Primary and specialty care providers want to extend care beyond the clinic, but it’s tough to do alone. Enter the community pharmacist uniquely positioned to support a successful Remote Patient (aka physiological) Monitoring (RPM) service.
By collaborating with pharmacists, providers can enhance patient access to RPM services, deliver enhanced support and follow-up, as well as address the complex drug therapy management needs of specific patient populations like those living in rural communities, advanced in age, historically marginalized, or experiencing inadequate care access.
Implementing an RPM program with a pharmacist aligns with The Joint Commission’s Pharmacist Patient Care Process. Community pharmacists have access to patients throughout their care journey and can collect, assess, and analyze patient data while providing education, engagement, and continuity between patient and physician.
Additionally, RPM services provide new and diverse revenue sources to provider organizations, keeping many small-town practices and hospitals independent. These services also lead to greater patient engagement and satisfaction, supporting value- and performance-based quality measures. Finally, RPM can underpin or enhance a population health management program while supporting care accessible at home and through community services.
Pharmacists have a pivotal role in RPM service delivery
In 2020, the Centers for Medicare & Medicaid Services (CMS) expanded its RPM program, enabling pharmacists to oversee remote patient monitoring under general supervision rules. According to a report published by the journal Pharmacy, “RPM may serve as a gateway to strengthening community pharmacy partnerships. Their knowledge of medications, disease state evaluation, and counseling skills enhance the value within a healthcare team.”
As a service that provides digital data to clinicians, RPM supported by pharmacists enables more clinical “eyes" on the patients between office visits. While not recognized as billing providers, pharmacists can collaborate with providers by collecting, analyzing, assessing, and interpreting digitally collected physiologic data. The pharmacist, in turn, can use this information to provide medication management, disease state evaluation, patient counseling, and inform a primary care or specialist physician for further consideration.
This more holistic, data-driven, and personalized approach to care leverages easy access to pharmacists, keeps physicians informed and supports continuity of care. Pharmacist-led RPM is beneficial when helping patients with chronic conditions, such as diabetes, hyperlipidemia, hypertension, and chronic pain.
Benefits of leveraging pharmacists for an RPM program
Remote patient monitoring studies have shown positive impacts like reducing hospitalizations and meeting disease management goals. A study published by Science and Practice Research stated, “Data demonstrate the opportunity for pharmacists to maintain and improve clinical outcomes related to type 2 diabetes.” Their RPM trial group showed A1C reductions of 2.0% and 2.2% versus 1.3% and 1.2% for a non-RPM group.
One study uncovered three patient benefits from participating in RPM:
- Patients learned how to manage their chronic disease better
- They felt that their RPM readings triggered actions by their healthcare providers
- Knowing that their data was being reviewed by their healthcare team, patients reported greater reassurance and security
In addition to better patient education, engagement, and disease management, RPM benefits the physician practice that wants to grow their team-based care model, value-based care contracts, or enhance quality and performance measures.
RPM fits with evolving pharmacy services
Many community pharmacies provide services besides dispensing, including delivery services, medication therapy management (MTM), Chronic Care Management, disease state screening, disease state prevention through counseling, and immunization services. RPM aligns well with these complementary services, building upon the trusting relationships pharmacists have built with patients.
One example of a pharmacy-provider partnership is Rx Clinic Pharmacy. As an independent community pharmacy located in Charlotte, North Carolina, the pharmacy launched an RPM pilot with 100 patients in four collaborating clinics, monitoring blood pressure and weight via devices equipped with cellular connectivity. Pharmacists, pharmacy technicians, and student pharmacists were vital to the program’s success, providing education and analysis, as well as disease and drug management.
As telemedicine and RPM join other digital health and prescription therapeutic technologies, pharmacists are on the cutting edge of their use and adoption. This trend enables provider organizations to segue into technology-supported care models through a collaborative, team-based approach.
CMS expansion of RPM provides opportunities for new services and profitable partnerships
Between 2018 and 2020, CMS made many changes to remote patient monitoring coverage. They created Current Procedural Terminology (CPT) code 99091 as an RPM code, added CPT codes to cover additional time increments, and adjusted supervision requirements. This last change allows pharmacists to provide RPM services without direct, personal oversight.
Today, there are CPT codes for the setup of devices (99453) that includes education on device use, for supplying the device to collect the digital physiologic data with daily monitoring (99454), and two codes (99457 and 99458) for initial and subsequent clinical staff time increments of 20 minutes within a calendar month. CPT code 99091 covers time for interactive communication between the patient or caregiver and the physician or other qualified healthcare professional, including a pharmacist.
While CMS has made establishing a new RPM service more accessible to provider organizations, and pharmacists are an impeccable choice for physician partnerships, having a comprehensive software solution is critical to managing the inner workings of a physician-pharmacist RPM program. Here are a few considerations when planning for operations and implementation.
Questions to answer when considering the launch of a new RPM service
Provider and pharmacy leadership can use the following questions when vetting whether a new RPM service would be a favorable business decision and align with broader strategic goals.
- What patient populations or conditions could be best supported by remote patient monitoring?
- Where could RPM services make the most significant impact on the organization?
- Would care goals include reducing readmissions or emergency department utilization, or are there existing programs and initiatives where RPM could help with care plan adherence, continuity of care, and patient outcomes?
- Are patients ready for RPM, or do they need support to acquire high-speed internet access, other technologies, or skills?
- What complementary business, patient, and care goals do physicians and pharmacists have that can be foundational to creating an RPM service?
In addition to strategic and patient readiness, physician practices and pharmacists can use RPM software to provide complete, end-to-end program management and oversight, including:
- RPM patient onboarding, time tracking, progress dashboarding, communication, and reporting
- Real-time vital collection and data analytics to identify health trends
- Integrate with remote monitoring devices, including cellular solutions like scales, pulse oximeters, and blood pressure
- Track billable time and team-based care coordination
- Overall RPM program management, including metrics and billing requirements
ThoroughCare’s platform enables the wireless collection of patient vitals, supports personalized care planning, and facilitates coordination, essential to any RPM program, particularly a team-based model between physician and pharmacist.
Building a collaborative, patient-centered RPM program
The pharmacist's role is evolving while care outside the clinic takes hold via remote patient monitoring. These trends allow provider organizations to extend care into patients’ homes and diversify clinical services and revenue. Partnerships between physicians and pharmacists provide a robust, community-centered approach to delivering new levels of care.
