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Patient Engagement RPM

RPM healthcare: benefits, challenges, and solutions

Beth Osborne | 06 February 2024
10 minute read

The new era of chronic disease healthcare combines technology, data, insights and continuous care. With this approach, those with chronic conditions can achieve healthier outcomes. The key to this is remote patient monitoring (RPM). RPM healthcare delivers care continuity and real-time vital readings. As a result, physicians can make data-driven decisions.

While RPM healthcare is expanding, thanks to improved clinical outcomes, increased reimbursements, and more sophisticated platforms, challenges persist. Those can be overcome with the right solutions, yielding benefits for practitioners and patients.

In this guide, you’ll learn about the benefits, challenges, and solutions of RPM.

What is RPM healthcare?

RPM healthcare describes remote care programs that use connected medical devices to monitor patient vitals between office visits. You can support a variety of chronic conditions with RPM, including:

  • Diabetes
  • Obesity
  • Chronic kidney failure
  • Hypertension
  • Chronic heart failure
  • COPD

Patients take daily vital readings, such as blood pressure, A1C, weight, and oxygen saturation. These numbers automatically transmit into an RPM software platform. Clinicians review these readings, looking for any critical readings or trends that need intervention. 

This is the basic workflow of an RPM program. The more data you collect, the better clinical decisions you can make. It supports improved quality of life for those with one or more chronic diseases.  

Putting an RPM plan in place is not without its challenges. Many of these correlate with building and sustaining a program.  

Benefits of RPM healthcare

What can you expect from an RPM healthcare program? The benefits for patients and care teams are significant.

Collect data to inform care decisions.

The age of data in healthcare delivers keen insights into how patients deal with chronic diseases daily. You wouldn’t be able to glean this from the few annual interactions you have with them. Visibility into conditions, their progression, and treatment effectiveness are now within reach.  

All patients using RPM are at risk and often end up in the emergency department (ED). These may have been avoidable with RPM. Gathering data easily through connected devices gives you a clearer picture of each individual’s health. You’ll use this to adjust care plans, often leading to better clinical outcomes.

Strengthen care coordination and continuity.

The patients you monitor with RPM may have multiple conditions. Care teams can include a variety of specialists along with primary care physicians. Ensuring all parties have access to the vital readings improves care coordination and continuity. Readings sync into the EHR (electronic health record). As a result, everyone has information, which removes blind spots. 

Intervene at the right time.

As noted, chronic condition patients often seek care in the ED. Without the connection between patients and clinical monitoring, people are more likely to head to the ED. This strains the healthcare system and often results in subpar care, as the physicians in the ED don’t know the patient’s history.  

Ideally, RPM should facilitate immediate mitigation. Studies support the idea that RPM does reduce ED visits and readmissions. A review of 91 studies on RPM and its impact on acute care determined that 49% reported decreases in ED visits.  

Achieving intervention requires an escalation process with monitoring teams. It should be a built-in feature in RPM software. It would involve these steps: 

  1. Patients have their threshold for vitals configured in the platform.
  2. Nursing teams track patient vitals and review them, often contacting individuals for more information. 
  3. If deemed critical, the nurse will escalate it to the attending physician.
  4. Doctors then provide instructions to patients, including recommendations to take medications, titrate dosage, or come into the clinic. 

Get insights into disease progression and treatment efficacy. 

Chronic disease patients can be in many phases of their condition. Progression of it and treatment effectiveness are more concrete when you have daily vital data. Based on these learnings, you can discern if patients are seeing better outcomes. Those could include a drop in A1C, lower blood pressure, and weight loss.  

On the other hand, you will also have information if these things worsen. Each piece of data sheds light on how a patient is managing their chronic disease. It can inform what you prescribe in terms of medication or activities. Vitals offer critical context to improving patient outcomes.

Improve patient engagement.

RPM can be an avenue for better patient engagement. With such a program, clinical monitoring teams have regular communication with patients and increase touchpoints. You’re engaging with them daily, which increases their ownership in the care plan. Patients who have not been able to keep up with follow-ups or complicated treatment plans now have an opportunity to be more involved in their health. 

Grow revenue with reimbursement support.

The central benefits of RPM healthcare relate to care and clinical outcomes. There is also the revenue aspect for practices. Ensuring that billing and reimbursements are part of the RPM solution you choose enables you to manage this more easily. The technology tracks the time spent with patients, which is crucial for claims.  

Additionally, with clinical monitoring services, eligibility, and onboarding provided by your RPM vendor, you can expand the program to more patients, increasing reimbursement.

In reviewing the challenges and benefits of RPM, you’ll need a robust platform and clinical monitoring services to overcome the latter and realize the former.

The top challenges of deploying an RPM program and solutions

Establishing RPM healthcare has many dimensions and requirements. Many healthcare organizations have concerns about setting up RPM and allocating the resources to monitor patients. These challenges prevent practices and physicians from taking advantage of implementing such programs that would bring significant benefits to patients with chronic conditions.  

Defining patient populations that are a good match for RPM

The first part of the process is identifying which patients are good candidates for RPM. This would involve looking at the criteria of your patient population. The delivery of RPM services doesn’t require a specific diagnosis. Most likely, a substantial segment of your patients would benefit from RPM healthcare.

Solution: Work with a seasoned RPM company to alleviate the burden of this step and have the vendor help you onboard suitable patients.

Ensuring insurance eligibility

Once you identify patients, you’ll need to make sure their insurance covers RPM. Medicare and Medicaid have specific CPT® code reimbursements. Private insurance may also reimburse for RPM. It can be a lot of paper-pushing.

Solution: Pass this on to your RPM vendor. They should use HIPAA-secure tools to determine insurance eligibility.

Getting patients onboarded successfully

Each patient using RPM must undergo onboarding and education on using their connected device and the importance of taking daily readings. 

Solution: Partner with an RPM service provider who supports patient onboarding and device shipping. The process should be easy for them and you. Onboarding should be flexible with on-site, virtual, or hybrid options. Your RPM healthcare vendor should also be able to handle shipping logistics for you.

Staffing clinical monitoring

This RPM healthcare challenge is the most common. RPM requires constant monitoring by licensed healthcare professionals. Small practices and large healthcare systems each struggle with resource allocation. 

Solution: Outsource this to your RPM partner. Our U.S.-based, licensed nurses with clinical expertise monitor patients for you. It involves 1:1 engagement between nurses and patients. Nurses communicate with those using RPM devices, reminding them to take readings. They are the first point of contact for triage if these go outside the designated norm. If deemed serious, they escalate critical readings to physicians for intervention. Clinical monitoring services allow you to expand the RPM program with nurses who function as an extension of your care team.

Managing billing and revenue

Another challenge healthcare providers may face is understanding the billing cycle and managing reimbursement. Without specific features in RPM software, it becomes cumbersome to keep documentation of the monitoring services provided manually. 

Solution: Choose an RPM software with features for measuring, calculating, and assessing revenue data.

These obstacles may be keeping you from launching RPM. The good news is that they are easy to overcome. When all these things are solvable, you and your patients realize the benefits of RPM. 

Optimize Health solutions for RPM healthcare 

In building an RPM healthcare program, you’ll need solutions from a trusted partner that offers technology and monitoring services. Optimize Health is a leader in both. Here’s what you can expect from our solutions. 

RPM software that’s accessible and feature-rich

The heart of your RPM program is the software you use, and we provide a platform that includes all the functionality you’ll need to deploy and maintain your program, including:

  • Viewing vitals anytime and anywhere with prioritization, new reading timestamps, and evaluations in graph form
  • Accessing all patients across your practice in one view with search functionality and custom configurations
  • Tracking the progress of each patient with thresholds for each individual and personalizing care plans
  • Engaging patients with two-way communication in the platform by phone or text
  • Management of billing and revenue in one spot with real-time data views 

Clinical monitoring services to power RPM programs

In this RPM solution discussion, there are also all the services needed to get a program started and to grow it. These things are just as important as the software. Our clinical services include:

  • Patient identification: We help you find patients best suited for RPM.
  • Insurance eligibility verification: Our RPM experts determine who in the patient population has coverage through Medicare, Medicaid, or private insurance.
  • Patient onboarding: Our implementation is full-service. We can onboard and educate patients on-site, virtually, or in a hybrid model.
  • Clinical monitoring of patients: Our nurse teams are based in the U.S. and licensed. They track patient readings and have specific expertise in RPM. They can triage, communicate, and escalate as needed.

Cellular-connected patient-friendly devices delivered to patients

We provide the devices needed for your patients, shipping them to their homes. We recommend cellular devices over Bluetooth. A cellular network supports more devices across a network by leveraging the higher speed of 5G. It allows for data collection from devices to occur in real-time and is more stable than Bluetooth, which requires uninterrupted Wi-Fi access and apps on smartphones. 

FAQs about RPM healthcare

What are the requirements for an RPM healthcare program?

For a compliant, billable RPM program, you’ll need the following things:

  • Patient consent to monitoring
  • FDA-approved connected devices, along with onboarding and education
  • A compliant platform to collect physiologic data that then transmits to RPM software
  • Monitoring of the vital readings by licensed clinical staff
  • Additional requirements around time spent and set up to bill for specific codes

What conditions qualify for remote patient monitoring?

Common conditions for RPM include hypertension, diabetes, heart failure, lung disease, chronic kidney disease, obesity, and pain management. RPM does NOT require a specific diagnosis.

How do connected devices and RPM software work together?

Devices record the vitals and sync automatically with the software. The RPM solution will also share the data to the patient’s EHR. Readings can trigger alerts if they are outside of the thresholds set, and data exchange occurs continuously. 

What types of RPM devices are available?

The most common include:

  • Blood pressure monitors
  • Blood glucose trackers
  • Weight scales
  • Pulse oximeters
  • Cardiac monitor
  • Spirometer

Are RPM devices safe, secure, and compliant?

All devices we provide are FDA-approved and HIPAA-compliant. The agency requires many components to ensure they are safe to use. Additionally, manufacturers must have processes in place for data security. 

Who can provide RPM clinical monitoring services to patients?

Clinical staff under the general supervision of a physician can perform monitoring. You can outsource this to your RPM provider. Our solutions include U.S.-based licensed nurses who monitor vitals from connected devices and respond appropriately. 

Get started with RPM healthcare today with Optimize Health

RPM has life-changing benefits for your patients. Having a program in place can ensure that chronic disease patients get the attention they need. You’ll enjoy a turnkey RPM program with our solution. From software to connected devices to clinical monitoring, you’ll be able to streamline and grow RPM to help your diverse patient population.

Begin your RPM journey by booking a consultation with our experts.