CPT code 99453), for instance, a connected RPM device must first transmit 16 days of patient-generated health data. Certain conditions necessitate shorter periods of monitoring, which, under current CMS rules, would not be reimbursable. For this reason, providers seeing patients with more acute medical needs may be dissuaded from considering RPM and instead opt to monitor patients in person, despite the potentially higher long-term costs related to staffing and overhead.

Insufficient training and IT infrastructure

RPM systems and devices come in a variety of forms designed by an equally varied number of manufacturers. Implementing these systems at a medical practice or facility necessitates training—in addition to the continuing medical education that most healthcare professionals are already required to participate in each year.

Unfortunately, that training doesn’t always transfer. Two ECGs from two different device makers may be operated differently, for instance, and any software systems used in tandem with RPM devices will require additional training to ensure accuracy and data security.

While savvy RPM vendors include training and implementation assistance as part of their sales package, some providers may not be convinced that the potential benefits of remote care outweigh its cost in time or resources.

Furthermore, integrating RPM solutions within existing IT systems isn’t always simple. Plenty of third-party vendors offer options to connect RPM tech with electronic health records (EHRs) and care management systems, but organizational decisionmakers may wish to keep these processes in-house, whether to reduce security risks, ease integration with other systems, or simply maintain ownership over the resulting data.

There’s always the possibility that a practice’s IT infrastructure simply isn’t built to effectively use RPM. This may be especially true among cash-strapped rural practices with unreliable internet connectivity or those relying on proprietary software systems.

Low reimbursement, misaligned policies

As discussed in Part I, CMS has done its fair share to incentivize RPM over the span of five short years through the implementation of Medicare reimbursement. However, according to the Center for Connected Health Policy, only 34 state Medicaid programs currently reimburse providers for RPM services. In contrast, all 50 state Medicaid programs offer reimbursement for video telehealth services.

These reimbursement policies vary from state to state. Plus, just over 70 private payors reimburse for RPM.

For providers, the calculus behind the profitability of RPM will largely depend on the payor mix of their patient base and the state in which they operate.

That calculus gets even more complex when factoring in reimbursement for asynchronous telehealth or “store-and-forward” services, which involve electronically sending patient data from a primary care provider, technician, or the patient themselves to a specialist for analysis using a secure cloud-based platform.

Store-and-forward services can be used to supplement traditional phone or video telehealth, other RPM services, or in-person care with specialist insights, but the significant disparities in reimbursement from state to state could disincentivize specialists’ participation.

Patient-side technology barriers

In our hyper-connected modern age, it can be easy to forget that technological access isn’t equitably distributed.

Indeed, more Americans than ever own a smartphone (about 85%, according to a 2021 Pew Research Center poll) and over 80% of the country has access to broadband with 100 megabit-per-second download speeds according to the Federal Communications Commission.

However, the latest FCC Broadband Progress Report shows that around 19 million Americans still lack access to high-speed internet. Nearly a quarter of the U.S. rural population and about one-third of people living in tribal jurisdictions don’t have access to these services.

When combined with other factors that disproportionately impact these regions, like poverty and poor health literacy, it can be difficult or impossible to implement effective RPM strategies. Furthermore, providers serving these areas tend to be cash-strapped themselves, operating on shoestring budgets and skeleton crews to deliver care over sprawling acres.

While rural regions and practices present some of the best use cases for RPM’s benefits, patients and providers are unfortunately left to contend with financial and technological realities that disincentivize investment and positive change: lack of existing infrastructure, low population density (and thus limited patient base), and reduced private payor presence.

Part III: How to accelerate the adoption
of remote patient monitoring

The challenges facing remote patient monitoring are, in many cases, systemic. By and large, they’re indicative of a healthcare system that has yet to adapt to its own rapidly evolving technological capabilities and the shifting needs and preferences of its constituents.

To at least some degree, the systemic nature of these challenges mandates further intervention at the highest levels of the healthcare system. New regulations, reimbursement programs, and other incentives implemented by CMS and other governing bodies could help to speed up the adoption of RPM services, while making existing services more effective.

However, there are still plenty of opportunities for innovative and enterprising organizations to step in with market-based solutions. And there are plenty of reasons to do so:

• RPM implementation has been shown to reduce readmissions, improving hospital performance metrics and reducing costs to providers and payors
• RPM services offer additional opportunities for reimbursement and referrals, raising net patient revenue for providers
• Patients can use RPM to keep a closer eye on their health and well-being, helping them stay out of the hospital and reducing household medical expenses
• RPM improves access to care (especially in rural and underserved regions), encourages greater patient engagement, and gives patients more flexibility in their care, boosting overall satisfaction
• RPM reduces the need for in-person patient touchpoints, reducing the strain on overburdened staff and limiting the spread of infectious disease

This section will examine how governmental and private entities could address RPM’s existing obstacles and pave the way for a brighter future.

Integrate RPM management into electronic health record systems

Electronic health records are digital representations of patients’ charts, containing information on demographics, medical history, diagnoses, test results, and medical imaging. EHRs simplify and secure the capture, storage, and transmission of medical information. Under current CMS guidelines, providers that don’t employ EHRs receive docked reimbursement for Medicare claims.

According to the Office of the National Coordinator for Health Information Technology, about 88% of providers were using EHRs as of 2021, with 78% using EHR systems certified by the Department of Health and Human Services. While many EHR developers have added telehealth-related functionality to their software offerings, most EHRs do not currently offer native RPM integration, requiring providers to either manually enter RPM data into their EHRs—often with the additional requirement of custom-built templates to accommodate the information— or turn to third-party vendors for software that can bridge the gap between RPM and EHR systems.

The extra work, training, and expense necessary to integrate RPM data into existing EHRs might disincentivize providers from adopting this useful technology. While the situation represents an opportunity for software and IT developers to create gap-bridging solutions, there’s just as much opportunity for major EHR companies to add native RPM integration to their platforms.

As shown in Fig. 11, nearly three-quarters of providers rely on one of three major EHR platforms from Epic Systems Corporation, Oracle Cerner, and MEDITECH. It’s not hard to imagine one of these organizations upgrading their platforms with native RPM capabilities to claim a huge competitive advantage, potentially reshaping the market while drastically reducing barriers to RPM implementation.

Pilot new RPM tech and use cases in the private sector

While the government tends to move slowly on matters related to healthcare reimbursement and incentivization, private payors are better equipped to jump at opportunities for increased revenue, including through the implementation of new RPM policies and programs.