The Chain of RPM Success: Defining a strong RPM team linked towards exceptional patient care
Clinicians have longed for a way to crack the code of a patient’s health by using more than just the snapshot provided by an office visit. By diving deeper into the day to day details of a patient’s health, remote patient monitoring (RPM) provides clarity and is the gateway to successfully knowing the patient in a meaningful way. Understanding cause and effect, empowering the patient with self awareness and intervening before a crisis ensues is what makes RPM so valuable. Collaborating with a team of providers allows patients and providers to put their best foot forward in optimizing care and tailoring the treatment plan to meet the patient’s individual needs. But like any team working toward a common goal, we are only as strong as the weakest member. So, how do we ensure our RPM teams are qualified and strong so the pressure of delivering exceptional patient care won’t break a link in the RPM team chain?
The first link in defining a successful RPM team chain begins with selecting patients wishing to engage the RPM process. Patients need to recognize and own their role since submitting digital vital signs, answering questionnaires and engaging in virtual visits is essential for success. The Dignio platform has a patient facing app, MyDignio, that is easy to use and has been successfully navigated by digitally immature patients for 10+ years. The MyDignio App functions with apple and android products and can be downloaded on phones or smart tablets with ease. Patients participating in the United Kingdom’s Mastercall Healthcare RPM program reported satisfaction ratings and an improved follow up experience of 100% in an analysis of 1100 patients utilizing the Dignio platform from 2020-2021. The Mastercall patient population spans between ages 50 to 102 years old.
While many clinicians may be skeptical about our aging population embracing digital health technology, research shows seniors are willing to engage. According to an AARP Telehealth Redux study completed March 2022, “interest in telehealth services is holding steady, with about one-third of the U.S. adults age 50-plus reporting they are extremely or very interested in using telehealth services for themselves or for a loved one.” However, once older adults have successfully completed a telemedicine visit, they are more willing to continue using telemedicine as part of their care, especially to see providers with whom they have prior established in-person relationships with up to 72% of patients being interested in using telehealth to connect with their established provider. RPM programs are typically initiated by members of the patient’s established healthcare team which can include their local pharmacist or home health provider. As a result, patient willingness and comfort engaging with RPM technology is high further promoting RPM success.
The next crucial team link is the qualified health provider (QHP) defined by Medicare as any health provider who can successfully bill for evaluation/management (E/M) codes and is practicing within the scope of his/her medical license. This includes physicians, nurse practitioners, physician assistants, chiropractors, naturopathic providers, certified nurse midwives, and certified nurse specialists. For any non-physician provider reimbursement rates may be reduced per their credentialed contracted health plan rates, often 70-85% of the physician rate. Ideally, the RPM qualified health provider will have a pre-existing relationship with the patient and have a vested, long-term interest in the patient’s medical outcome. But, as healthcare delivery models shift, some patients may meet the RPM qualified health provider for the first time through the RPM program. During the public health emergency remote patient monitoring can be initiated without a pre-existing patient-provider relationship but unless something changes an established pre-existing relationship will be required as of December 31, 2024.
To effectively function as a qualified health provider the clinician must have broad medical knowledge, the ability to synthesize data and know how to appropriately apply that data for individualized patient treatment plans. The RPM team needs strong medical leadership with a QHP that confidently guides clinical staff and motivates patients. While many of the QHP’s will have an established relationship with the patient, some will not, which means taking time to know the patient will be key for program success. Creating an RPM onboarding process that possibly includes a “get established” office visit billed through traditional E/M outpatient codes (99202-99205, 99212-99215) may be necessary. This type of visit is not billed as part of the RPM program but as a separate office visit based on traditional medical decision making. As with all E/M services the qualified health provider should also have knowledge of health plan billing and know the essentials of appropriate medical documentation elements. Only the qualified health provider bills for RPM services so the provider needs to be considered an in-network provider already credentialed with the patient’s health insurance plan.
The last link in our successful RPM team chain is the clinical staff who interact with patients at a foundational level and allow the monitoring and educational process to flourish. Clinical staff can take the form of in-office staff members like nurses and medical assistants but also can broaden to include pharmacists, physical therapists, dieticians and home health clinicians. In many respects the clinical staff members are what fortify the team chain and link together patient progress with daily threshold monitoring. The clinical staff are supervised by the qualified health provider but ideally the staff will have enough knowledge to trigger an escalation of care when needed or, conversely, provide gentle patient support when education and course correction are the only interventions required.
Although the qualified health provider is tasked with supervising the team as a whole, the clinical staff provide the majority of patient facing time within the RPM month. The staff should feel comfortable with both phone and synchronous face to face virtual visits and have the ability to clearly document patient encounters. The staff should also have enough knowledge of the RPM technology that they can serve as front line technical support for patients and their families.
Adding remote monitoring to an existing model of health care delivery requires consistency and engagement. It is the team creating the process that is most critical. Cultivating trust within the RPM team and recognizing that each team member brings unique contributions will elevate the level of team accomplishment to new heights. By allowing each link in the team chain to serve a purpose and share the burden of responsibility the team chain is reinforced and capable of delivering exceptional patient care.
To create your own successful RPM care chain or just to learn more about RPM, feel free to reach out to our Dignio customer success team.
 Şahin E, Yavuz Veizi BG, Naharci MI. Telemedicine interventions for older adults: a systematic review. J Telemed Telecare 2021 Nov 26:1357633X211058340.