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:
- 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.
- 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.
- 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:
- Reduce readmission
- Reduce use of emergency room – divert them to a provider encounter
- Increased access to care
- Intervene Prior to clinical event(s)
- Enhance patient engagement via continuous care delivery model
- Advance patient journey along an awareness to wellness continuum
- Enhanced Clinical and Financial Outcomes
Those noted outcomes and others should be outlined as stated objective of your RPM program.
- Out of Pocket Expenses: There are two major items to clarify before finalizing your plan:
- Purchase on the medical device – there are approaches which mitigate cash out of pocket to cover the cost of the medical devices
- Logistics cost associated with getting the medical device into the hands of the patient
- 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:
- Proper training and expectation setting with participating patients
- Establishing personalize measure/care plan for each patient
- Ensure your RPM platform has an internal clock that captures patient engagement time as well as logs respective activities
- Establish workflow/protocol to handle the escalation of alerts indicating patient physiological measure has breach defined measure.
- 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.