formerly Centura Health

Gerard Frunzi

Telehealth became a household name during the COVID-19 pandemic. Most of the expansion was live video visits with providers. Remote patient monitoring (RPM) and a new offering, remote therapeutic monitoring (RTM), are not commonly known and have not seen national adoption like video visits. This article will review some of the issues and barriers surrounding RPM and what the future might hold. 

Before 2020, if I had a conversation with a stranger asking what I did for a living, I'd answer I was in business operations at a hospital system. There was just too much effort explaining telehealth to strangers. Now, it's an engaging conversation with strangers. Everyone has experience with telemedicine and has a strong opinion about it. Some truly love it, while others dislike it. 

RPM involves the use of technology to monitor patient health outside brick-and-mortar healthcare facilities. It allows healthcare providers to track vital signs, symptoms, and other health data remotely, enabling timely interventions and personalized care plans. RTM is an expansion into therapy-based services leveraging similar technologies, gaining acceptance with Medicaid coverage that started in 2022.

The uptake of RPM was significant throughout the pandemic, seeing well over 1000 percent increase since 2020. Care by video care had a different trend of acceptance than RPM. Video care skyrocketed in 2020 and then slowed down steadily to the new normal. RPM, on the other hand, did not do the 2020 skyrocket and has instead steadily increased over the years, with the most significant jump this past year. This recent jump can be attributed to better coverage by private insurance and Medicare. State Medicaid has not yet fully embraced RPM nationally. For example, coverage for RPM in some states Medicaid might be limited to home health patients or, in another example, only for a subset of cardiology patients. 

"Remote therapy monitoring is the newest version and has promising opportunities for patients needing therapy restorative care.’"

Organizational adoption of RPM has been an issue. The startup costs are notable for licensing, logistics, and labor to start an RPM program. Creating an RPM service is much more complex than a project adding video for telehealth. Integrating RPM into the electronic medical record can be costly as it’s not well standardized for integration or interoperability. There are far too many systems and clinical groups that lack even the option to leverage RPM for patient care. 

Groups that have gone through the investment to initiate RPM must also address the barriers to expanding the program. Each new offering is built for a clinical use case. This requires time and effort by the telehealth program, IT technical team, and clinician partners. Figuring out which tools to include in the home kit, setting alert barriers, and building customization for services. Beyond state Medicare coverage issues, Federal Medicaid and private insurance reimbursement is limited. It is not going to be a large profit center like emergency care. Diligent program support to maximize reimbursement can slightly exceed the cost of physician and nursing time. There are large organizations focused on RPM having success, unlike many hospital systems.

Clinicians have yet to universally accept RPM as part of the standard of care. Many services like cardiology have seen great evidence-based practice demonstrating the quality care that comes with RPM. The opportunity to do it for more patients and expand the services to new disease states is often bypassed in the name of continuing with the current care model. That is one of the top issues of telehealth adoption. The opinion is that the patient is taken care of well enough with current services. Alternatively, there is no pull where patients expect to have a home kit RPM product. More are expecting wearable support for their smart devices, which is a far cry from the rigor and quality of an RPM program.

RTM has yet to be fully accepted by private insurance as a few of the big names have not adopted and covered those codes. In 2024 and beyond, I expect to see better coverage for these types of services out of the home. CMS has led RTM as an offering, differentiating it from traditional remote monitoring. Recognizing there are opportunities for therapy service expansion and approaching that part of care in a new manner.

In conclusion, while remote patient monitoring holds immense potential to transform healthcare, it remains a relatively unknown concept to the general public. Overcoming challenges related to awareness, insurance coverage, and technical barriers is essential for RPM to become a household name. Remote therapy monitoring is the newest version and has promising opportunities for patients needing therapy restorative care. As technology continues to evolve and stakeholders collaborate to address these challenges, remote patient monitoring can only continue moving further into the public square with more acceptance. State support of RPM has far too many restrictions and needs to change. The next phase will be patients expecting better at-home monitoring and care, allowing for RPM to fulfill the system's needs.