The use of remote patient monitoring (RPM) to provide at-home care for a variety of different patient populations — especially seniors and those with chronic disease — has grown by leaps and bounds in recent years. As healthcare organizations move to implement RPM programs, here’s what they should know about the difference between creating an in-house solution, or partnering with a third-party vendor.

What’s RPM? Is it the same as telehealth? Get a primer on digital health terminology here.

Setting up a new RPM program: Where to begin

There are many good reasons for providers to embrace RPM programs. “When used by clinicians, RPM can provide a more holistic view of a patient’s health over time, increase visibility into a patient’s adherence to a treatment, and enable timely intervention before a costly care episode,” as the American Heart Association (AHA) stated in its endorsement of evidence-based RPM programs.

For payers, RPM programs can help curb costs by reducing the number of readmissions and hospitalizations experienced by at-risk patients. And because it empowers and engages patients to better manage their own health, remote care can boost their overall satisfaction, too. And that can also directly benefit payers and providers in terms of higher star ratings and increased referrals.

With that in mind, many providers have seized the opportunities offered by the CMS’ remote patient monitoring reimbursement model. Implemented in 2018, the five CPT® codes that now make up this model offer providers reimbursement for time spent setting up patients on remote devices, consulting with them, and more. You can explore these RPM reimbursement codes in more detail here.

So, what’s the right way to set up an RPM program to best seize the opportunities offered by these codes? The specific answer to that question will depend on the unique circumstances of each organization and its specific patient care needs. But as a starting point, there are two primary types of RPM programs to choose from:

1. An in-house system that’s assembled by the organization, or

2. An outsourced solution that relies upon the services of a third-party vendor.

What’s the difference between in-house and outsourced RPM programs?

The difference between in-house and outsourced RPM programs is precisely as it sounds — in one instance, an organization takes on the responsibility of building a program on its own shoulders. In the other, it partners with a third-party vendor for those services.

Each of these choices is a different way to create and manage an RPM program’s key components, which include:

  • Medical devices, data and integration. Devices are necessary to capture important patient data on a point-in-time, continuous or near-continuous basis. This includes a huge variety of potential solutions including implantable devices, but usually involves standard wireless devices like remote BP monitors, pulse oximeters, weight scales and others.

    In addition, an overall framework is needed to manage the data gained from those devices. This must include the capacity to securely and seamlessly transfer or temporarily store that data, as well as integrate patient devices and dataflows into larger EHR systems.

  • The act of monitoring the patients, including the workflow design, triage, monitoring and escalation to the provider. This requires a clinical care team of doctors, nurses and other clinical specialists, as required by each organization’s specific care requirements.
  • An administrative management component that enables and controls access, users, groups, branding, and performance assessment and quality measures. This should include a wide range of reporting capabilities showing utilization, KPI achievement, population health analysis and billing summaries.
  • Facilitation of communication between patients and their care teams, including outreach and some form of patient education to ensure engagement and compliance. A few years ago, this component leaned heavily on virtual or video visits. But as a result of the pandemic, restrictions have eased, and RPM reimbursement now allows for telephone and even text consultations.

These different components can be assembled into a functioning RPM program in two main ways:

  1. Healthcare organizations can take a self-managed approach and build their own clinical framework to run their RPM program. This will require a combination of in-house or outsourced technology, and the separate purchasing or leasing of the devices need to power the program.
  1. Or, healthcare organizations can also choose to partner with a third-party RPM vendor that provides all of the necessary parts, as well as some additional services like a proprietary patient interface or educational resources for patients and clinicians.

Another key consideration here is the use of in-house clinical staff to perform the actual monitoring vs. a vendor supplied monitoring capability. If in-house staff resources are available or can be easily added, this is often the most successful model as it directly ties the staff to the organization’s care mission, as well as having the most involved relationship with the patients.

When in-house staff is not available, RPM program vendors may offer a clinical monitoring solution as an added service. It’s important to do comprehensive diligence on that vendor’s capabilities, as this can be a make-or-break element to the success of RPM programs.

Another emerging model has vendors teaming up with other successful health system users of its RPM programs to expand virtual care management services outside of their own service area. Essentially, these partnerships combine an organization’s successful best practices for running an RPM program with a vendor’s technology and platform, offering it as a service to less experienced health systems.

Should organizations choose outsourced or in-house RPM programs?

Both of these options for RPM programs have their advantages when it comes to RPM costs and reimbursement opportunities. The outsourced, full-service option enables healthcare providers to expedite program setup to begin with established workflows from the start. Meanwhile, the in-house, “build-your-own” approach provides greater control and potential economies of scale down the road.

While the upfront costs may be greater for outsourced, full-service solutions, organizations can save time and money by streamlining complex strategic matters such as the supplying of devices to patients. They’ll also get reliable, ongoing assistance for implementation, support and maintenance of all the technology and workflows being used.

On the other hand, the self-managed approach also imposes initial costs. Whether it’s hiring new personnel to manage the technology or workflows, or licensing the necessary software, these costs can also be significant. Yet, as with full-service solutions, these can also be seen as savvy long-term investments, likely to offer a positive return over time as the program gains acceptance and efficiency.

While vendors of RPM programs do not provide doctors and other clinical team members, the extent to which their service performs data monitoring will decide how much time is needed for in-house staff will also need to do so (if at all). Similarly, the extent to which vendors can provide staff education and training could make a big different in a program’s overall effectiveness. Organizations should assess the readiness of their staff to work effectively with a new RPM program, while expecting a certain level of assistance from their RPM vendor.

Of course, an organization’s ultimate choice will likely coincide with its current practices and philosophy. This could involve breaking down the finer points of the reimbursement model — for instance, whether a practice has the resources to cover time spent in extensive patient consultation, and thus receive the maximum reimbursement for CPT® codes 99457 and 99458.

What to look for in an outsourced RPM provider

When it comes to deciding whether an in-house or an outsourced RPM program is best, leaders should choose based on the solution that best meets their precise needs. But for those who do choose a full-service partner, we’ve got a few additional words of guidance.

It’s important to note that not all RPM programs are created equally! To ensure that they’re getting solutions that will truly meet their long-term patient care needs, organizations should choose an RPM service provider that can:

  • Help set up the reporting and metrics by which to measure the success of the program, and allow for its ongoing improvement.
  • Reliably take care of any device management needs, including providing a basis for patients to reliably order and receive their devices, and then smoothly and securely integrate those devices and associated data flows into a healthcare provider’s EHR system.
  • Offer an advanced understanding of the patient journey, and how technology can most effectively be integrated within that journey to achieve the best possible results.

If you’re looking for more details on RPM programs and what makes them effective, you can get an overview of the CareSimple full-service RPM platform here. Offering everything from patient device management to program billing and data review, the CareSimple platform is the standard in customizable, effective and proven RPM solutions.

And if you want to see one of the nation’s leading RPM programs in action, you can get an inside look at the CareSimple RPM solution by scheduling a demo today.