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How Remote Patient Monitoring Companies Support High-Risk Patients

Written by Daniel Godla | Mar 18, 2025 1:35:45 AM

In 2020, the Centers for Medicare & Medicaid Services (CMS) finalized that auxiliary personnel, including contracted vendors or service companies, may perform Remote Patient Monitoring (RPM). This includes services described by CPT codes 99453, 99454, and 99457. 

Third-party RPM companies provide specific services on behalf of the billing practitioner under general supervision.

RPM’s growth is expected to almost double to 70.6 million in the next two years. However, an American Medical Association survey in 2022 found that only 30% of physicians were using technology to monitor patients at home. 

A 2024 study with physicians found several factors kept them from implementing RPM, including:

  • Substantial role changes needed to review and handle incoming patient data results
  • Lack of time to educate patients and raise digital literacy
  • Level of care team changes required to implement and manage an RPM program

Outsourcing core aspects of Remote Patient Monitoring allows providers to reap the measurable benefits of the program with less effort, impact on staff, or upfront investment.

Medicare providers can contract third-party companies to outsource RPM to perform tasks, including:

  • Device set-up
  • Patient education
  • Patient data review
  • Follow-up with patients to support device usage
  • Patient triage and escalation

What do providers want from Remote Patient Monitoring companies?

RPM has been shown to provide a host of benefits, including: 

  • Extending care
  • Connecting patients and care teams
  • Enabling early interventions and continuous monitoring
  • Avoiding decompensation
  • Supporting higher acuity care

Research from the Mayo Clinic shows RPM helping manage more than 16 diseases and clinical scenarios for nearly 22,000 patients.

This resulted in:

  • 95% of patients being satisfied with the RPM program
  • 83% of providers reported overall satisfaction with the program
  • 88% of providers would recommend RPM to future patients

Their RPM program also saw significant reductions in:

  • 30-day, all-cause hospitalizations
  • Prolonged hospitalization >7 days
  • ICU admissions
  • Mortality rates

Three different reviews of numerous studies found consistent improvements of varying degrees in the following clinical outcomes:

  • Fewer major complications after discharge
  • Lower risk of mortality
  • Higher adherence to exercise, lifestyle, and medication regimens
  • Lower admissions
  • Lower risk of 30-day readmission
  • Significantly shorter lengths of stay
  • Decreased emergency department presentations

Other studies focused on specific chronic conditions and found RPM compelling. 

For example, a study published by the American Heart Association revealed RPM can cut heart attack and stroke rates by 50% compared to self-monitoring alone.

Cost-utility analysis showed that RPM was associated with positive outcomes:

  • 87% fewer hospitalizations
  • 77% fewer deaths
  • Reduced per-patient costs of $11,472 over standard care

While these contribute to the Quadruple Aim, physicians are motivated to adopt RPM for four specific reasons:

  1. Physicians want better oversight of their high-risk, high-cost, or complex patients between appointments
  2. They want actionable RPM data when it requires clinical intervention
  3. They want notable trending data that indicates treatment is working or needs to be adjusted
  4. They want data and approaches that improve performance metrics toward increased shared savings and value-based care rewards

Outsourcing could be the best option for providers who want to realize these outcomes but don’t want to take on the entire task of building RPM services.

How providers can maximize value, outcomes, and compliance with outsourced RPM

Working with a third-party Remote Patient Monitoring company offers many benefits. This type of partnership enables providers to offer the service without the burden of creating, implementing, and managing it themselves.

The key to a successful, compliant, and ROI-positive endeavor is to start small. A provider should have a clear view of how to work with the vendor to ensure RPM services meet operational, financial, and patient care objectives. Here are four steps toward a rewarding outsourced experience.

1. Start with a prioritized patient population

Recommendations from RPM research suggest that developing clear criteria is fundamental, particularly when starting a new program.

Establish when patients should be enrolled based on Medicare’s requirements. Enrollment should also ensure the initial patient population meets the provider’s overarching goals. 

These could include:

  • Increasing the percentage of patients with controlled blood pressure for hypertension patients
  • Improving medication adherence rates for diabetes patients
  • Achieving specific targets for HbA1c levels in diabetic populations
  • Reducing hospital readmission rates for heart failure patients
  • Enhancing self-management skills through patient education programs for chronic conditions 

Research suggests several key considerations for identifying RPM patients. These include:

Suitability: Is the patient’s medical condition one that could benefit from RPM data collection and analysis?

Chronic conditions: Diseases such as diabetes, heart failure, hypertension, or COPD are well-suited for RPM, as it allows for continuous monitoring of vital health metrics (e.g., blood glucose, weight, blood pressure) and timely intervention when necessary

Comorbidities: Multiple chronic conditions or complex health situations may benefit more from comprehensive monitoring

Noncompliant history: Patients who struggle with adhering to a treatment plan might benefit from the additional support offered by an RPM program

2. Establish clear standards for escalation and clinical intervention

One key benefit of outsourcing RPM to an experienced service provider is that physicians and care teams can trust that patients are being monitored. They will be alerted when a patient’s data reaches specific escalation criteria.

Clinicians must work with the vendor to ensure clear policies and population- or patient-level protocols are in place. These should detail when intervention is required, based on the data being collected. 

By monitoring and identifying trends that indicate potential risks—such as deviations in vitals or medication nonadherence— care teams can intervene before a situation becomes critical.

3. Prioritize alerts from RPM companies

Providers should create operational standards for their practices, in addition to having clear data thresholds by disease, population, or patient. These can help staff understand how to handle alerts from the RPM company and when to engage the physician for timely interventions.

 Protocols should address: 

  • How and when staff should alert the physician 
  • Procedure for how the care team should address the patient
  • How and when to notify the vendor of changes going forward

4. Leverage internal staff for specific data analysis and patient care tasks

While third-party RPM service companies can support many critical aspects of the program, the clinical care team or internal staff should still perform certain duties. These include periodic and consistent review of patient-generated data to identify trends that should be discussed at the next in-person appointment.

Staff can help with reviewing data for performance reporting related to possible shared savings or value-based care contracts.

5. Build competency around CMS billing and program requirements

Lastly, outsourcing RPM services delivers measurable value to patient outcomes and revenue. However, the billing physician is still responsible for meeting CMS billing and program requirements.

The billing physician must know how the third-party vendor complies with CMS rules for RPM. 

Some of the RPM requirements include:

  • Patient consent is required and documented
  • The physician has an established patient relationship
  • Monitoring a patient’s acute or chronic condition must be medically reasonable and necessary
  • Data collection reaches monthly minimums
  • Only one practitioner can bill for RPM per patient in a 30-day period
  • Concurrent billing rules when RPM is used alongside other care management programs, such as Chronic Care Management

Any third-party RPM service should be well-versed in CMS requirements. The company should be able to demonstrate how they meet and document compliance.

ThoroughCare equips third-party RPM service providers

Whether Remote Patient Monitoring is delivered via internal clinicians and staff or an outsourced service, ThoroughCare is the platform of choice. From evidence-based standards and patient education to workflows, integrated device ordering, and data analytics and alerts, ThoroughCare offers the tools needed for RPM.

In addition to comprehensive software, ThoroughCare offers clinical advisory services to help providers and vendors create, implement, and manage compliant and effective RPM programs. 

Key questions answered

Why should providers consider outsourcing Remote Patient Monitoring services?

There are four priorities that physicians want from patient data without taking on the full burden of creating, implementing, and managing a RPM program:

  1. Better oversight of their high-risk, high-cost, or complex patients between appointments
  2. Actionable RPM data when it requires clinical intervention
  3. Notable trending data that indicates treatment is working or needs to be adjusted
  4. Data and approaches that improve performance metrics toward increased shared savings and value-based care rewards

Outsourcing to a qualified RPM company can give clinicians the data they want to improve outcomes and performance metrics. 

How can you maximize the value of outsourcing RPM to a third-party vendor?

There are five ways providers can leverage outsourcing RPM for maximum gain, including:

  • Start with a prioritized patient population
  • Establish clear standards for escalation and clinical intervention
  • Prioritize alerts from RPM vendor
  • Leverage internal staff for specific data analysis and patient care tasks
  • Build competency around CMS competency and program requirements

Ultimately, the Medicare billing physician is responsible for CMS compliance. Creating clear objectives and establishing policies and standards for both the vendor and internal staff are critical to success.