Looking back at a year and a half of significant changes to our way of life, it is easy to become enveloped by the negative news stories, death tolls, and suffering close to home. The weight of the last 18-plus months is not one any of us will forget. I find it particularly interesting, and slightly less macabre, to reflect on the mechanisms we have adopted as a community that was forced into isolation and now tries to move back to some semblance of normalcy.
Consider virtual meetings. They no longer cause anyone to think twice, yet the idea of virtual medicine can take a bit longer for patients and physicians to warm up to. I think that is fair. Most of us are accustomed to a relationship with our patients existing primarily within the confines of the office. During these one-off encounters, we know that patients will often work to present the best side of themselves while we work to capture a snapshot of vital information on a day when they often seem to make sure to avoid caffeine and wear their lightest clothes.
The idea of forming a relationship with our patients outside of the restrictions of a scheduled, face-to-face—and body-to-face—appointment requires a level of commitment and vulnerability from both parties that can feel daunting for many patients and some physicians. As such, while the idea of telemedicine has existed for decades, it has never been as widely embraced by patients and physicians as it has been since March 2020, out of necessity.
Suddenly, physicians found themselves scrambling for means of managing their most vulnerable patients effectively at a safe distance, with patients desperate for a way to manage their daily health concerns in the middle of a public health emergency. The evolution and acceptance of telehealth broadly since the beginning of the pandemic has been fascinating and long overdue. But, in my opinion, one of the most significant and largely unsung silver linings of the public health emergency has been the adoption and normalization of remote patient monitoring (RPM), which has allowed physicians to take advantage of what has been essentially a system-wide removal of barriers to virtual care. I’ll explain.
Emergence of Remote Patient Monitoring
RPM is a tool specifically designed for managing patients remotely. This sounds straightforward enough, but it is another concept that has been around for decades without gaining much traction before the last few years. While part of this could be attributed to the recent—and welcomed—increases in Medicare RPM reimbursement, I believe COVID-19 created the perfect environment for the large-scale adoption of RPM across the continuum of care.
Let me set the stage with a common example. At an internal medicine office I managed a few years ago, a subset of our patients came into the office 1-2 times a week simply to have a nurse check their blood pressure. The nurse would then consult with the physician, if needed, and make any necessary changes to the patient’s medication regimen before sending them on their way. While patients were discouraged from coming in if they did not feel well, this recommendation was largely not emphasized, as the vital data was necessary for managing the patient’s chronic conditions. Of course, the idea of following that workflow during the waves of COVID-19 would have certainly inspired many super-spreading nightmares for staff and patients.
Yet, despite the pandemic, such patients and many others were still in need of the oversight from their care teams in managing chronic conditions. Those physicians who had adopted and were leveraging RPM prior to the pandemic doubled down on the service and encouraged more of their patients to embrace the solution to help keep them out of the office. Unfortunately, a constantly changing and increasingly complex bureaucratic landscape has historically made providing RPM services—and certainly other services—difficult if not illogical for most practices. COVID-19 and the realization that comorbidities put patients at increased risk of additional complications and hospitalization not only exacerbated this need but added the additional challenge of our patients not being able to interact face-to-face with their care team. Physicians wanted to deliver uninterrupted care but found themselves burdened by the all-too-familiar restrictive regulations and lacking the necessary infrastructure to implement new programs in the middle of a pandemic. Fortunately, CMS was quick to pave the way among payers willing to expand beneficiary coverage and offer temporary changes to regulations that reduced the barriers for physicians to implement telehealth services, including RPM. These actions also sent the irreversible message that CMS was endorsing the importance of virtual care for our patients.
Seemingly overnight, and with the wave of a regulatory wand, patients and physicians were granted access to a service unlike anything they had experienced before. With the ability to take a wide range of critical health measurements from outside the confines of an office (eg, blood pressure, weight, blood sugar), RPM gives physicians a truly wholistic view into the health trends of patients as opposed to being forced to make assumptions from a well-timed, in-person snapshot.
When physicians researched their RPM technology options, they found there were software platforms that could streamline data capture, analysis, and coding and billing. In addition, the devices that patients would need to use often required little setup beyond inserting batteries and powering on the equipment, with data transmission occurring over cellular networks. Even for some of the more “complex” devices that required Bluetooth integration and data transmission via Wi-Fi, setup and usage proved to be fairly straightforward for many patients thanks to their comfort and familiarity with smartphones. Pew Research Center data show that the share of Americans who own a smartphone is 85%, with more than six in 10 Americans age 65 and older now owning a smartphone.
RPM’s Key Benefit
Which brings me to the key benefit of RPM: It incentivizes proactive management of patient’s conditions. Turning back to those patients from my old office who required the regular in-office blood pressure checks. By simply implementing an RPM program, they could take their blood pressure from wherever they are and have that data transmitted directly to my care team no matter where they are. There would be no worrying about scheduling, nurse visit co-pays, or doing everything that may be required of office staff to get our patients in for an appointment. There would also be no concern about needing to reschedule an appointment and creating even more of a gap between health assessments.
Even with such a simple example, the impacts of implementing an RPM program are not only apparent, but they’re likely lifechanging for many patients. With a single program, physicians can increase the availability of care, reduce in-office flow of patients, manage disease states (eg, congestive heart failure, diabetes, obesity, chronic obstructive pulmonary disease, hypertension), monitor vital signs on an ongoing basis for early complication detection, and increase patient engagement. This occurs while also generating significant and, importantly, consistent reimbursement for providing top-quality care to our patients. It’s also a service that’s easier for physicians to scale than most and one that’s only going to be in greater demand as the population ages and the crisis of chronic disease in the United States continues to grow.
Without COVID-19 and the necessity of learning to cope with distanced medicine, I am unsure whether RPM would have ever gained the popularity it has achieved since Spring 2020 based purely on the regulatory restrictions that existed before the pandemic. Patients would continue to present the best versions of themselves to their providers in the office, and physicians would continue to operate with the limited information captured when patients come into the office for an appointment.
Appreciation for Remote Patient Monitoring
RPM is fostering the idea that virtual medicine can allow us to supplement in-person patient care and do so to a degree that we were not allowed to experience previously because of cumbersome and largely misguided bureaucratic red tape. These are restrictions that were easily lifted, which then provided substantial health benefits to people who greatly needed them at a time when their wellness faced a significant threat and to physicians who were looking for ways to continue supporting patients while generating revenue that would help keep their doors open.
Reflecting on a period when a deadly virus has increased restrictions on almost every facet of our lives, RPM is giving physicians and patients a taste of the freedom and flexibility—and their many benefits—that can be experienced when care is delivered remotely.