Using Remote Patient Monitoring to Improve Quality Metrics, Experience

Interest in remote patient monitoring (RPM) is on the rise, and this interest is not limited to large, well-resourced health systems alone. Even smaller medical groups and rural private practices are taking advantage of this care modality.

About 40 percent of 103 C-suite executives, clinical leaders, and healthcare professionals said that they are currently using RPM solutions, according to a survey conducted by Sage Growth Partners, on behalf of RPM company WebCareHealth, in the summer. Of those who used RPM, 67 percent reported reduced emergency department visits, 48 percent reported fewer avoidable admissions, and 44 percent reported reduced risk of adverse events.

Alan Smith, MD, a family medicine physician in Delta, Utah, is among the practitioners using RPM with the aim of improving patient outcomes. Smith provides the full spectrum of family medicine, from obstetrics and delivery to geriatrics.

Smith started looking into RPM for his practice, Delta Family Medicine-Revere Health, about 18 months ago as a way to keep track of patient's health without having them travel to his clinic.

"We are a rural community, and we have many outlying areas, and it became difficult for me to get my patients to really come in on a regular basis to follow up on certain things," Smith said in a phone interview.

Setting up the RPM program

It took Smith about six months to get the ball rolling on RPM. He began by doing some research on RPM platforms and services, and eventually settled on 100Plus' offering.

100Plus provides all the equipment and technology support to the patients, and also gathers data and makes it available to care teams via its website. Further, the platform has an artificial intelligence-driven virtual medical assistant that reminds patients to check their vitals and provides positive reinforcement to users.

Smith uses the RPM platform primarily to keep track of patients' blood pressure and blood sugar control.

"I can see directly in real time what the patient's numbers are doing which is quite interesting," Smith said. "When I see a patient — for example, I saw several patients yesterday who came in for a routine checkup and I could see what their blood pressure and what their blood sugars were that morning."

Overall, Smith sees close to 8,000 patients a year. Of these, he remotely monitors between 175 and 180 patients.

In addition to diabetes and blood pressure control, Smith uses RPM for weight management.

"More specifically for patients with congestive heart failure, monitoring their fluid levels with daily weight measurement — not necessarily a weight loss program — but it's been a very, very enlightening proposition," he said.

A staff member at Smith's clinic is tasked with reviewing all the patient-generated data once a week, examining usage and looking for trends. The staff member alerts Smith to anything unusual. Smith himself reviews each group of data for each patient once a month.

As for reimbursement, Smith bills Medicare for his time and his staff's.

"It is actually a good process," he said. "As far as income extension, I can pay for my staff's time and my time. And it makes [the RPM service] very worthwhile from a financial standpoint too."

Challenges of implementing RPM

Getting patients to buy in was the biggest hurdle Smith faced.

"When I set it up, I was worried that my patients would think that this was a gimmick or that this was a fraud type process that they were being approached with," he said.

So, Smith handpicked certain patients and sent them a letter explaining the RPM platform and the program. Once the patient agreed to be a part of the program, they received the equipment in about a week.

The logistics of the program from that point on were simpler than one might assume. The devices require very little effort from the patient side, automatically taking the readings and transmitting it to the company.

But, as the program continued, another problem emerged.

"Some patients were very enthusiastic initially, but then the enthusiasm waxes and wanes as time goes by," Smith said.

Smith and his staff have had to ensure that they are motivating their patients to keep using the equipment. This is where the platform's virtual medical assistant has especially come in handy, providing feedback to the patient on their metrics and reminding them to check their vitals.

"Some places that are focusing only on quality metrics, for example, would send [patients a] blood pressure machine, [and] once they get their blood pressure under control, then they would stop the remote patient monitoring," he said. "I don't do it that way. I like to keep [RPM] as an ongoing process with my patients because month after month, year after year, situations change and someone that was in control [of their health] six months ago is no longer in control."

Program results

Smith has seen improved quality measures since launching the RPM program.

As part of Revere Health, Smith helps run a Medicare accountable care organization. Successfully running an ACO involves keep a tight rein on quality metrics, and as a result, Revere Health closely monitors patient vitals, including blood pressure control and hemoglobin A1C among diabetics, Smith said.

Since implementing the RPM program, the percentage of Smith's patients that reach the ACO's goals for blood pressure and blood sugar control have increased to over 90 percent, as compared with about 60 percent prior to using RPM.

Another major boon of the RPM program has been patients taking control of their own health.

"It's helped give the patient something tangible that they can do to help with their healthcare," Smith said. "For blood pressure for example, of course, it may be quite tedious to have to check their blood pressure every day, and that may seem even obsessive, but it helps people to be involved."

From an individual patient-to-patient perspective, the RPM experience has "been very, very good," he added.

Smith does not have any current plans to grow his RPM program, though he is keeping an eye on how the technology evolves.

"I don't have personal plans to expand any further, at least until I can see more equipment come out," he said. "There's quite a few things that can be done with cardiac rhythm control and those things. I think they're going to be very important as the time goes by, but I haven't seen anything yet on the equipment side that I have wanted to jump into yet."