Practical steps for remote patient monitoring service line success

MGMA Stat - September 17, 2020

Electronic Health Records

Patient Care Technology

MGMA Staff Members

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: “Does your practice offer remote monitoring services?” The majority (79%) answered “no,” while 21% responded “yes.” The most popular responses were cardiac monitoring and blood pressure monitoring. The poll was conducted September 15, 2020, with 845 applicable responses.

The results show that the expansion of remote patient monitoring services remains slow. A June 13, 2017, MGMA Stat poll, which revealed that only 6% of medical practice leaders use data from patients’ consumer/health wearables, whereas 81% of respondents said they were not.

As Katie Nunn, MBA, CMPE, chief executive officer, Bright Ideas Medical Consulting LLC, recently wrote in an MGMA Connection article

Remote patient monitoring (RPM) is more than just fancy activity trackers. It is a way to reduce hospital admissions, lower healthcare costs and provide better care and outcomes for patients. With RPM, physicians can leverage data to help give patients better feedback regarding their conditions and treatment. In addition, RPM can also be a way to increase revenue for outpatient practices.

In simple terms, RPM is a device that collects patient data and transmits it via the internet to a physician. The collected data allows a physician to monitor changes in patient vital signs and act accordingly. There are many types of devices on the market, which all monitor different vital
signs.
Components of an RPM program
Nunn notes that “most medical practices work with a vendor to supply devices and the monitoring platform. The Centers for Medicare & Medicaid Services (CMS) now allows these services to be outsourced completely, so practices can decide between setting patients up and providing monitoring or outsourcing all services.” According to Dunn, these include: 
  • Device
  • Monitoring platform
  • Staff time to initiate patients
  • Staff time to perform patient setup
  • Staff time for billing.
RPM’s growth during the COVID-19 pandemic 
As a subset of telehealth, RPM has increasingly been adopted during the COVID-19 pandemic for several reasons, including policy changes, contactless care, ease of use, improved patient monitoring that leads to a reduction in readmissions. In March, CMS expanded Medicare coverage for RPM for patients with acute conditions, as well as for new and existing patients. In addition, the U.S. Food and Drug Administration (FDA) introduced a new policy allowing FDA-approved non-invasive devices for monitoring vital signs in remote settings. 

This led hospital systems such as Mount Sinai in New York to establish RPM programs to monitor vital sign and symptom data and evaluate the condition of COVID-19 patients. It also opened the door for others, such as Mayo Clinic in Minneapolis, to create RPM programs for patients with congestive heart failure

RMPs are particularly important for patients with chronic and acute health conditions who are safer at home during the pandemic, as practices can monitor their condition and take appropriate measures if their condition worsens without potential exposure from an office visit.

Patient data can be collected and monitored for several health-related metrics, including blood pressure, blood sugar levels, electrocardiograms, heart rate, vital signs and weight. In turn, EHR vendors have made it easy to synchronize devices to platforms to track key metrics. RPM has been an asset during the pandemic because it makes contactless monitoring possible between physicians and patients, which can help when deciding on a course of treatment. 

In addition to COVID-19 necessitating the use of RPM for patients who don’t need to come to an office, there are other factors that can make RPM a key aspect of continuity of care. 
  • Reimbursement and CPT codes — Most RPM payments are billed to RPM services under four CPT codes: 99453, 99454, 99457 and 99458. The services, which include initial patient enrollment, a monthly payment to manage the device and readings, and optional clinician care management, can earn practices up to $210 per patient, per month. 
  • Medicare — Thanks to Medicare’s broader guidelines, which also permit auxiliary clinical staff under “general supervision” to carry out these services, RPM and chronic care management (CCM) services are able to be billed independently for a patient in the same month. 
  • Increased coverage — Many commercial insurance companies reimburse for RPM as part of their telehealth coverage policies, with some provisions, and some states have made coverage for these services mandatory. Furthermore, several state Medicaid programs reimburse for RPM.
  • Patient buy-in — It’s important for patients to be engaged when participating in an RPM program, because it can lead to better health outcomes. Clinicians can help make patients feel empowered by customizing the program to meet each patient’s needs and comfort level, answering each patient’s questions and concerns regarding technology and clinical oversight, and engaging family and care givers to support each patient. 
Starting RPM in a medical practice
After considering barriers to adoption and selecting the right vendor for your practice, an RPM program should be implemented properly. Dunn suggests the following:
  1. Do a pilot — Start with one provider who will be the “champion” and commit to working the kinks out for the rest of the practice.
  2. Nonphysician provider buy-in — This will not be a huge time commitment for medical assistants (MAs) and nurses, but it can also be something they forget to do on a daily basis. Make sure there’s buy-in, they understand the process and that there is someone reviewing the metrics.
  3. Initial setup — It may be slow at first until staff and providers know what they are doing. Create detailed instructions for patients.
  4. Patient education — Be prepared to educate your patients about the program and have answers ready when questions rise.
    • Have patient phone calls routed to a knowledgeable point person to avoid patient and staff frustration.
    • Make sure patients with issues know not to call physicians at night.
    • Prepare an FAQ on a handout and post it on the practice website.
  5. Billing and coding — Make sure your billing team is up to speed before getting started and that you have a plan in place for capturing charges.
MGMA Stat 
Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat
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