As part of digital health technologies, remote patient monitoring (RPM) has been used for disease management, like pacemakers or implantable cardioverter-defibrillators, for many years. The COVID-19 pandemic prompted expanded coverage and reimbursement in 2020, leading to accelerated RPM adoption and research into more potential applications.
Two recent journal articles by Harvard researchers, Tan, et al, highlight adoption trends by provider specialty, geographical location, and diagnosis in two studies. The first article, published in Health Affairs, looked at RPM claims from January 2019 through March 2021 with 20M commercial and Medicare Advantage enrollees. The second article, published in JAMA Internal Medicine, looked at RPM claims from February 2020 through September 2021 with traditional Medicare enrollees. Below is a recap.
Remote patient monitoring adoption and claims for commercial and MA enrollees
January 2019 to March 2021
Remote patient monitoring claims data:
- 20M commercial and Medicare Advantage annual enrollees from the Optum Labs Data Warehouse
Remote patient monitoring research results:
- During the pandemic, March 2020-March 2021, general RPM claims increased by 400%
- 50% of all general RPM claims were from primary care providers (PCPs)
- 342 providers generated 69% of general RPM claims
- Of those 40% (136 providers) were high-volume prescribers of RPM
- Six out of the top 10 markets in the U.S. for general RPM user were in the southern U.S.
- 51% of patients stayed on RPM six months after they were onboarded
Notable outcome:
“There were modest or no differences in remote patient monitoring use based on condition complexity, number of chronic conditions, and disease control."
Remote patient monitoring adoption and claims for traditional Medicare enrollees
February 2020 to September 2021
Remote patient monitoring claims data:
- Traditional Medicare enrollees
Remote patient monitoring research results:
- During the pandemic, February 2020-September 2021, general RPM claims increased by 555%
- 63.1% of all general RPM claims were from primary care providers (PCPs)
- 17.7% of all general RPM claims were for cardiology
- 4.1% of all general RPM claims were for pulmonary
- The diagnoses with the most use of general RPM were 62.5% for hypertension, 8.3% for diabetes, and 3.9% for sleep disorders
Notable outcome:
“Costs must be balanced with RPM's potential benefits, such as reducing hospital admissions. Randomized clinical trials of RPM showed mixed results overall, but some targeted use cases showed promise."
Remote patient monitoring value requires financial and tech standards
Traditional RPM use for heart issues, like atrial fibrillation, have proven to reduce cost, heighten surveillance, and supplement in-office care. The increase adoption of RPM during the pandemic, however, raises questions around novel value and use cases, as well as how to address reimbursement going forward. Additionally, the use of digital health and IoT devices in the home are widening what may be considered remote patient monitoring.
According to an editorial by Ms. Mecklai, et al, in the New England Journal of Medicine, “Research is urgently needed to elucidate which patients benefit most from RPM services and which devices and specifications provide the highest clinical value."
RPM shows early promise, but further research is needed
A 2018 meta-analysis of RPM randomized controlled trials (RCTs) showed “early promise in improving outcomes for patients with select conditions, including obstructive pulmonary disease, Parkinson's disease, hypertension, and low back pain." However, many studies noted the need for further research.
Hypertension: Subjects over 55 years old using remote patient monitoring “experienced significant decreases in the adjusted mean sitting systolic blood pressure when compared to the control group." Their findings indicate that RPM could be effective in hypertension treatment for a select patient cohort, possibly those of a certain age range.
Chronic obstructive pulmonary disease and heart failure: Patients received telehealth equipment to monitor vital signs daily. Those in the intervention group had less hospitalizations, emergency department visits, and shorter lengths of stay, however their results weren't statistically significant when compared to the control group. Yet, the costs savings were $2931 per person, which indicated that a larger study might see significant cost and utilization savings.
The potential for remote patient monitoring is coming to light during increased adoption and innovation precipitated by the pandemic. When the public health emergency ends, the federal government will adjust reimbursement for the longer term. Before then, however, healthcare providers will need to analyze the value to their patients and clinicians, as well as its potential to lower cost and scale care with current workforce constraints.
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