How Providence is Leveraging RPM to Alleviate Clinician Burnout

Evidence that remote patient monitoring (RPM) can enhance healthcare delivery and improve patient outcomes is growing. But, if these services are not implemented effectively, they can exacerbate an ongoing and pervasive problem in healthcare: clinician burnout.

Clinician burnout is a long-term stress reaction, according to the American Medical Association. Symptoms can include emotional exhaustion and depersonalization. While rates of physician burnout were already on the rise, they reached new heights during the COVID-19 pandemic. A survey, which polled 2,500 US physicians between December 2021, and January 2022, shows that nearly 63 percent of physicians had at least one manifestation of burnout in 2021, compared with 38.2 percent in 2020 and 43.9 percent in 2017.

The use of virtual care technologies also skyrocketed during the pandemic. And while virtual care can alleviate some burdens on physicians by providing flexibility in their workflow, it can also add tasks and make care delivery more overwhelming.

Ensuring that RPM implementation did not exacerbate burnout was a key focus for Providence as it implemented and scaled RPM services, according to Eve Cunningham, MD, group vice president and chief of virtual care and digital health. The 52-hospital system recently partnered with health technology company Cadence to add RPM services and a responsive virtual care program to support chronic disease management.

Generally, effective chronic disease management requires frequent communication and data sharing between physicians and patients, which isn't always possible.

"A lot of times, the primary care doctor doesn't have an hour or an hour and a half to go into detail with [the chronic care] patient about some of the things related to their behavioral health issues or related to their diet and exercise," Cunningham said in a phone interview.

Ideally, health systems would employ a collaborative care model for chronic disease management, which includes primary care physicians, behavioral health specialists, pharmacists, and diabetes educators. But with staffing and resource challenges, health systems may not be able to implement this model, leaving the broad spectrum of chronic care to one clinician alone, Cunningham noted.

"It's pretty overwhelming for the clinician when you have a very medically complex patient, and their chart is stacked," she said. "If you had printed it out, it would be stacks and stacks of paper. And then, on top of that, if you don't have resources to support the patient with their complex disease states — these are the types of things that are driving burnout for the clinicians."

Being overwhelmed can result in stress and losing joy in providing healthcare. This, in turn, can lead to poor quality outcomes, low patient satisfaction, and in extreme cases, substance use and other risky behaviors among clinicians, Cunningham added.

This is where RPM can help. The services enable the tracking of health metrics between clinic visits and facilitate real-time communication between clinicians and patients, thereby helping ease the burdens of chronic care management.

For example, consider a patient with high blood pressure, Cunningham said. This patient would typically visit the office, see their physician, and receive a physical examination. Their physician then might adjust their medication based on the exam and the prior blood pressure figures they report, which they measured outside the clinic.

"But then if that blood pressure medicine needs to be further adjusted, it could be weeks to months before they're coming back to see the doc again," she said. "So, physicians are not really able to get the patient in good guideline-directed medical therapy when they have very limited data points over months at a time of the typical routine office visit. With remote patient monitoring, you're now sending the patient home with a device."

These devices allow physicians to adjust medications between clinic visits based on daily blood pressure readings, improving patient outcomes.

However, the patient care benefits of RPM can be outweighed by improper implementation.

First, there is the issue of data. While the data generated by RPM devices provide invaluable insights for clinicians, collecting and analyzing it can be challenging.

"You have to have people to help with ingesting this information and this data…if you want to be able to stand [RPM services] up successfully," Cunningham said. "Otherwise, if you're just going to funnel all of that information and that data to the clinician, they're going to get overwhelmed."

This was a key issue that Providence hoped to solve with its partnership with Cadence, which provided the health system with AI capabilities to support data collection and analysis, as well as a care team. The care team can help gather insights from the analyses, as well as connect with patients, answer questions, and adjust medications on the clinician's behalf, provided a protocol has been developed in partnership with the health system.

"What we found was only 0.5 percent of the actual messages and alerts and things like that came to the primary care doc," Cunningham said. "So, 99 percent of the interactions that occurred could be managed by this team. And so, for the docs, the provider or the advanced practice providers, and the physician that participated in the pilot, it was good because they were able to manage their patients in a different way."

Another strategy Providence used to ensure RPM implementation did not lead to burnout was gaining buy-in through a pilot program. The health system began an RPM model pilot at two Washington clinics, St. Mary Cardiology, and Lacey Family Medicine, in June 2022. Through these, Providence was able to assess the model and find bottlenecks.

For instance, the health system conducted an inbox management study to examine whether the new model of care would add to clinicians' inbox messages and overwhelm them with information, Cunningham said. They found that it would not.

"And that was an important data point because doctors want to see data," she added. "You can't just tell them it's not going to overwhelm their inbox; you actually have to show them."

Not only is it critical to reduce operational burdens associated with RPM services, but it is also important that provider organizations focus on streamlining the billing process for RPM.

The RPM-related CPT codes are relatively new and very challenging to bill for, Cunningham noted. According to an American College of Physicians (ACP) resource, to be reimbursed for RPM services, monitoring must occur for at least 16 days within a 30-day period.

Ensuring staff can complete these requirements is essential. RPM platforms can help by sending reminders when those targets aren't being hit, supporting providers by making it easier to meet them and bill for these services, Cunningham said.

Providence has seen positive results from its RPM model pilot. These services are currently being offered to chronic hypertension and congestive heart failure patients, but the health system plans to expand them to diabetes patients in the near future.

According to Cunningham, patient and provider satisfaction with the program has been high, and there has been a 200-percent increase in guideline-directed medical therapy compliance for congestive heart failure.

"And then we've seen a significant decline or a significant reduction in the average blood pressure for our cohort on hypertension, meaning their average blood pressure is closer to where it needs to be," she added.

Next, the health system plans to integrate the RPM platform with the Epic EHR and expand the program across its Washington service area. The program will eventually be deployed across all seven states where Providence hospitals are located.

Amid this scaling, the health system aims to ensure that the upcoming rollouts also alleviate clinician burnout, allowing clinicians and their patients to benefit from the advantages of RPM.

"You have to be really thoughtful about making sure that you have put all of the things in place so as to not make things worse," Cunningham said. "It's more than just the technology of RPM. It's the support services that are connected to RPM that are centered around the clinician…You can't just throw an RPM platform into the clinical environment and not do the other work, which is the workflow design and being thoughtful about measuring the impact to influence the change, those types of things. You have got to be really thoughtful about that."