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:
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:
RPM has been shown to provide a host of benefits, including:
Research from the Mayo Clinic shows RPM helping manage more than 16 diseases and clinical scenarios for nearly 22,000 patients.
This resulted in:
Their RPM program also saw significant reductions in:
Three different reviews of numerous studies found consistent improvements of varying degrees in the following clinical outcomes:
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:
While these contribute to the Quadruple Aim, physicians are motivated to adopt RPM for four specific reasons:
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.
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.
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:
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
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.
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:
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.
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:
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.
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.
There are four priorities that physicians want from patient data without taking on the full burden of creating, implementing, and managing a RPM program:
Outsourcing to a qualified RPM company can give clinicians the data they want to improve outcomes and performance metrics.
There are five ways providers can leverage outsourcing RPM for maximum gain, including:
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.