Vendor Survey IDs Challenges for Remote Patient Monitoring Programs

A vendor-initiated study on remote patient monitoring programs that address patients with cardiac disease finds that many are missing out on important clinical and financial benefits.

Conducted by RPM vendor Vector Remote Care, the survey of more than 110 healthcare providers specializing in cardiology found that roughly 43 percent of physicians are only using RPM platforms for 20 percent or less of their patients. The findings suggest that providers don’t yet have the resources to expand their platforms or they aren’t yet sure how to run the program properly.

“These numbers are not surprising, as RCM is still relatively new,” Kristin Stitt, DNP, APRN, the company’s chief clinical officer, said in a press release. “Strong satisfaction with a program that has low connection rates indicates that many practices focus on getting the devices up and running, but are not fully aware of what is possible when you design your program around patient care.”

The study offers an early look at the potential and challenges of a fast-growing connected health service, due in part to the coronavirus pandemic. Faced with reducing in-person care and isolating both patients and providers to reduce the chance of infection, health systems are launching RPM programs to push as much care as they can into the home.

Vector’s research focuses on a long-term approach to RPM – using telehealth and mHealth tools for care management of specific populations, such as those with chronic conditions. Some health systems have moved beyond COVID-19 to target those populations, and they’re finding challenges in identifying the right patients, tools and measurable outcomes.

The survey found that almost 94 percent are using RPM to track rhythm management, but a third are collecting that data from less than 60 percent of their patients. Also, less than 68 percent are monitoring for heart failure, and less than 15 percent are tracking hypertension.

“These numbers indicate missed opportunities,” the report points out. “In the year following their hospitalization for heart failure, 61.3 percent of patients with hypertension and a first diagnosis of heart failure are readmitted and 21.4 percent die within a year of discharge. Capturing actionable warning signs in a timely manner offers clinicians more options aimed at preventing those outcomes and improving the patient’s quality of life.”

Aside from making sure the program is gathering the right data, an RPM program needs to get as many patients that fit the profile as possible on board. According to the study, those programs with 80 percent of more of their target population enrolled are getting the revenue they need to keep going, while those with 60 percent or less connected are reporting challenges meeting their costs.

Add to that the reality that RPM is a tricky program to launch and get right.

“The reasons for sub-optimal utilization are likely complex,” the report notes. “(Remote cardiac monitoring) and RPM are relatively new and not all practices are fully prepared to integrate them into their workflows before instituting their programs. Monitoring implantable cardiac devices for arrhythmias alone demands a dizzying array of data and patient management tasks, including managing transmissions from different devices via different manufacturers’ portals, resetting devices, and following up with patients. This is time-consuming work even with a dedicated device clinic, which not all practices have.”

The report also notes the challenges with specializing in cardiac monitoring. Specialists may be fluent in rhythm management, but not physiological monitoring for heart failure, and the chances of a hospital or clinic having the right specialists on hand are low. A provider may have to coordinate with primary care while integrating different subspecialties, just to make sure all the relevant data points are covered and analyzed properly.

“Add to all this the challenge of coding properly for reimbursement and, perhaps, underutilization becomes understandable.”

But not unsolvable. It all points to the need to plan an RPM program well in advance of launching one, and to make sure all the issues are addressed.

“Successful programs address the overwhelming administrative tasks by using technology and strategically-informed workflows to free clinicians and device experts to work to the top of their licensures and abilities,” the report says. “This investment of time and resources typically only happens with buy-in and support from practice leaders. If they haven’t already, those leaders, particularly physicians, might need to spend some time with their monitoring teams to see firsthand what a time-consuming effort monitoring is.”

Those challenges may be why payers are moving slowly to embrace RPM, and the Centers for Medicare & Medicaid Services is only offering Medicare coverage for certain and small parts of the process – and separate from telehealth reimbursements. They want proof that RPM will boost outcomes and reduce wasteful spending, and when the research and studies start coming in from health systems and hospitals who’ve used the platform and demonstrated sustainability, the coverage will improve.

Finally, the Vector study also delves into whether providers should take on an RPM program in-house or using a third-party vendor to run the program. It suggests that in-house programs are more apt to struggle, while those outsourcing the platform are reporting much higher satisfaction rates. Those results have to be taken with a grain of salt, considering the survey was conducted by a company selling those services.

That said, providers need to assess their capabilities to run an RPM program. Can they train staff (especially nurses) and adjust workflows to comfortably handle RPM, or will the program cost more in time and effort than it’s worth? Conversely, will a third-party vendor deliver the results that a provider needs to justify both the expense and the separation of services?

In any case, this study offers a good perspective of how the RPM market is evolving, and how vendors are seeing opportunities to help providers move forward. With the platform sure to be part of the healthcare ecosystem from now on, it’s incumbent on care providers to weigh the risks and benefits and plan well in advance.