By JAY BEST
- An American Hospital Association Annual Survey conducted in 2018 revealed that over 60 percent of hospitals have implemented some level of remote patient monitoring program (American Hospital Association, 2019).
- 68 percent of physicians surveyed by the Consumer Technology Association, “strongly intend to use remote patient monitoring technology in the future” (Pennic, 2019).
- The Spyglass Trends in Remote Patient Monitoring 2019 report revealed that 88 percent of providers surveyed either desire to or have already invested in RPM technologies to manage readmission risk in their unstable chronic care management population (Spyglass Consulting, 2019).
- Three new CPT codes were released by CMS in January 2019 that enable reimbursement of RPM physiologic monitoring services.
- The new reimbursement opportunities for RPM services, themselves, make RPM programs more attractive to long-term care; especially coupled with the recent ability to be reimbursed for providing chronic care management to patients with a single chronic disease.
To date, many hospital systems are scrapping their remote patient monitoring (RPM) programs. The reason; the RPM systems are not working to improve patient health as proactive actions are not executed as intended. However, all is not lost, as there are solutions which are working - but in an unexpected way.
The current offerings of RPM devices in the marketplace are technology-only, data-centric solutions. In other words, they are a pure tech play that only provides results back to an EMR. This data then must be acted upon by a clinician, or another healthcare worker. However, there is not always a vested interest by that hospital staff to act. Instead, they are deeming the alerts as insignificant.
An example would be sudden weight gain. If an RPM device reports back to the EMR that there is a sudden 6lbs gained by the patient, an alert is sent to the responsible staff member to act. Yet sudden weight gain is not an actionable event for most hospital staff. Rather, it is perceived as frivolous information in the scheme of all that bombards the clinician on a daily basis. Thus, nothing happens. But a 3lb weight gain can be serious in a CHF patient. If no action takes place to validate the weight gain or the acuity level of the alert, the patient likely ends up back in the ER - exactly what the RPM was designed to prevent.
There is a clear disconnect between the RPM, the patient, and hospital staff; perceived acuity and taking action. Actionable events reported by the RPM are usually reserved for serious indicators - such as a massive spike in blood pressure or heart rate. However, there are many indicators that must also be taken seriously. Weight gain, oxygenation of the blood, cardiac output, etc. can all be serious indicators of emergencies. But the acute care hospitals just do not have the staffing model that accommodates tracking of risk and complications in the ambulatory care arena.
The disconnect between the RPM results and hospital staff is solved with an intermediary service. A warm observation of all RPM alerts must be acted upon by a dedicated clinician in order for the system to reach full potential. This is the only proven method that creates success in an RPM system is to include a clinical wrapper.
Hospitals should not consider an RPM solution which does not include dedicated clinician monitoring results. If left to already overburdened hospital staff, much of the RPM’s results will go unchecked. It is the lack of dedicated staff that is fueling the RPM failures nationwide.
Going forward, RPM will succeed, but hospital systems must acknowledge that the tech alone is not enough. A warm delivery of the information, by way of a phone call to the primary physician, or pharmacy, is the only way to guarantee success given the current technology offerings.
John (Jay) Best is a partner in Nahakama Investments, CEO of Total Medical Concepts and Chief Sales Officer of NAHA Health, a multi-platform healthcare consortium focused primarily on transitional, chronic, critical, and behavioral post-discharge patient care. He can be reached at firstname.lastname@example.org, or visit www.nahakama.com