Improve Patient Outcomes – Increase Financial Performance

5 Key Criteria to Realize the Benefits of Remote Patient Monitoring

Remote Patient Monitoring (RPM) fundamentals provide a significant tool to payers and providers to close the gap in care.  If the care plan is to drive toward a better state of wellness, then what happens when the patient is outside the presence of their provider(s) is critical.  Study after study reflects the value of patient engagement – the more you engage in a material manner – the greater the response.  RPM is a tool that encourages patient engagement wherever they may be.

The top line opportunity promotes the idea that Remote Patient Monitoring (RPM) can drive a significant amount of new revenue for a given provider.  After all, CMS will pay a total of $188 per patient per month (PPPM) when criteria for the respective CPT codes (ie. 99454, 99457 and 99458(twice)) are achieved.  Eating that $188 PPPM carrot is much more difficult than painted by many vendors first – it would drive an audit flag if every RPM patient was billed at the maximize allowable.

The following outlines 5 key criteria to realize the clinical and financial performance when adopting RPM:

  1. Patient Adherence: RPM CPT code 99454 requires the patient to submit a clinical measure, automatically submitted via a medical device, on 16 days within a 30-day period. There are two key elements to understand:
    • What is the past performance of your potential RPM partner – what percentage of the patient base reported a measure on 16 days within a 30-day period? A strong target would be 95%
    • What are you being asked to pay if 99454 criteria if not met? Quick answer – you should pay nothing.
  2. Patient Engagement/Experience: RPM CPT code 99457 and 99458(2) permits 3 separate 20-minute segments. The same questions need to be asked.
    • Every patient base is different; however, it is worthwhile to know the previous performance: percentage criteria billed for 99457 and 99458. A strong measure would to engage patients, on average, of 40 minutes (10 minutes per week) across your patient panel.
    • Certainly, you should only pay your vendor when they achieve defined criteria.
  3. Outcomes: Whether adopting RPM in a Fee-For-Service (FFS) model or in a risk-oriented environment – value is all about the patient changing behaviors and moving toward a greater state of wellness. So, what is your desired outcomes?  Don’t partner with an RPM patient or register a patient into the program unless you know what outcomes have been mutually established.  Certainly, outcomes to consider are:
    1. Reduce readmission
    2. Reduce use of emergency room – divert them to a provider encounter
    3. Increased access to care
    4. Intervene Prior to clinical event(s)
    5. Enhance patient engagement via continuous care delivery model
    6. Advance patient journey along an awareness to wellness continuum
    7. Enhanced Clinical and Financial Outcomes

Those noted outcomes and others should be outlined as stated objective of your RPM program.

  1. Out of Pocket Expenses: There are two major items to clarify before finalizing your plan:
    1. Purchase on the medical device – there are approaches which mitigate cash out of pocket to cover the cost of the medical devices
    2. Logistics cost associated with getting the medical device into the hands of the patient
    3. Integrating the RPM system with your EHR and/or your billing system
  • Risk Management: Aside from the 4 key elements outlined above there are specific program elements to be considered:
    1. Proper training and expectation setting with participating patients
    2. Establishing personalize measure/care plan for each patient
    3. Ensure your RPM platform has an internal clock that captures patient engagement time as well as logs respective activities
    4. Establish workflow/protocol to handle the escalation of alerts indicating patient physiological measure has breach defined measure.
    5. Does your RPM program also include Telehealth and Chronic Care Management (CCM) capabilities? It should.

Upon successful implementation of your RPM program – you may want to explore further enhancing your delivery of care model it would be a good time to consider adding CCM coupled with Principal Care Management (PCM).

Written by Nicole Guethler, Sr Manager, Patient Experience at GenieMD.